mp-02 pharmacology, hormones

45

J Sex Med 2008;5(suppl 2):45–68

PODIUM SESSIONS ABSTRACTS

Objective: There is evidence suggesting that testosterone is an impor-tant regulator of insulin sensitivity in men. Observational studies haveshown that testosterone levels are low in obese adult men, but dataconcerning overweight and obese young subjects are scarce. The aimof the study is to evaluate the impact of body weight on free testos-terone and adiponectin levels and insulin resistance in clinicallyhealthy young men aged 17 to 20 years.Methods: Eighty men aged 17–20 years were included in this cross-sectional study. The subjects were divided according to their BMI(cutoff 25 kg/m2) in two groups: group N (normal; n = 55; age 17.9 ± 1.5 years), and group OW/O (overweight and obese; n = 25; age 17.9 ± 1.6 years).Waist/hip ratio (W/H), free testosterone (FT),adiponectin, fasting blood glucose and IRI and HOMA-index weredetermined in both groups. Data were analyzed by SPSS 10.0 usingvariation and correlation tests. The values express mean ± SD.Results: Compared with N group, the OW/O group had higher BMI29.7 ± 3,2 vs. 21,8 ± 1.9 kg/m2; W/H ratio 0,91 ± 0,07 vs. 0,81 ± 0,05(both p < 0.001); IRI 17,7 ± 16,4 vs. 9,8 ± 5,6 mcIU/ml; HOMA 4,3± 4,4 vs. 2,4 ± 1,5 (both p < 0.05), and lower adiponectin levels 18,7 ±8,1 vs. 24,5 ± 13,0 ng/ml (p < 0.05). Fasting glucose 5,3 ± 0,6 vs. 5,2± 0,6 mmol/l and FT 16,9 ± 11,8 vs. 19,7 ± 12,9 pg/ml levels were notsignificantly different among groups, although a tendency for lowerFT in the OW/O group was observed. Adiponectin negatively corre-lated with BMI, insulin and testosterone in both groups. FT positivelycorrelated with insulin in the N group and negatively in the OW/Ogroup.Conclusion: The results show that elevated BMI is associated withdecreased levels of adiponectin, and increased insulin resistance inyoung men. The difference in FT between two groups did not reachstatistical significance.Policy of full disclosure: This study was supported by an Universitygrant.

P-01-003

Testosterone replacement in symptomatic late-onsethypogonadism—clinical and metabolic responses in arandomized, placebo-controlled studyMeuleman, E.1; Bouloux, P.2; Legros, J.-J.3; Geurts, P.4; Kaspers, M.5;Elbers, J.6

1Free University Medical Centre, Dept. of Urology, Amsterdam, The Nether-lands; 2University College School of M, Centre for Neuroendocrinology,London, United Kingdom; 3University of Liege, CHR de la, Endocrinology,Belgium; 4NV Organon, Global Communications R&D, Oss, The Nether-lands; 5NV Organon, Global Clinical Information -, Oss, The Netherlands;6NV Organon, Global Clinical Development, Oss, The Netherlands

Objective: The availability of novel improved androgen preparationshas led to a resurgence of interest in late-onset hypogonadism (LOH)and its treatment. The objective of this multicenter, randomized,double-blind, placebo-controlled trial was to investigate the effects oforal testosterone undecanoate (TU) on clinical outcomes associatedwith LOH.Methods: In 14 study centers in 7 European countries, 322 eligiblemen >50 years with documented testosterone deficiency (calculatedfree testosterone <0.26 nmol/L) were randomized to treatment for 12months with placebo, oral TU 80 mg/d, oral TU 160 mg/d or oral TU240 mg/d in divided doses. The effects of treatment on LOH symp-toms were measured using the Aging Males Symptoms (AMS) ratingscale. Bone mineral density (BMD), lean body mass (LBM) and bodyfat mass (BFM) were measured using dual energy x-ray absorptiome-try. Prostate safety was monitored using prostate specific antigen (PSA)and the International Prostate Symptom Score (IPSS).

Monday, 26 November 200711.00–12.30 Auditorium VI/VIIP-01 Hormones and sexuality, risk factorsChairs: P.-M. Bouloux, United Kingdom

D. Bucuras, Romania

P-01-001

Diagnostic and therapeutic implications of usingcalculated free testosterone in men with low—normaltotal testosterone levelsChitale, S.1; Dhatariya, K.2; Sethia, K.11Norfolk & Norwich Uni.Hospital, Urology, United Kingdom; 2Norfolk &Norwich Uni.Hosp, Endocrinology & Diabetes, United Kingdom

Objective: Making the diagnosis of biochemical hypogonadism iscritical in the management of men presenting with clinically suspectedhypogonadism. A wide laboratory range for normal levels of totaltestosterone (TT) may lead to under-diagnosis of hypogonadism inmen with low—normal TT. We examined the role of calculated freetestosterone (cFT) in this group of men.Methods: 28 men with erectile dysfunction (ED) and varying symp-toms of late onset hypogonadism (LOH) were investigated with TT,SHBG, and albumin. Free testosterone and bio-available testosterone(BAT) were calculated using the calculator on the ISSAM website(http://www.issam.ch/freetesto.htm). Therapy for ED was based onthe cFT levels regardless of TT.Results: The mean age was 55.57 years (range: 27–76 yrs S.D. +/−11.48). Mean body mass index was 29.69 Kg/m2 (range: 19.02–39.19S.D. +/− 4.33). 28.5% had type 2 diabetes. Only 5/28 (17.8%) menhad their TT assessed by primary care physicians prior to referral. 7/28(25%) men were clearly hypogonadal based on TT. Of the remaining21 men with TT in the normal range (9.0–27 nmol/l), 13 (61.9%) hadTT < 14 nmol/l (borderline TT) and 8 (38.1%) had more than 14nmol/l. 10/13 (76.9%) men with borderline TT had low cFT, and 3/13had normal cFT. BAT was subnormal in 5/10 but within the referencerange in 5/10 with low cFT. This is likely to be due to the normallevels of albumin and relatively low SHBG. Men with TT > 14 nmol/lhad normal cFT values. Men with low cFT were successfully treatedwith testosterone replacement therapy using topical gel to addresstheir ED before introducing PDE5 inhibitors.Conclusion: Our study highlights the importance of calculating cFTin order to accurately diagnose biochemical hypogonadism in men pre-senting with clinical hypogonadism but low—normal levels of TT.Policy of full disclosure: We have no financial interest or other affil-iation with a funding organization or commercial supporter of thesession or provider of commercial services.

P-01-002

Body weight-related differences between freetestosterone, adiponectin and isulin resistance inyoung men, aged 17–20 yearsTodorova, M.1; Baleva, M.2; Kamenov, Z.3; Ramshev, K.4; Ramsheva, Z.5;Alexiev, L.6; Stojnev, A.1

1Department of Pathophysiology, Sofia, Bulgaria; 2Clinic of Allergology,Medical university, Sofia, Bulgaria; 3Clinic of Endocrinology, Medical Uni-versity, Sofia, Bulgaria; 4Department of Cardiology, Military MedicalAcademy, Sofia, Bulgaria; 5Central laboratory, Military Medical Academy,Sofia, Bulgaria; 6Main Military Comission, Military Medical Academy,Sofia, Bulgaria

http://www.issam.ch/freetesto.htm

46 Podium Sessions Abstracts

J Sex Med 2008;5(suppl 2):45–68

Results: Oral TU treatment in men with LOH symptoms of moder-ate severity did not result in statistically significant changes on the totalscore of the AMS rating scale compared to placebo. The AMS sexualsymptoms sub-domain improved statistically significantly with oralTU 160 mg/d at Months 6, 9 and 12 compared to placebo (P < 0.05).After 12 months, treatment with oral TU statistically significantlyincreased BMD at the lumbar vertebrae and total hip (240 mg/d),increased LBM (80, 160 and 240 mg/d) and decreased BFM (160 mg/d). Oral TU had no effects on serum PSA level or IPSS. OralTU was well tolerated and there were no between-group differencesin (serious) adverse events or drop-out rates.Conclusion: In one of the largest trials in this field so far, treatmentwith oral TU improved objective symptoms of LOH, but was not dif-ferent from placebo on subjective LOH symptoms (except for sexualfunction) as assessed with the AMS rating scale. There was no increaseof prostate adverse events. There is a need for a validated rating scalefor the measurement of clinical symptoms associated with LOH andthe effects of androgen intervention.Policy of full disclosure: This study was sponsored by NV Organon,P.O. Box 20, 5340 BH, Oss, the The Netherlands.

P-01-004

CAG polymorphism of androgen receptor affectstarget organ response to exogenous testosteroneCanale, D.1; Caglieresi, C.1; Moschini, C.1; Moscatelli, A.1; Gavioli, S.1;Martino, E.1; Macchia, E.1

1University of Pisa, Dept. of Endocrinology, Italy

Objective: Androgen receptor (AR) is characterized by the presenceof a variable number of glutamine residues in the NH2 terminaldomain, which are encoded by a variable number of CAG repeats[(CAGr)n] in the first exon, and are inversely correlated with the tran-scriptional activity of target genes. Cross-sectional studies have inves-tigated the influence of (CAGr)n on several parameters of testosteroneaction, such as bone density, spermatogenesis, mood and hair devel-opment in both sexes. Additionally, hypo-androgenised patients appearto have a (CAGr)n higher than the controls. In the present study weevaluated the phenotype and AR genotype of three patients all affectedby a congenital selective hypogonadotropic hypogonadism and treatedwith similar doses of androgens.Methods: DNA was extracted from blood and amplified by PCR usingthe primers flanking the CAGr. PCR products were electrophoresedon the auto sequencer to determine the exact (CAGr)n.Results: Phenotypic androgenic characteristics were completely dif-ferent among them. One had a “female” hair pattern with no beard,no hair in the chest and lower abdomen, pubic hair stage 3, anddepressed mood. One was well androgenised, with “extraordinarymale” hair pattern, good muscular development, married with chil-dren. The third one had intermediary characteristics. The sequencingof their first AR exon revealed a (CAGr)n of 30, 18 and 22, respec-tively. Since time of onset, duration, and dose of testosterone replace-ment therapy were the same in these patients, the phenotypicandrogenic effect appears to be mainly due to (CAGr)n.Conclusion: In conclusion, the present data reveal a variation inresponses to drugs that is genetically determined, and further supportthe usefulness of a pharmacogenetic approach in hypogonadal indi-viduals, which includes an evaluation of AR polymorphism before ini-tiating a long-term androgen replacement treatment, with the aim ofproviding a satisfactory androgenic effect on target organs.Policy of full disclosure: None

P-01-005

Sex steroids and leptin regulate the KiSS 1/GPR54system in human olfactory GnRH-secreting neuronsMorelli, A.1; Marini, M.2; Mancina, R.1; Luconi, M.1; Vignozzi, L.1; Fibbi, B.1; Filippi, S.3; Forti, G.1; Vannelli, G. B.2; Maggi, M.1

1University of Florence, Clinical Physiopathology, Italy; 2University of Florence, Anatomy, Histology and Forensi, Italy; 3University of Florence,Pharmacology, Italy

Objective: The G protein-coupled receptor 54 (GPR54) and its ligandkisspeptin, encoded by the KiSS-1 gene, have been involved in themolecular mechanisms underlying the reawakening of GnRH neuronsat puberty. GPR54 mutations cause hypogonadotropic hypogonadismin human and mice. We used the previously characterized primaryculture of human fetal olfactory GnRH-secreting neurons, FNC-B4,to study regulation of the KiSS-1/GPR54 system.Methods: Expression of kisspeptin and GPR54 in fetal olfactorymucosa (OM) and in FNC-B4 cells was analyzed with confocalmicroscopy. Effect of sexual steroids and leptin on KiSS-1/GPR54gene and protein expression were evaluated by qRT-PCR, immuno-cytochemistry and western blot.Results: Kisspeptin and GPR54 were immunolocalized in OM andFNC-B4. Co-expression of kisspeptin or GPR54 with GnRH wasfound in fetal OM and FNC-B4. Kisspeptin (1 microM, 24 h) inducedGnRH secretion, but not GnRH mRNA, and dose-dependently inhib-ited migration (IC50 = 6.28 ± 3.71 nM) in FNC-B4. The 24 h expo-sure to increasing concentrations of 17beta-estradiol (0.01–1 nM)significantly and dose-dependently decreased, whereas androgens(DHT, 0.01–1 nM) significantly stimulated KiSS-1/GPR54 mRNA(qRT-PCR). Testosterone (1 nM) treatment showed no effect, but afterblocking its aromatization with letrozole, it showed a stimulatory effectcomparable to DHT. Finally, leptin (1 nM, 24 h), an adipocyte-derivedhormone acting on the reproductive axis, significantly increased KiSS-1/GPR54 gene expression in FNC-B4. The sex steroid and leptin reg-ulation of kisspeptin were also confirmed with immunocytochemistryand western blot analysis. Interestingly, leptin (1 nM, 24 h) also sig-nificantly increased both leptin receptor (LEPR) and androgen recep-tor (AR) mRNA. DHT (0.01–1 nM) also up-regulated LEPR and ARgenes, suggesting a synergistic action between leptin and androgens inorder to up-regulate the KiSS-1/GPR54 system, which, in contrast,was inhibited by estrogens.Conclusion: In conclusion, our results indicate that an interplaybetween metabolic and sexual hormones is involved in the regulationof KiSS-1/GPR54 signaling to GnRH neurons suggesting new mech-anisms which regulate puberty onset.Policy of full disclosure: None

P-01-006

Prostate safety of androgen replacement therapy:Laying stress on PSACho, I. R.1; Cho, S. Y.1

1Inje University Ilsanpaik Hosp, Urology, Koyang/ Gyunggido, Republic ofKorea

Objective: The greatest concern in the androgen replacement therapy(ART) is the possible side effects to the prostate. We have studied onthis ART laying stress on the prostate specific antigen.Methods: The subjects were 47 patients who has been treated withandrogen from 2003 to 2006. Digital rectal examination prior to theART, serum evaluations on testosterone and prostate specific antigen,and trans-rectal ultrasound have been performed on the subjects.Patches were used the most (42.6%) for the testosterone administra-tion, followed by oral pill and injection. The mean age of the patientswas 60.1 ± 8.5 (44–75). The subjects were re-examined in the samemanner after 7.9 ± 7.7 (1–41) months on the average from the initialtreatment, and the result was compared with the previous one. Sub-jects were divided into two groups based on the PSA level—eitherabove 2 or below 2—prior to the treatment.Results: The comparison of two results showed significant increasesin testosterone level(262.3 ± 149.8, 594.1 ± 588.2 ng/dl for each), inPSA(1.22 ± 1.15, 1.55 ± 1.67 ng/ml) and in free PSA(±0.51, 1.32 ± 1.05ng/ml). Nevertheless, there has been little change in prostatevolume(29.4 ± 7.9, 29.7 ± 8.1 ml). We performed biopsy to 4 subjects(8.5%) whose PSA level increased more than 4, but no prostate cancerwas detected. The absolute amount of change was higher in the groupof subjects whose PSA level was larger than 2 (0.61 ± 2.25 ng/ml com-pared to 0.28 ± 0.65 ng/ml).Conclusion: Both total-PSA and free PSA have increased significantlyafter androgen replacement therapy. The change for the ones with

Podium Sessions Abstracts 47

J Sex Med 2008;5(suppl 2):45–68

higher PSA levels (over 2) was smaller in terms of ratio, but bigger interms of absolute value, compared to the ones with lower PSA levels(below 2). They also showed higher chance of having biopsy.Policy of full disclosure: None

P-01-007

The effect of cancer on relationship and sexuality and the need for counseling in an oncology patient populationKurtz, L.1; Mock, M.2; Mamet, Y.31Laniado Medical Center, Oncology, Netanya, Israel; 2Raanana, Israel;3Laniado Medical Center, Gynecology, Netanya, Israel

Objective: As treatments for cancer improve, and patients live longer,cancer is today considered a chronic illness and Sexual Health isbecoming an important aspect of well being in cancer survivors. Thisstudy evaluates the impact of cancer on Couple Relationship and Sex-uality in an sample of 50 oncological patients and investigates the needfor information, counseling and treatment of their Sexual dysfunctions.Methods: A questionnaire consisting of 21 closed questions and 8questions on a rating scale, concerning sexual function, relationship,self esteem and body image were distributed among 50 oncologicalpatients during treatment. The patients were in a stable relationshipat least for one year. The questionnaire was available in Hebrew andRussian and open with no age restriction.Results: 27 men and 23 women participated in the survey with a meanage of 58.6. The most common cancer diagnosis were: Hematologi-cal:14; Gastrointestinal:12; Gynecological:9; Breast:7; Urological:3and unknown:5. 70% were operated on, 68% recieved Chemotherapyand 28% Radiation therapy. Before the onset of cancer, 84% describetheir relationship as (very) good, and during the treatment period 44%describe a deteriotion in their relationship. The results of the respon-ders showed an 80% decrease, 4% increase and 16% no change in theirsexual relationship. Their self esteem diminished in 72% and the bodyimage also decreased in 72% of the patients. 84% did not receive anycounseling regarding sexuality and relationship during their treatment.36% felt a strong need for counseling to have a better understandingof the effects of the operation, radiation and chemotherapy on theirsexuality, self esteem, body image and relationship. Patients under theage of 60 and more women expressed a wish for counseling.Conclusion: The survey proved that cancer had a strong negativeeffect on Sexual Health and Relationship. The need for counseling onthese effects was expressed. It is essential that oncological staff has theappropiate knowledge, skills and attitude to address the oncologypatient concerns about Sexuality and Relationship. In response to theseresults we opened in the Laniado Medical Center in Netanya, the firstoutpatient clinic for Oncosexology in Israel.Policy of full disclosure: None

P-01-008

Clinical characteristics of a cohort of genderdysphoria patients treated with cross-sex hormonesGutierrez, P.1; Hernandez, P.2; Fernandez, M.3; Baez, D.4; Mas, M.51University of La Laguna, Medical School, La Laguna, Tenerife, Spain;2University of La Laguna, Surgery & CESEX, La Laguna, Tenerife, Spain;3University of La Laguna, CESEX, La Laguna, Tenerife, Spain; 4Univer-sity of La Laguna, Gynecology & CESEX, La Laguna, Tenerife, Spain;5University of La Laguna, Physiology & CESEX, La Laguna, Tenerife,Spain

Objective: To summarize the most relevant clinical features in a seriesof transsexual subjects receiving cross-sex hormones in a multidisci-plinary Gender Dysphoria Unit run by the CESEX in the Canary Uni-versity Hospital since 1998.Methods: Diagnostic procedures, follow-up and treatments are incompliance with the Harry Benjamin International Gender Dyspho-ria Association’s guidelines. They included diagnosis by a qualified

Psychologist, with psychiatric assessment if deemed necessary, fol-lowed by general and genital physical examination, somatometry,bioimpedance, karyotyping, blood chemistry, and serum sex hormonesand prolactin levels. The ensuing cross-sex hormone treatment toMale-to-Female (M-F) patients included estrogenization with eithertransdermal 17beta-Estradiol (200 mcg each 3 days) or oral EthynilEstradiol (35–70 mcg/day) and, if required, the antiandrogen Cypro-terone Acetate (50–100 mg/day). Female-to-Male (F-M) patients weregiven either Transdermal Testosterone (5 mg/day) or i.m. TestosteroneUndecanoate (1 g quarterly). The follow-up protocol included physi-cal and hormonal evaluation, first at 3 months for dose adjustmentsand every 6 months thereafter. Psychological assessment and supportwas offered throughout the follow-up period.Results: Out of 128 subjects diagnosed with Gender Dysphoria 107have received cross-sex hormones to date. Of these, 70 patients (72%)were M-F and 30 (28%) F-M; 101 were diagnosed as primary and 6as secondary (all M-F). Sexual orientation of most of the subjects washeterosexual (i.e. towards the same biological sex). Median follow-uptime was 5 years (maximum 8.5 y). Most of the patients were satisfiedwith the hormonal treatment. Decreased sexual desire was reported by5 patients receiving cyproterone acetate. One estrogen-treated patientshowing serum prolactin >100 ng/ml was diagnosed of pituitarymicroadenoma. No venous thromboembolism nor other serious mor-bidity has been detected to date.Conclusion: The reported protocol for the assessment, dosing, andfollow-up of cross-sex hormone treatment to transsexual patientsseems reasonably effective and safe.Policy of full disclosure: Supported by Grant GC 2005/056 from theCanary Islands Government.

P-01-009

Testosterone replacement in post gender reassignmentsurgery male-to-female transsexualSeal, L.1; McHugh, C.2; Karra, E.3; Barrett, J.1; Seal, L.11Charing Cross Hospital, Gender Identity Clinic, London, United Kingdom;2St Georges Hospital, London, United Kingdom; 3St Georges Hospital,Department of Endocrinology, London, United Kingdom

Objective: Libido is an androgenic function in both sexes. Followingthe menopause or gonadectomy in females, hypoactive sexual disordercan ensue. In a subgroup of male to female transsexuals (MtF) a similardisorder can occur following gender assignment surgery (GRS). Libidodisturbance following GRS will respond to testosterone treatments ina similar manner to post gonadectomy hyposexual disorder.Methods: A 34 year old post op MtF reported a low libido. Pretreat-ment she reported normal erections and external genitalia. She was ina stable relationship with a heterosexually identifying male. Preoper-atively she was treated with PremarinTM 7.5 mgs od and cyproteroneacetate 50 mg od which inhibited erectile function but libido was main-tained. Post operatively she was initially treated with premarin 2.5 mgthen oestrogen valerate 2 mg o.d. Postoperatively she had a dramaticdecrease in libido decreasing her frequency of sexual intercourse from1–2/week to less than once per month. Clinical examination demon-strated breast augmentation, unequivocal female presentation, and ablood pressure of 110/50 mmHg. Serum FSH of 79 (range 1–10)IU/L, LH of 36. (range 1–9) IU/L, oestradiol 177 pmol/L [400–600],testosterone 1.7 nmol/l [0.4–2.8] and DHEAS 3.1 mcmol/l [0.7–11.5]indicating suboptimal oestrogen therapy.Results: Her oestradiol valerate was increased to 4 mg o.d. Howeverlibido did not improve and she was commenced on testosteronereplacement at a dose that would be used for postmenopausal libidodisorder [Testim gel® (Ipsen) 10 mg (1 ml) o.d.]. 8 months later libidohad returned preoperative levels with increased energy and drive.Testosterone levels had increased to 4.5 nmol/l. There was a minorincrease in vellus facial hair; however she elected to continue therapyin view of her improved libido and well being.Conclusion: Post GRS libido disturbance can respond to testosteronesupplementation administered at the dose used to treat postmenopausal libido disturbance in females.Policy of full disclosure: None


J Sex Med 2008;5(suppl 2):45–68

P-01-010

Complications of hormonal therapy in male to femaletranssexuals is uncommonSeal, L.1; Baig, H.2; Barrett, J.1; Iqbal, S.21Charing Cross Hospital, Gender Identity Clinic, London, United Kingdom;2St George’s Hospital Medical S, Deaprtment of Endocrinology, London,United Kingdom

Objective: Transsexuals in Britain are prescribed hormones as part ofGender Reassignment Treatment. Oestrogen therapy is associatedwith the development of deep vein thrombosis (DVT) with a 25 foldincreased risk, and breast cancer; particularly in the older age groupand smokers. To investigate the risk of developing deep vein throm-boses in male to female transsexual patients who are, or have been, onoestrogen therapy, and seeing if this differs with age, smoking historyor route of transmission. The effect on changing the dose on hormonetreatment after gender reassignment surgery was also explored.Methods: A retrospective cohort study using the notes of 108 trans-sexual patients who attended a gender clinic between the dates of Wed1 January 2003 and 13 June 2003.Results: 3.95% of male to female patients who had history of oestro-gen treatment (MTF + O) developed DVTs, whereas 3.13% of patientswith no history of oestrogen treatment (MTF − O) developed DVTs.5.23% of MTF + O who developed DVTs were smokers, while 5.26%were non smokers. 6.25% of the MTF + O group who developedDVTs were over 40, and no patients under 40 developed DVTs. 4.11%of MTF + O who developed DVTs had a history of oral oestrogen use, and no patients who had taken transdermal oestrogens deve-loped DVTs. No patients in this group developed breast cancer orosteoporosis.Conclusion: There is no significant difference between DVT rates inMTF + O and MTF − O. The incidence is higher for those who wereover 40, on oral oestrogens and in non-smokers. There was no differ-ence in the incidence of breast cancer MTF + O and MTF − O, andno difference in the incidence of osteoporosis in all transsexuals whowere on oestrogen therapy and those that were not, regardless of thedose taken post operatively.Policy of full disclosure: None

Monday, 26 November 200714.30–16.00 Auditorium VI/VIIP-02 Pathophysiology of sexual dysfunctionsChairs: C. Vlachopoulos, Greece

S. Ückert, Germany

P-02-011

Inhibitory effect of atorvastatin on high-glucoseinduced perturbation of human penile smooth musclecells phenotype and activityMorelli, A.1; Mancina, R.1; Fibbi, B.1; Chavalmane, A.1; Silvestrini, E.1;Marini, M.2; Vignozzi, L.1; Filippi, S.3; Vannelli, G. B.2; Maggi, M.1

1University of Florence, Clinical Physiopathology, Italy; 2University of Florence, Anatomy, Histology and Forensi, Italy; 3University of Florence,Pharmacology, Italy

Objective: RhoA/Rho-kinase (ROCK) signalling was recently recog-nized as pathogenetic in cardiovascular diseases including vascularremodelling, atherosclerosis and diabetes-induced vascular damage. Inparticular, activation of the pathway affects smooth muscle (SM) activ-ity (contraction/proliferation/migration), differentiation and pheno-type, thorough stimulation of multiple CArG-dependent genes andtranscriptional factors, as myocardin, myocardin-related transcriptionfactor (MKL1), transgelin (SM22alfa), desmin and alfa-SM actin (alfa-SMA). Statins have been recently proposed as a new class of agentsthat, by decreasing RhoA membrane translocation and transcriptionalactivity, can down-regulate RhoA/ROCK signalling. We now report“in vitro” effect of atorvastatin on RhoA/ROCK in human foetal penileSM cells (hfPSMC) activated by increasing concentration of glucose(5, 22 and 40 mM).Methods: Characterization of hfPSMC was previously described (MolHum Reprod 8:1053, 2002). RhoA activation was studied by confocalmicroscopy and western blot analysis. Steady-state gene transcriptionwas evaluated by qRT-PCR. Proliferation/migration was studied bydescribed methods.Results: In hfPSMC, high-glucose (22 and 40 mM), but not equimo-lar mannitol, stimulated RhoA membrane translocation, along withmigration, proliferation and CArG-dependent gene transcription.Atorvastatin, even in basal conditions, dose-dependently (shared IC50= 0.97+/− 0.3 microM) inhibited cell migration and proliferation stim-ulated by endothelin-1 (10–7 M) or PDGF-BB (25 ng/mL), respec-tively. In high-glucose, atorvastatin (1 microM) restored cell migrationand proliferation as in normal-glucose, an effect that was dose-dependently prevented by geranyl-geranyl pyrophosphate, the productinhibited by statins and required for plasma membrane anchoring ofRhoA. Accordingly, in atorvastatin-treated hfPSMC RhoA accumu-lated in the cytoplasm and was less expressed at the membrane. 48 htreatment with atorvastatin reduced overexpression of ROCK2,myocardin, MKL1, SM22alfa, desmin, and alfa-SMA.Conclusion: High-glucose stimulates human penile SMC to prolifer-ate, migrate and acquiring a new phenotype. All these processes areRhoA-dependent and inhibited by atorvastatin, a cholesterol-loweringdrug exhibiting pleiotropic activities that might be useful in limitingdiabetes-induced erectile dysfunction.Policy of full disclosure: None

P-02-012

Association between severity of LUTS, erectiledysfunction and components of metabolic syndromeDemir, O.1; Akgul, K.2; Akar, Z.3; Cakmak, O.4; Ozdemir, I.1; Bolukbasi, A.4; Can, E.2; Gumus, B.3

1Dokuz Eylul University, Urology, Izmir, Turkey; 2Tepecik Trainig Hospi-tal, Urology, Izmir, Turkey; 3Celal Bayar University, Urology, Manisa,Turkey; 4Ataturk Training Hospital, Urology, Izmir, Turkey

Objective: The purpose of the this study was to investigate the asso-ciation between severity of lower urinary tract symptoms (LUTS),erectile dysfunction (ED) and metabolic syndrome.


J Sex Med 2008;5(suppl 2):45–68

Methods: Our study population included a consecutive series of 190patients with lower urinary tract symptoms (International ProstateSymptom Score-IPSS > 7) with or without manifestations of the meta-bolic syndrome. The diagnoses atherosclerosis, diabetes mellitus andtreated hypertension were obtained from the patient’s medical history.Data on blood pressure, waist and hip measure, body height andweight were collected and body mass index and waist/hip ratio werecalculated. First five and 15th questions of the International Index ofErectile Function (IIEF) and IPSS were replied by all the patients. Thepatients were assessed based on the IIEF for ED and IPSS for LUTS.Blood samples were drawn from fasting patients to determine, fastingblood glucose (FBG), triglycerides, HDL-cholesterol and serum totaltestosterone levels.Results: Our results show that severity of LUTS associated withincresed prevalence of metabolic syndrome (26% vs 46%, p = 0.009).The severe form of the LUTS was significantly correlated with waistcircumference >102 cm (p < 0.05), blood pressure≥130/85 mmHg (p < 0.005) and FBG > 110 mg/dl (p < 0.001). In severe LUTS patientgroup IIEF EF domain scores were significantly lower than moderateLUTS patient group (p < 0.05).Conclusion: On the basis of our findings, we concluded that obesity,high plasma level of FBG and high blood pressure or treated hyper-tension constitute risk factors for the development of severe LUTS.The results suggest that LUTS is a facet of the metabolic syndromeand that LUTS patients may share the same metabolic abnormality ofa defective glucose metabolism and obesity as patients with the meta-bolic syndrome. Increased severity of LUTS seems to be an importantrisk factor for ED.Policy of full disclosure: None

P-02-013

Graded association between aortic stiffness, wavereflections, and duration of vasculogenic erectiledysfunction: Linking erectile dysfunction withgeneralized vascular diseaseVlachopoulos, C.1; Rokkas, K.1; Aznaouridis, K.1; Ioakeimidis, N.1; Aggeli, K.1; Roussakis, G.1; Samentzas, A.1; Bratsas, A.1; Askitis, T.1; Stefanadis, C.11Athens Medical School, 1st Cardiology Department, Greece

Objective: Aortic stiffness and wave reflections are markers of sub-clinical atherosclerosis and prognosticators of cardiovascular risk.Erectile dysfunction (ED) may be the early clinical manifestation of ageneralized vascular disease. The association between aortic stiffness,wave reflections and duration of ED has not been investigated.Methods: A total of 244 men with ED (detected with a validated ques-tionnaire) were studied: 75 men (62 ± 9 yrs, mean time interval of ED =3 years) with coronary artery disease (ED-CAD) and 169 men (59 ±11 yrs) without CAD. Men without CAD were divided into threegroups, according to ED duration: Group A (<2 yrs, n = 80), group B(2–3 yrs, n = 44) and group C (>3 yrs, n = 45). Aortic stiffness was evalu-ated with carotid-femoral pulse wave velocity (PWV) and wave reflec-tions with augmentation index (AIx) of the aortic pressure waveform.Results: PWV and AIx values were comparable among ED-CADpatients and patients with time interval longer than 3 years (group C)and higher of those in men of groups A and B (P < 0.01, for both,figure). In men without CAD, there was a stepwise augmentation inaortic stiffness and wave reflections throughout increasing duration ofED. This last relationship remained significant in multivariate analy-sis (P < 0.05 by ANCOVA after adjusting for age, mean pressure, heartrate, height, smoking, metabolic profile and C-reactive protein).

Conclusion: In men with ED symptoms, the longer duration of ED,the greater impairment of aortic elastic properties and the higher aug-mentation of the aortic pressure waveform. These findings may par-tially elucidate the complex mechanisms linking ED with generalizedvascular disease and increased cardiovascular risk.Policy of full disclosure: None

P-02-014

Erectile dysfunction and silent coronary disease: The evidence from CT coronary angiographyJackson, G.1; Cooper, A.2; McGing, E.2; McLeod, C.2

1London Bridge Hospital, United Kingdom; 2Guy’s & St Thomas’ NHSTrust, Cardiothoracic Centre, London, United Kingdom

Objective: To assess the extent of silent coronary artery disease usingCT coronary angiograpy in 19 men with erectile dysfunction and nocardiac symptoms.Methods: The 19 men aged 39–69 years with erectile dysfunction(ED) and no cardiac symptoms underwent screening for cardiovascu-lar risk.Results: Erectile dysfunction was assessed using the Sexual HealthInventory for men. Scores were from 5–22 (25 is normal) and all hadnormal Hospital Anxiety and Depression scores except one with highanxiety. All were normotensive (7 on therapy), 2 smoked cigarettes, 17had elevated LDL cholesterols (3.0–4.47 mmol/L), 9 had waists above94 cms and none were diabetic. Treadmill exercise ECG’s to maximalpredicted heart rates were abnormal in 4 (inferolateral ST depression1–2 mm) in the absence of chest pain. Coronary calcium scores weresignificantly raised in 10 (54–1234), marginally in 4 (6–10) and normalin 5. CT angiography identified evidence of significant coronarydisease in the 10 with high calcium scores and single plaques in the 4with marginal scores and no lesions in the absence of calcium. Sevenof the 10 with high calcium scores had normal exercise ECGs.Conclusion: ED can therefore be a marker of silent CAD even whenexercise ECGs are normal. Cardiovascular risk should always beassessed even when there are no symptoms and CT coronary angiog-raphy may identify none flow limiting but potentially vulnerableplaque disease and the need for aggressive risk factor reduction.Policy of full disclosure: None

P-02-015

Evidence that pathogenic vascular remodeling in thepudendal artery is linked to the extremes ofhemodynamic stresses during erections: Effect ofantihypertensive treatment or lifestyle modificationHannan, J.1; Pang, J. J.2; Smallegange, C.3; Pang, S. C.2; Heaton, J. P. W.4; Adams, M. A.31Queen’s University, Pharmacology & Toxicology, Kingston, Canada;2Queen’s University, Anatomy & Cell Biology, Kingston, Canada; 3Queen’sUniversity, Pharmacology & Toxicology, Kingston, Canada; 4Queen’s Uni-versity, Urology, Kingston, Canada

Objective: There is increasing risk of sexual dysfunction and cardio-vascular disease with age; conditions that have similar etiologies, andcommonly coexist. A unifying concept that we tested was that abnor-mal vascular structure and function underlie both, but that the changesspecific to the penile vasculature are critical.Methods: Kidneys were cross-transplanted between losartan-treatedand untreated SHR to assess whether erectile function related more topenile vasculature status or to kidney-dictated pressure. Whetheraging induced obesity was a confounding influence on erectile func-tion was assessed using ‘lifestyle modifications’ (exercise and caloricrestriction). Morphometric assessments (wall thickness, lumen diame-ter, extracellular matrix) of the pudendal artery were performed inyoung and aged normotensive and hypertensive rats ± antihyperten-sive treatment.Results: Cross-over kidney transplantations revealed that penile vas-cular changes and not the kidney-dictated alterations in the circulationwere key to normalizing erectile responses. Visceral fat accumulation


J Sex Med 2008;5(suppl 2):45–68

was found to be a confounding risk factor in aging rats since exerciseand caloric restriction induced weight loss facilitated recovery of erec-tions (0.2 ± 0.39 vs 1.7 ± 1.37, p < 0.01). Given that the pudendal arterycontributes 70% of the total resistance, it was confirmed that thisartery had a distinctive morphological profile. In all aged rats withsevere ED, the pudendal had a disproportionately thick wall contain-ing excessive extracellular matrix (10 ± 1.9 vs 26 ± 10.6 × 103 µm2, p < 0.01). In aged SHR specifically, but not in normotensive aged rats,there was marked intimal thickening that severely encroached on thelumen. Antihypertensive treatment in SHR normalized lumen diame-ter (265 µm ± 21.1 vs 339 µm ± 10.3, p < 0.05) but assessment ofwhether this was sustainable remains unresolved.Conclusion: These studies provide significant evidence stressing theimportance of the pudendal artery in erectile function and that theimprovements seen with different treatments may be linked to the vas-cular remodeling of this critical penile vessel.Policy of full disclosure: Funded by the Heart and Stroke Founda-tion of Ontario.

P-02-016

COMP-Angiopoietin-1 Gene Transfer RestoresCavernous Angiogenesis and Erectile Function in aMouse Model of HypercholesterolemiaShin, H.-Y.1; Koh, Y. J.2; Piao, S.3; Ryu, J.-K.3; Choi, M. J.3; Zhang, L.-W.3; Jin, H.-R.3; Hong, S.-S.4; Han, J.-Y.5; Koh, G. Y.2; Suh, J.-K.3

1Inha University Hospital, Incheon, Democratic People’s Republic of Korea;2Korea Advanced Institute of Sc, Biological Sciences, Daejeon, Republic ofKorea; 3Inha University Hospital, Urology, Incheon, Republic of Korea; 4InhaUniversity Hospital, Clinical Research Center, Incheon, Republic of Korea;5Inha University Hospital, PATHOLOGY, Incheon, Republic of Korea

Objective: Angiopoietin-1(Ang1) is a specific growth factor function-ing to generate a stable and functional vasculature. We investigated the effectiveness of local delivery of cartilage oligomeric matrixprotein(COMP)-Ang1, stable and potent Ang1 variant, for the treat-ment of vascular disease-induced erectile dysfunction.Methods: C57BL/6J mice were fed a normal diet or a high choles-terol diet for 3 months. Hypercholesterolemic mice were further clas-sified into the group with no treatment, intracavernous injection ofad-LacZ, or adeno(ad)-COMP-Ang1. COMP-Ang1 mRNA, proteinexpression or localization of transgene in the corpus cavernosum(CC)was evaluated after treatment. In each group, erectile function and cav-ernous blood flow was measured by cavernous nerve stimulation at 2and 8 weeks postdelivery. PECAM-1 or α-SMA immunostaining toquantify endothelial cell was performed. We evaluated endothelialnitric oxide synthase(eNOS) system by measuring the expression of phospho-eNOS/eNOS in human umbilical vein endothelialcell(HUVEC) or mouse CC and erectile response in eNOS-/- mice orL-NAME-treated wild type mice, respectively. Cavernous cGMP orcAMP concentration was further measured in HUVEC or CC.Results: After ad-COMP-Ang1 transfer, exogenous COMP-Ang1mRNA or protein was detected in the CC until 3 weeks and FLAGprotein for COMP-Ang1 was mainly localized to endothelial cells. Ad-COMP-Ang1(2 × 10*8 particles/20 µl) completely normalized botherection parameters and cavernous blood flow at 2 and 8 weeks aftertreatment. In parallel, COMP-Ang1 treatment group also normalizedPECAM1-positive endothelial density, compared with other groups.COMP-Ang1 significantly increased endogenous eNOS phosphoryla-tion in both cells and tissues by 3–6 fold, compared with that in thecontrols. Furthermore, COMP-Ang1 did not restore erectile functionin eNOS-/- mice or L-NAME mice, fed high cholesterol diet. COMP-Ang1 group also dramatically increased concentration of cGMP butnot cAMP, compared with control.Conclusion: These results indicate that COMP-Ang1 gene therapyinduces complete and long-lasting recovery of erectile functionthrough enhanced cavernous angiogenesis, depending on eNOS, inerectile dysfunction with hypercholesterolemia.

Policy of full disclosure: This study was supported by grant no. R01-2005-000-10411-0 (2005, JKS) from the Basic Research Program ofthe Korea Science and Engineering Foundation.

P-02-017

Increased Interleukin-18 levels and subclinicalcoronary artery disease in men with vasculogenicerectile dysfunctionIoakeimidis, N.1; Vlachopoulos, C.1; Rokkas, K.1; Baou, K.1; Dima, I.1; Antoniou, G.1; Samentzas, A.1; Fassoulakis, C.1; Askitis, T.1; Stefanadis, C.1

1Athens Medical School, 1st Cardiology Department, Greece

Objective: Erectile dysfunction (ED) and coronary artery disease(CAD) are closely related and enhanced vascular inflammation may bea common pathophysiological link. Increased interleukin 18 (IL-18)levels have been associated with risk factors for atherosclerosis. Weinvestigated the association of circulating IL-18 levels with ED andCAD.Methods: 51 consecutive patients presenting with ultrasonographydocumented vascular ED, without known CAD, were evaluated withnon-invasive tests and coronary angiography to reveal CAD. Accord-ingly, they were divided into a subgroup with angiographically docu-mented CAD (ED-CAD) and a subgroup without evidence forunderlying CAD (ED-noCAD). 31 men, with negative non-invasivetest, without ED (control subgroup), matched for age and risk factorswith ED patients were also entered the study. Levels of hsCRP, IL-6and IL-18 were measured in all subjects.Results: There was a progressive increase in IL-18 levels from controlto ED-no CAD subgroup (n = 33) and to ED-CAD subgroup (n = 18)(160 ± 63 vs 174 ± 60 vs 220 ± 44 pg/mL, P < 0.05). In particular, menwith CAD compared to ED patients without CAD, had greater penilevascular damage as estimated by mean peak systolic velocity of penilearteries (26.5 ± 8 vs 31.2 ± 10 cm/s, P < 0.05), longer duration of ED(2.6 ± 0.8 vs 1.9 ± 0.2 yrs, P < 0.01) and significantly increased con-centrations of IL-6 (4.7 ± 0.8 vs 3.3 ± 0.7 pg/mL, P < 0.05) and IL-18while groups did not differ regarding risk factors, metabolic profile andhsCRP. Analysis of covariance revealed that IL-18 remained signifi-cantly different between subgroups after adjustment for confoundingfactors (P < 0.05). Furthermore IL-18 levels were correlated signifi-cantly with duration of ED (r = 0.25, P < 0.05) and penile vasculardamage (figure).Conclusion: Our study shows that IL-18 levels are increased inpatients with subclinical CAD presenting with ED symptoms and cor-relate with increasing severity and duration of penile vascular disease.This finding may have implications for the cardiovascular risk in EDpatients.Policy of full disclosure: None


J Sex Med 2008;5(suppl 2):45–68

P-02-018

The impact of C-type natriuretic peptide andendothelin-1 levels on sexual performance in menwith erectile dysfunction: a novel approach to erectiledysfunctionIoakeimidis, N.1; Vlachopoulos, C.1; Rokkas, K.1; Aznaouridis, K.1; Baou, K.1;Bratsas, A.1; Antoniou, G.1; Askitis, A.1; Stefanadis, C.11Athens Medical School, 1st Cardiology Department, Greece

Objective: Endothelial dysfunction is a key-event in the pathophysi-ology of erectile dysfunction (ED) and generalized vascular disease. C-type natriuretic peptide (CNP) and endothelin-1 (ET-1) are paracrinepeptides with opposing effects on endothelial integrity and vasculartone. We investigated the role of these peptides with potent activity inmen with ED.Methods: 40 consecutive men with no clinical evidence of coronaryartery disease affected by non-psychogenic and non-hormonal ED formore than 6 months were compared with 32 subjects with normal erec-tile function matched for age, BMI and traditional risk factors. ED wasdiagnosed according to history and score of the 5-item Sexual HealthInventory for Men (SHIM-5, cut-off value <21). Moreover, venousblood samples were drawn for estimation of ET-1, N-terminal frag-ment CNP (NT-proCNP) and hs-CRP levels.Results: ED men compared to controls had higher systolic BP values(139 ± 14 vs 129 ± 12 mmHg, P < 0.01) and hs-CRP levels (1.7 ± 0.9vs 1.1 ± 0.7 mg/l, P = 0.001). ED patients compared to controls, exhib-ited greater ET-1 levels (0.26 ± 0.05 vs 0.22 ± 0.03 fmol/l, p < 0.05)and lower NT-pro CNP levels (0.21 ± 0.08 vs 0.34 ± 0.09 pmol/l, P <0.001, for both cases). Analysis of covariance revealed that NT-proCNP and ET-1 values were significantly different between the twogroups after adjustment for confounders (p < 0.01). Moreover, in theentire population SHIM-5 score exhibited a negative correlation withET-1 and a positive correlation with NT-proCNP (figure). Multiplelinear regression analysis revealed that NT-proCNP and ET-1 levelswere significant independent predictors of ED (p < 0.05 for all).Conclusion: CNP and ET-1 levels are associated with presence andseverity of ED and also exhibit an opposing effect on erectile function.Our findings provide further insights for the potential role of thesepeptides in ED patients.Policy of full disclosure: None

use?’. According to their peak systolic velocity (PSV) cut-off at 35 cm/s, patients were divided into two groups: Organic (O; n = 30)and Non-Organic (NO; n = 34). Eighteen random subjects for eachgroup underwent veno-occlusive pletismography (VOP) for the eval-uation of basal and endothelium-dependent forearm blood flow (FBF).Seven healthy age-matched subjects served as controls for VOP.Results: No differences in mean age (30 ± 5.8 ys), BMI (18 ± 2.2),mean systolic blood pressure (119 ± 7 mm/Hg) and cigarette smokingincidence (50%) were found in each group. Cannabinoid use was morefrequent in O-ED vs NO-ED (80% vs. 2%, p < 0.001). Mean PSV ofcavernous arteries was higher in NO-ED vs O-ED (48 ± 1 cm/s vs. 25± 1, p < 0.0001) with normal veno-occlusive function in both groups.VOP studies revealed lower FBFs in O-ED compared with NO-EDand controls (12 ± 6 vs. 32 ± 4 and 34 ± 5 ml/min-1, respectively; p =0.003). Surprisingly, the HOMA-index (HOMA = glucose nmolL ×insulinemia mUImL /22.5) was higher in O-ED vs NO-ED and con-trols (2.6 ± 0.15 vs. 2.0 ± 0.2 and 1.8 ± 0.1, respectively; p = 0.02) withsignificant differences in fasting insulin levels (12 ± 0.67 vs. 8.7 ± 0.81,p = 0.006).Conclusion: Vascular damage as detected by both VOP and PDU isthe common denominator in young ED men with a history of con-tinuative cannabinoid use. Further studies are necessary to establishwhether HOMA-index may be considered an early marker of endothe-lial dysfunction that may contribute to the development of ED.Policy of full disclosure: None

P-02-020

Estimated cardiovascular risk and arteriogenic erectiledysfunctionCorona, G.1; Mannucci, E.2; Fisher, A. D.1; Lotti, F.1; Balercia, G.3; Petrone, L.1; Forti, G.1; Maggi, M.4

1Andrology Unit, University of Florence, Italy; 2Diabetes Section GeriatricUni, University of Florence, Italy; 3Endocrinology Unit, Polytechnic Uni-versity of Marc, Ancona, Italy; 4University of Florence, Clinical Phys-iopathology, Italy

Objective: Recommending general dynamic penile color dopplerultrasound (D-PCDU) screening in patients with erectile dysfunction(ED) has been questioned due to an inadequate cost-benefit ratio. Theaim of the present study is to asses the validity of different risk scoresin the identification of patients being screened for arteriogenic ED atD-PCDU.Methods: A consecutive series of 738 (mean age 53.6 +/-9.2 years)patients with ED was studied. All patients underwent D-PCDU. Arte-riogenic ED was defined when peak systolic velocity (PSV) was lowerthan 25 cm/sec. The assessment of cardiovascular risk was evaluatedusing different risk engines, derived from the Framingham, thePROCAM and the Progetto Cuore studies. An iterative ROC curveanalysis was used to determine the most proper threshold for differ-ent scales for the screening of arteriogenic ED. Sensitivity and speci-ficity at those thresholds were calculated.Results: Among the patients studied, 52 (7%) had PSV < 25 cm/sec.The area under the ROC curves for pathological PSV in relation tocardiovascular risk estimated with different engines was 0.762 ± 0.03,0.716 ± 0.03 and 0.667 ± 0.03 for Progetto Cuore, Framingham andPROCAM engines, respectively. Sensitivity and specificity of ProgettoCuore estimated risk were 67%, 71% when a threshold of 15% waschosen. Corresponding figures for Framingham and PROCAM enginewere 74%, 57% and 69%, 55%, respectively.Conclusion: If D-PCDU is performed only on patients with cardio-vascular risk > 15%, who represent about 1/4 of all patients (26.8%),as estimated by Progetto Cuore, about 70% of cases of arteriogenicED can be identified. This means that well over two thirds of casescan be diagnosed by performing D-PCDU on one patient out of four.Estimated cardiovascular risk, assessed through risk engines, could beused to identify patients who should undergo D-PCDU evaluation forthe diagnosis of arteriogenic ED.Policy of full disclosure: None

P-02-019

Erectile dysfunction after chronic cannabis use: Isendothelial dysfunction the common denominator?Aversa, A.1; Rossi, F.1; Bruzziches, R.1; Bertone, C.1; Francomano, D.1; Pili, M.1; Santiemma, V.1; Spera, G.1

1Sapienza Universita di Roma, Dip. Fisiopatologia Medica, Rome, Italy

Objective: We sought to assess the relationship between cannabis useand vascular alterations in young men complaining ED, without car-diovascular risk factors.Methods: 64 men were selected from overall 300 penile duplex ultra-sound (PDU) database. Inclusion criteria were: age < 40, BMI < 27,cardiovascular risk < 20%, no concomitant medication. All patientshad undergone a detailed medical and sexual history, which includedthe question: ‘Are you currently using cannabinoids for recreational


J Sex Med 2008;5(suppl 2):45–68

Monday, 26 November 200716.30–18.00 Room 3P-03 Female sexual healthChairs: R. van Lunsen, The Netherlands

J. Alder, Switzerland

P-03-021

Beyond cerebral networks of women’s sexual pleasureOrtigue, S.1; Bianchi-Demicheli, F.2; Grafton, S.3

1UCSB4D Brain Electrodyn. lab, Brain Imaging Center, Santa Barbara,USA; 2University Hospital of Geneva, Gynaecology and Sexology Unit,Switzerland; 3UCSB Brain Imaging Center, Psychology, Santa Barbara,USA

Objective: The current models of sexual function acknowledge a com-bined role of central and peripheral processes implicated in orgasmexperience. The recent astonishing advances of neuroimaging techniques applied in parallel with a neuropsychological approachreinforced this assumption by unravelling specific functional neuro-anatomy of a woman’s orgasm. However, the neural basis of subjectivefeelings related to women’s sexual pleasure remains unresolved. Theaim of our presentation is to highlight the central component ofwomen’s orgasm and unravel the cerebral networks sustaining the sub-jective feeling of women’s sexual pleasure.Methods: Using a 3T Phillips MRI scanner, we assessed brain activ-ity elicited when 29 healthy female volunteers (20.41 ± 3.42 years) wereunconsciously exposed to stimuli representing their significant sexualpartner (Bianchi-Demicheli et al., 2006, Ortigue et al., 2007) and cor-related it with individual scores obtained from different sexual dimen-sions: self-reported partnered-orgasm responses (Female SexualFunctioning Index, FSFI, Rosen et al., 2000).Results: Neuroimaging data demonstrated the involvement of a spe-cific left-lateralized insula focus of neural activity correlating withorgasm scores, irrespective of dimension. BOLD responses and par-ticipant’s individual differences in orgasm’s scores (as characterizedwith the composite measure of FSFI’s orgasm scores) showed a signif-icant positive correlation with activity in one specific site: the left insula(−34, 8, −6; x,y,z mm coordinates; r = 0.65; p = 0.001). Participantswho scored higher on the composite measure of FSFI’s orgasm scoresshowed stronger activations in this specific neural substrate.Conclusion: These findings strongly suggest that, among the broadorgasm-related cerebral network, self-reported subjective feelings ofwomen’s sexual pleasure significantly correlate with the left anteriorinsula, a brain area known to play a pivotal role in somatic, reward,and expectancies processes. This suggests the importance of somaticinformation in the integration of sexual experience and takes a steptoward the understanding of the unconscious sexual brain.Policy of full disclosure: None

P-03-022

The P300 method for libido assessment applied toHSDD patientsVardi, Y.1; Gruenwald, I.2; Eliot, S.1; Yelena, G.1; Yarnitsky, D.3

1Rambam Medical Center, Neuro- urology, Haifa, Israel; 2Rambam MedicalCenter, Neuro- Physiology unit, Haifa, Israel; 3Rambam Medical Center,Neurology Department, Haifa, Israel

Objective: We previously demonstrated significant reduction in audi-tory P300 amplitude in sexually healthy subjects during visual sexualstimuli. The aim of this study was to determine if this methodologycould be used to diagnose and differentiate between females with andwithout Hypoactive Sexual Desire Disorder (HSDD).Methods: 23 sexually healthy (NORM group) and 19 sexually dys-functional females participated in this study, ages 22–61. The latter

group of patients were sub-divided into an HSDD group (13 with lowdesire domain scores of the FSFI questionnaire) and an OTHER FSDgroup (6 subjects with no desire problem). All subjects underwent audi-tory P300 EEG recording under three conditions: 1. Auditory stimulionly; 2. Auditory combined with high sexual intensity video stimuli(sexual content including penetration), and; 3. Auditory and lowersexual intensity video stimuli (erotic content without penetration). Foreach participant, an amplitude reduction score, based on P300 ampli-tude change during exposure to each video type vs. auditory-only baseline, was determined. Amplitude reduction scores under eachvideo condition were compared between the NORM and both FSDsub-groups.Results: Subject groups responded differently to the two video types(P = 0.0079); In the HSDD group we found a significant change (74%reduction) while viewing low intensity vs. high intensity videos (reduc-tion of only 22%), without such differences observed in the two othergroups. A further analysis was performed focusing on the high inten-sity videos only, which indicated significant differences between theNORM group (reduction of 64%) vs. the HSDD group (22% reduc-tion; P = 0.0232).Conclusion: Using the P300 auditory/visual method and sexuallyintense video clips, we can differentiate between females with HSDDvs. normal subjects or vs. FSD patients with normal libido. We believethat fine-tuning of this methodology could allow accurate and precisequantification of libido and more subtle diagnostic distinctions.Policy of full disclosure: None

P-03-023

Sexual difficulties after breast cancer: Whom can weblame?Alder, J.1; Zanetti, R.2; Bitzer, J.1

1University Hospital Basel, Gyn. Psychosomatics, Switzerland; 2UniversityHospital Basel, Gyn. Oncology, Switzerland

Objective: To determine the impact of sex steroids, relationship sat-isfaction, depression and chemotherapy on sexuality after breastcancer.Methods: 30 women with premenopausal stage I and II breast cancerdiagnosis and termination of cancer treatment at least 6 months agowere included. Serum levels of estrogens and testosterone, DHT, theirmetabolites as a marker of total pool of androgens (ADT, 3α-diol) andprecursors hormones (DHEA, 4-Dione) were analysed. Informationon sexuality (FSFI), relationship (PFB), depression (BDI) and bodyimage (FBEK) were assessed by questionnaire. The impact ofchemotherapy on sex steroids and sexuality was analysed using t-tests.Linear regression analysis was used to determine the predictive valueof hormones, relationship satisfaction, depression and chemotherapyon sexual domain scores.Results: Mean FSFI scores (2.9 for desire, 3.7 for arousal, 3.2 forlubrication, 3.3 for orgasm, 3.8 for satisfaction, 3.2 for pain and 20.1total score) reflected sexual impairment comparable to women withFSAD. Patients who had undergone chemotherapy had significantlylower scores in all sexual domains, with women without history ofchemotherapy reflecting FSFI scores comparable to sexually healthycontrols. A history of chemotherapy however, was not associated withdifferences in sexsteroids. In all regression models, relationship satis-faction was the most stable predictor of higher scores in the domainsdesire, arousal, satisfaction and low pain, while neither chemotherapy,nor sexsteroids explained sexual outcome.Conclusion: The aftermath of chemotherapy on sexuality has beendescribed in the past. However, the mechanisms of its detrimentaleffect remain unresolved in this study: neither androgens nor estro-gens differed between patients with or without a history of chemother-apy. Relationship satisfaction remains the strongest predictor for sexualsymptoms, attenuating the direct association of sexuality in breastcancer survivors and sex hormones.Policy of full disclosure: None


J Sex Med 2008;5(suppl 2):45–68

P-03-024

Development and validation of a new distress measurefor female sexual dysfunction—women’s sexual distressquestionnaire (WSDQ)Abraham, L.1; Symonds, T.2; May, K.3; DeRogatis, L. R.4; Patrick, D. L.5;Martin, M. L.6; Bushnell, D. M.6

1Pfizer Ltd, Outcomes Research (ipc 160), Sandwich, United Kingdom;2Pfizer Ltd, Outcomes Research, Sandwich, United Kingdom; 3Pfizer Ltd,Clinical R&D, Sandwich, United Kingdom; 4Sheppard Pratt, Center forSexual Medicine, Baltimore, MD, USA; 5University of Washington, SeattleQuality of Life Group, Seattle, WA, USA; 6Health Research Associates Inc,Outcomes, Seattle, WA, USA

Objective: Diagnosing female sexual dysfunction (FSD) requiresdetermining the primary condition and ensuring an associated level ofdistress. The aim of this study was to develop and assess the psycho-metric properties of a new distress measure for FSD—Women’s SexualDistress Questionnaire (WSDQ).Methods: To develop the content of the WSDQ, 58 qualitative inter-views were held with pre- and post-menopausal women with clinician-diagnosed FSD (23 FSAD, 35 HSDD as primary diagnosis) in the US,UK and Australia (mean age 46.6 years, S.D. 10.8). Based on tran-scripts and the conceptual model, 18 items capturing sexually-relateddistress were developed by an expert panel and taken forward to cog-nitive debriefing interviews. To psychometrically validate the WSDQ,a methodology study was conducted across 9 clinics in the USA, Spainand Germany. In total 336 women (mean age 44.4 years, SD 12.2) withclinician-diagnosed FSD (114 FSAD, 222 HSDD as primary diagno-sis) and 303 women (mean age 44.2 years, SD 12.2) without sexual dys-function were recruited.Results: Item reduction analyses for overlap and redundancy suggestedthat 11 items be dropped. Factor analysis showed the remaining 7 itemsto load onto one factor >0.7, explaining 63.3% of the variance. Factorstructure, loadings and variance explained were almost identical by FSDtype and menopausal status. Excellent internal consistency and test-retest reliability was demonstrated, with an alpha coefficient of 0.90 andan intraclass correlation coefficient of 0.85 (95% CI 0.82–0.88). Con-vergent validity was good, with scores being highly related to sexual dis-tress as measured by the Female Sexual Distress Scale (r = 0.80) andsexual quality of life as measured by the Sexual Quality of Life-Femalescale (r = −0.75). The WSDQ also demonstrated excellent discriminantvalidity with FSD women having significantly poorer WSDQ scoresthan the non-FSD group (F = 711.02, p < 0.001).Conclusion: These analyses provide support for the psychometricvalidity of the WSDQ for use in pre- and post-menopausal womenwith FSAD and/or HSDD.Policy of full disclosure: This research was funded by Pfizer Ltd.

P-03-025

Using e-Diaries to measure sexual desire in womenwith hypoactive sexual desire disorderClayton, A.1; van Lunsen, R.2; Nappi, R.3; Tignol, J.4; Goldmeier, D.5;Lewis-D’Agostino, D.6; Pyke, R.7; Wunderlich, G.8

1University of Virginia, Northridge Suite 210, USA; 2University of Amster-dam, Department of Sexology and Psy, The Netherlands; 3University of Pavia,Dept Ob/Gyn, Italy; 4Victor Segalen University, Psychiatry, Bordeaux,France; 5St Mary’s Hospital, GU/Sexual Medicine, London, United Kingdom;6Boehringer Ingelheim, Inc, General Medicine, Clinical Ope, Ridgefield,USA; 7Boehringer Ingelheim, Inc, Director Clinical Research, Ridgefield,USA; 8Boehringer Ingelheim, Ltd, Clinical Scientist, Burlington, Canada

Objective: Measuring the severity of Hypoactive Sexual Desire Dis-order (HSDD) is complex. Numerous available ratings of symptomsand related distress (e.g., Female Sexual Functioning Index [FSFI]),Female Sexual Distress Scale [FSDS]) can be criticized for recall bias.A valid electronic diary could address this issue.Methods: The e-Diary For HSDD Trials© (e-Diary) collected infor-mation on sexual events and attitudes in 3 clinical non-treatmentstudies, 511.73, 511.106 (both North American), and 511.85 (Euro-

pean), which recruited women with HSDD (n = 381) and women withno Female Sexual Dysfunction (no FSD; n = 260). Each study includeda desire-related question; the e-diaries were used for 28 days and themean results calculated. Standard rating scales were completed for ref-erence: Changes in Sexual Functioning Questionnaire (CSFQ) and/orFSFI and FSDS and/or FSDS-R(evised).Results: All 3 studies showed discriminant validity. 1) In study 511.73,105 women with HSDD reported sexual desire on 4.6 days, comparedwith 13.6 days for women with no FSD (p < 0.0001). 2) Study 511.85provided similar data, women with HSDD had sexual desire on 4.7 dayscompared with 13.3 days in the 120 women with no FSD (p < 0.0001). 3)In study 511.106, women with HSDD rated their sexual desire as mod-erate or strong on 4.5 days/month compared with 17.4 days/month inwomen with no FSD (p < 0.001). Convergent validity was also shown;Pearson correlation between the FSFI desire subscale score and the e-Diary sexual desire score (total points for the month) for all subjects (fullanalysis set; n = 245) was high, 0.8179; the corresponding correlation fordesire days moderate to strong was 0.8233. E-Diary compliance wasexcellent; e.g., in 511.73, 77% of subjects missed 3 or fewer days ofentries and only 5% of subjects missed entries for >10 days.Conclusion: A simple daily e-Diary question provides high discrimi-nant validity, convergent validity, and compliance for assessment ofsexual desire in women with HSDD.Policy of full disclosure: This study was funded by Boehringer Ingelheim.

P-03-026

Validation of the sexual interest and desire inventory-female (SIDI-F) in European womenvan Lunsen, R.1; Nappi, R.2; Tignol, J.3; Goldmeier, D.4; Pyke, R.5; Staehle, H.61University of Amsterdam, The Netherlands; 2University of Pavia, Obstet-rics and Gynecology, Italy; 3Ch. Perrens Hospital, Department of Psychiatry,Bordeaux, France; 4St Mary’s Hospital, GU/Sexual Medicine, London,United Kingdom; 5Boehringer Ingelheim, Inc, Director, Clinical Research,Ridgefield, USA; 6Boehringer Ingelheim Pharma Gm, Medical Data Services / Biosta, Biberach an der Riss, Germany

Objective: To determine the reliability and validity of the Sexual Inter-est and Desire Inventory—Female (SIDI-F), a 13-item clinician’s ratingwith 30-day recall, for assessment of the severity of Hypoactive SexualDesire Disorder (HSDD) in European women, using, for convergentvalidation, two standard self-ratings: Female Sexual Functioning Index(FSFI), Changes in Sexual Functioning Questionnaire-Female (CSFQ-F); for divergent validation, the Marital Adjustment Scale (MAS).Methods: 130 women with primary HSDD and 124 with no FemaleSexual Dysfunction (no FSD) were studied in 11 European countries(Austria, Belgium, Finland, France, Germany, Italy, The The Nether-lands, Norway, Spain, Sweden and the UK). Diagnosis and scales wereperformed on day 0 and day 28.Results: For HSDD patients, all results for SIDI-F confirmed relia-bility and validity. Test-retest reliability between day 0 and day 28 wasdemonstrated with an intraclass correlation coefficient of 0.67 and aPearson correlation coefficient of 0.70. Internal consistency was con-firmed by a Cronbach’s alpha of 0.79 for SIDI-F scores in HSDD atday 0. Convergent validity (assessed by measuring the correlationbetween SIDI-F and other tests at day 0) was also demonstrated:Pearson’s correlation to CSFQ-F (0.67) and FSFI (0.76). Low corre-lation of SIDI-F to MAS (0.23) showed divergent validity. SIDI-Fshowed more impairment in desire in HSDD than in no FSD women,with baseline values (mean ± SD) of 20.1 ± 8.4 and 41.8 ± 5.2, respec-tively (p < 0.0001), thus providing discriminant validity. With 13–24subjects (HSDD + no FSD) per country, the SIDI-F reliably distin-guished women with HSDD from no FSD women (p < 0.0001) in eachcountry. Mean SIDI-F scores ranged from 11.6–27.0 in women withHSDD and from 36.4–46.3 in no FSD women.Conclusion: This study provides strong support for the reliability andvalidity of the SIDI-F as a measure of HSDD severity in Europeanwomen.Policy of full disclosure: This study was funded by Boehringer Ingelheim.


J Sex Med 2008;5(suppl 2):45–68

P-03-027

Nasal testosterone shifts memory operations towardsmale faces in womenvan Wingen, G.1; Mattern, C.2; Verkes, R. J.3; Buitelaar, J.3; Fernandez, G.1

1Radboud University Nijmegen, F.C. Donders Centre, The Netherlands;2Mattern Pharmaceuticals AG, Mattern Pharmaceuticals AG, Stans,Switzerland; 3Radboud University Nijmegen Me, Department of Psychiatry,The Netherlands

Objective: Testosterone potentially biases cognitive processes towardsmen. The present study investigated whether nasal testosterone mod-ulates memory formation and retrieval of male faces.Methods: Twenty-five healthy, middle-aged women received a singlenasal testosterone administration in their follicular phase in a double-blind, placebo-controlled, crossover fashion. Participants were askedto memorize and recognize male and female faces while undergoingfunctional MRI.Results: Testosterone modulated the ability to categorize face genderduring encoding, without influencing recognition accuracy or bias.The imaging results showed that testosterone shifted memory forma-tion in the hippocampus and inferior temporal gyri from the encod-ing of female faces towards the encoding of male faces. The oppositepattern of results was observed in the left inferior frontal gyrus. Fur-thermore, the hippocampal contribution to memory retrieval shiftedfrom female towards male faces.Conclusion: This pattern of results indicates that nasal testosteroneshifts memory processes towards the relatively automatic encoding ofmales and intentional encoding of females. These results suggest thatnasal testosterone could influence cognitive processes towards men inwomen with female sexual dysfunction (FSD).Policy of full disclosure: None

P-03-029

Effect of estrogen on the expression of aquaporins inrat vaginaKim, S.-O.1; Park, K.1; Lee, H.-S.1; Kim, S. W.2; Jung, S. I.1; Ahn, K.3

1Chonnam National University Me, Urology, Gwangju, Republic of Korea;2Chonnam National University Me, Internal Medicine, Gwangju, Republicof Korea; 3Chonnam National University Me, Anatomy, Gwangju, Repub-lic of Korea

Objective: Aquaporins (AQPs) are membrane proteins that facilitatewater movement across biological membranes. Recently, the expres-sion of AQPs was reported in rat vagina. The purposes of this studywere to investigate the effect of estrogen on the expression of AQPsin rat vagina.Methods: Female Sprague-Dawley rats (230–240 g, n = 15) weredivided into 3 groups with 5 rats in each group: control (group C),bilateral oophorectomy (group O) and bilateral oophorectomy under-going subcutaneous injection of estrogen (50 µg/kg/day) (group E).After 4 weeks, the amount of vaginal secretion was measured afterpelvic nerve stimulation. The expression and localization of AQP1 andAPQ2 were determined by Western blot and immunohistochemistry.Results: Estimated vaginal secretion (mean ± SE) was significantlydecreased in group O (2.9 ± 0.62 mg) compared with group C (5.7 ±1.25 mg), which was restored to the control level in group E (6.5 ±1.22 mg)(p < 0.05). The expression of AQP 1 did not change signifi-cantly after castration. However, the expression of AQP 2 was signif-icantly decreased in group O and recovered to the control level afterestrogen replacement(p < 0.05).Conclusion: These results showed that estrogen deprivation resultsin differential effects on AQPs expression in rat vagina. It implies thatAQPs may have an important role in vaginal lubrication of menopausalwomen.Policy of full disclosure: None

P-03-030

Clitoral blood flow changes after surgery for stressurinary incontinence: Pilot study on TVT vs. TOTproceduresCaruso, S.1; Rugolo, S.1; Bandiera, S.1; Mirabella, D.1; Cavallaro, A.1;Cianci, A.1

1University of Catania, of MIcrob and Gynecol Science, Italy

Objective: To study the effects of mini-invasive surgery using thetension free vaginal tape (TVT) procedure and the transobturator tape(TOT) procedure in modifying clitoral blood flow in women affectedby stress urinary incontinence (SUI).Methods: The setting of the prospective open clinical study was theUrogynecologic Service of the Department of Microbiological andGynecological Science, University of Catania, Italy. A total of 105women underwent surgery; 42 (mean age 52.8 years) and 63 (mean age53.9 years) were treated with TVT and TOT, respectively. Eachwoman underwent translabial color Doppler ultrasonography tomeasure the resistance index (RI), pulsatility index (PI), peak systolicvelocity (PSV) and end diastolic velocity (EDV) of the clitoral arter-ies, before and 6 months postoperatively.Results: In the TVT group, the mean PI and the mean PSV were sig-nificantly lower, and the mean RI significantly greater compared withpretreatment values (p < 0.5). In the TOT group, each color Dopplermeasurement was similar to that obtained at baseline (p = NS).Conclusion: The different vaginal approach for these two surgicalmethods influenced clitoral blood-flow. Our data could add new infor-mation about sexual behavior after incontinence treatment, particu-larly the impact of clitoral flow changes.Policy of full disclosure: None


J Sex Med 2008;5(suppl 2):45–68

Tuesday, 27 November 200711.00–12.30 Auditorium IV / IIVP-04 Erectile dysfunctionChairs: D. Edwards, United Kingdom

A. Briganti, Italy

P-04-031

Male dyspareunia: A prospective surveyBondil, P.1; Ozone, F.1; Bouraoui, K.1; Demey, A.1; Adawi, F.1; Taccoen, X.1

1Centre Hospitalier, Chambery, France

Objective: Defined by the occurrence of pain provoked by sexualintercourse, male dyspareunia is rarely reported in medical literature.Objective: to analyse its frequency in our urological-andrological con-sultation since November 2004 to August 2007. The clinical features(age, aetiology and treatment) of men consulting only for this reason(painful ejaculations excluded) have been noted.Results: 112 cases of a mean age 48 (18–77) of various aetiology: a) 46La Peyronie diseases treated by intracavernous corticotherapy; b) 27post-traumatic: 21 partial ruptures of fraenulum (surgical treatment), 3partial cavernous ruptures and 3 superficial cutaneous scratches(medical treatment); c) 17 dermatological: 12 scleroatrophic lichens, 4chronic balanitis, 1 dorsal penile lymphangitis (medical or surgicaltreatment); d) 7 post-surgical iatrogenic: 1 distal pain after inflatableprosthesis implantation (removed), 3 after conservative surgery for LaPeyronie disease (2 ablations of no resorbable ligatures, 1 posthec-tomy), 2 painful fraenulum scars (Z plasty) and 1 painful post-posthec-tomy scar (Z plasty); e) 8 mechanical: 5 primary phimosis in young men,2 penile ventral curvatures (1 congenital, 1 La Peyronie disease) and 1chronic paraphimosis (surgical treatment); f) 7 idopathic but with a par-ticular context of both hyper sensitivity of glans and primary sexual dif-ficulties in 3 young men (sexological approach and anaesthetic cream),diabetic neuropathy (1), chronic priapism (1) and 1 without any anom-alies (oral or local analgesic before sexual intercourses).Conclusion: male dyspareunia is likely underestimated because it nota rare condition for consulting (3 by month in our experience). It isoften the revealing symptom of La Peyronie disease or foreskin pathol-ogy. According to its severity, it may impair the sexual life with oftena psychological suffering. The clinical analysis shows without difficul-ties its medical or surgical management with good results.Policy of full disclosure: None

P-04-032

Association between psychiatric symptoms anderectile dysfunctionCorona, G.1; Ricca, V.2; Bandini, E.2; Mannucci, E.3; Petrone, L.1; Fisher, A. D.1; Lotti, F.1; Balercia, G.4; Faravelli, C.5; Forti, G.1; Maggi, M.6

1Andrology Unit, University of Florence, Italy; 2Psychiatry Unit, UNIVER-SITY OF FLORENCE, Italy; 3Diabetes Section Geriatric Uni, Universityof Florence, Italy; 4Endocrinology Unit, Polytechnic University of Marc,Ancona, Italy; 5Psychiatry Unit, University of Florence, Italy; 6University ofFlorence, Clinical Physiopathology, Italy

Objective: Erectile dysfunction (ED) is often associated with a widearray of psychiatric symptoms, although few studies systematicallyaddress their specific association with ED determinants. Aim of thisstudy is to explore the relationship between ED and different psy-chopathological symptoms.Methods: A consecutive series of 1388 (mean age 51 ± 13 years) malepatients with ED was studied. Several hormonal and biochemicalparameters were investigated, along with SIEDY (13 item StructuredInterview, which identifies and quantifies the contribution of organic,relational and intrapsychic domains of ED) and the Middlesex Hospi-tal Questionnaire (a self-reported test for the screening of mental dis-orders in a non-psychiatric setting).Results: Psychiatric symptoms resulted differentially associated withSIEDY domains. Depressive and phobic-anxiety symptoms were asso-ciated with the relational domain, somatization with the organic one,

while free-floating anxiety, obsessive-compulsive and phobic symp-toms were significantly related with higher intra-psychic SIEDYscores. In addition, relevant depressive symptomatology (D) was asso-ciated with hypogonadism, the presence of low frequency of inter-course, hypoactive sexual desire (HSD), and conflictual relationshipswithin the couple and the family. Patients with high free-floatinganxiety symptoms were younger, and complained of an unsatisfactorywork and a conflictual relationships within family. Conversely, subjectswith higher phobic anxious symptoms displayed a more robust rela-tional functioning. Similar results were observed in subjects withobsessive-compulsive symptoms, who also reported a lower prevalenceof HSD. Finally, subjects with somatization symptoms showed theworst erectile function.Conclusion: The main value of this study is that it alters various cli-nicians that many psychiatric symptoms can be found among EDpatients. Systematic testing of patients with ED, through psychiatricquestionnaires, is recommended to detect even slight or moderate psy-chopathological distresses, which specifically associate and exacerbatesexual disturbances.Policy of full disclosure: None

P-04-033

Sexual function and quality of life in men with spinalcord injuryPe’er-Arazy, I.1; Justo, D.2; Ohry, A.3; Heruti, R. J.3

1Reuth Medical Center, Tel-Aviv, Israel; 2Sourasky Medical Center, Inter-nal Medicine, Tel-Aviv, Israel; 3Reuth Medical Center, The Sexual Rehabil-itation Clin, Tel-Aviv, Israel

Objective: Spinal cord injury (SCI) is associated with deficits of motorand sensory function, as well as autonomic control. Hence, it mightaffect sexual function and quality of life (QoL). We studied character-istics of sexuality in men with SCI and investigates the associationbetween sexuality, QoL and emotional distress among these men.Methods: 55 males with traumatic SCI filled questionnaires concern-ing QoL, sexuality, emotional distress and social skills. The followingquestionnaires were used: LSQ, SCI QL-23, SCL 90, and IIEF.Results: The decrease in sexual function was a major cause of QoLdecline. Impaired sexual function affected physical and social func-tioning of more then half of the participants, while 9.1% consideredit as their only disability. Although 30% of men with SCI suffered fromsevere erectile dysfunction and 72.7% reported prominent decrease inorgasmic ability, most men reported high libido and good overall sat-isfaction of sexual performance. There was a positive correlationbetween sexual performance and QoL (p < 0.05). No correlation wasfound between the level of injury and sexual performance.Conclusion: Sexuality following a SCI remains a central motivatingfactor in life and the overall rehabilitation outcome is substantiallyinfluenced by a successful sexual rehabilitation. Despite the importanceof sexual health in men with SCI, little attention is paid into sexualeducation of care-givers.Policy of full disclosure: None

P-04-034

Associations between female partner attitudes andmale-partner erectile dysfunction, treatment-seekingbehaviour and treatment utilisation: Findings of theFEMALES studyEardley, I.1; Fisher, W.2; McCabe, M.3; Sand, M.41St James’ University Hospital, Pyra Department of Urology, Leeds, UnitedKingdom; 2Universitly of Western Ontario, Department of Psychology,Canada; 3Deakin University, Department of Psychology, Burwood, Canada;4Bayer Schering Healthcare, Scientific Affairs, Wuppertal, Germany

Objective: Erectile dysfunction (ED) has a negative impact on patientsand their female partners and should therefore be regarded as a sharedsexual concern. The current analysis of the Female Experience ofMen’s Attitudes to Life Events and Sexuality (FEMALES) study dataexplores women’s perceptions, beliefs and attitudes regarding their


J Sex Med 2008;5(suppl 2):45–68

partner’s ED, and investigates whether these factors are associated withthe likelihood of men seeking medical advice and using phosphodi-esterase type-5 (PDE-5) inhibitor treatment.Methods: Questionnaires were sent to partners of men with ED whoparticipated in the Men’s Attitudes to Life Events and Sexuality(MALES) 2004 study, and who consented to their partner’s involve-ment. A modified version of the questionnaire used in the MALESstudy was developed. This comprised 65 items relating to women’s per-ceptions, beliefs and attitudes regarding aspects of ED. FEMALESquestionnaire responses were analysed in relation to responses toequivalent questions provided by male study participants.Results: There were significant associations between the woman’sbelief that her partner’s ED was permanent and men’s treatment-seeking behaviour (Chi-square = 86.43; p < 0.0001) and PDE-5inhibitor use (Chi-square = 18.79; p = 0.001); and the woman’s per-ception that her partner’s ED was more severe and men’s treatmentseeking (Chi-square = 92.84, p < 0.0001) and PDE-5 inhibitor use(Chi-square = 23.80, p = 0.001). Significant associations were observedbetween men’s treatment-seeking and PDE-5 utilisation and women’slevel of satisfaction with the relationship before and after ED onset;their perceptions of the impact of ED on quality-of-life; their desireto deal with ED; and their attitudes to ED treatment.Conclusion: This study illustrates the importance of the femalepartner’s attitudes to ED in the treatment-seeking behaviour andPDE-5 inhibitor utilisation of the male partner. These findingsstrongly support the potential benefits of integrating female partnersinto ED consultations and treatment strategies.Policy of full disclosure: Mr Eardley and Professor McCabe haveacted as paid consultants and speakers for Bayer Schering Pharma,Pfizer and Lilly ICOS. Professor Fisher has acted as a paid consultantand speaker for Bayer Schering Pharma and Pfizer. Dr Sand was anemployee of Bayer Schering Pharma at the time of the study.

P-04-035

Attitudes towards erectile dysfunction (ED) and itstreatmentEdwards, D.1; Hood, C.2; Collins, O.3

1White House Surgery, Oxfordshire, United Kingdom; 2Wycombe GeneralHospital, Department of Genito Urinary M, High Wycombe, UnitedKingdom; 3Bayer plc, Medical Affairs, Newbury, United Kingdom

Objective: To assess the attitudes towards the treatment of ED in mendiagnosed with ED.Methods: One-to-one qualitative interviews, conducted with 20 mentaking oral medication for ED, informed the design of a 51-part onlinequestionnaire that was used to collect quantitative data from 630 menwith ED. Respondents were recruited from research panels using bothon-line and off-line means.Results: The average age of respondents was 55 years; the averagediagnosis was 4.65 years, with an average 1.5 year wait before activelyseeking help. All had taken an oral treatment for ED at some stage;70% were still taking an oral medication. “High success rate” and“works quickly” were cited as the two most important attributes formen taking their first ED tablet and a majority (87%) were open tothe idea of switching their current treatment. When unable to havesatisfactory sex with their first tablet, 68% reported loss of self-esteem,58% felt their confidence was affected and 32% felt depressed; 24%thought their ED could never be treated; 77% worried their ED waspermanent; and 33% did not return to their GP to try an alternativetreatment. GPs were the most commonly used source of information(89%) followed by the internet (46%). However, 46% of patients pre-scribed an oral medication got no additional help with their ED.Conclusion: Men with ED symptoms wait, on average, two yearsbefore consulting their GP, during which time ED can significantlyimpact their psychological well-being. These data confirm that menare still reluctant to seek help for their ED and highlight the impor-tance of first-time success on improving aspects of well-being. It isimportant that, at the time of first consultation, patients are giveninformation and support on potential alternatives, and encouraged toreturn to their GP should their first treatment not be successful.

Policy of full disclosure: Dr D Edwards lectures for Bayer-Schering,Eli Lilly, Ipsen, Pfizer and Prostraken, acts as a consultant for OwenMumford and receives clinic funding from Bayer-Schering, Ipsen,Pfizer and Prostraken. Dr O Collins is an employee of Bayer plc.

P-04-036

Effect of on-demand Sildenafil in sexually healthymales—A randomized placebo controlled double blind studyGruenwald, I.1; Massarwa, O.1; Vardi, Y.11Rambam Medical Center, Neurourology, Haifa, Israel

Objective: In this study we aimed to evaluate the effect of Sildenafil50 mg on quality of sexual life (QSF) and quality of erections in a groupof sexually-active normally functioning males.Methods: This prospective, placebo-controlled, double-blind cros-sover study included sexually-active males that were never evaluated/treated for ED with an IIEF-ED Domain score (EDDS) ≥ 22. Thestudy included 4 visits in which the patients filled QSF questionnaireswith Liker scale (SEARS, IIEF and EDITS), and a sexual activityopen-questions scored questionnaire. All patients randomly received 6tablets of Sildenafil 50 mg or placebo, (visit 1and 3) in a crossovermanner. 51 subjects were eligible for analysis. We performed paired-tests between 2 groups-Sildenafil treated vs. placebo.Results: Average age was 52.14 ± 10.3 and an average EDDS of 25.6.We found significant differences between the Sildenafil vs. placebogroups in the EDITS (70.77 ± 18.3 vs. 60.32 ± 19.37, p = 0.013), andSEARS (57.62 ± 10.40 vs. 51.1 ± 10.57, P < 0.0001) questionnaires(total scores ± SD) respectively. Scores for a longer duration of sexualintercourse (3.03 ± 1.56, vs. 1.86 ± 1.61, p = 0.007), a shorter intervalbetween erections (2.38 ± 1.69 vs. 1.19 ± 1.44, p = 0.003), a better erec-tile quality (3.2 ± 1.72 vs 1.80 ± 1.7, p < 0.0002 and delayed ejacula-tion 3.11 ± 1.21 vs 1.23 ± 1.39, p = 0.001) were all significantly higherin the sildenafil vs. placebo groups, respectively. Self esteem questionsi.e. “felt like a real man” (4.16 ± 0.92 vs. 3.55 ± 1.11, p = 0.001) and“satisfied with my sexual function” (4.09 ± 0.94 vs. 3.38 ± 1.16, p =0.001) scores were also significantly higher in the Sildenafil group Wedid not find significant differences between the groups in the total IIEFscore nor in the frequency of sexual activity.Conclusion: Sexually healthy subjects may experience better qualityof erections and higher satisfaction from sexual life after treatmentwith sildenafil. We suggest a broader indication for the use of Silde-nafil and to include normally active males that wish to improve theirsexual life.Policy of full disclosure: This study was supported by an independ-ent research grant from pfizer.

P-04-037

Chronic sildenafil treatment improves penile, but non-systemic, endothelial function in patients with EDAppel, B.1; Gruenwald, I.2; Ofer, Y.3; Dayan, L.4; Jacob, G.4; Vardi, Y.31Haifa, Israel; 2Rambam Medical Center, IIT Fa, Neurourology Unit, Haifa,Israel; 3Rambam Medical Center—IIT Fa, Neurourology Unit, Haifa,Israel; 4Rambam Medical Center—IIT Fa, J. Recanati Autonomic Dysfunct,Haifa, Israel

Objective: The effect of chronic assumption of PDE5-I on penileendothelial function (EF) is unknown. Therefore, we aimed to evalu-ate the effect of chronic therapy with sildenafil on penile corporal EFcomparing to the systemic one, by using our previously reportedmethod for evaluation of the penile EF.Methods: Patients with ED were prospectively randomized blindly toeither placebo or sildenafil 50 mg on daily bases for one month. Penileand forearm blood flow were assessed (using the venous-occlusivestrain gauge method for both organs) at baseline and after reactivehyperemia induced by 4 minutes of ischemia. Area under the curve(AUC) of the sequential changes in flow after ischemia was consideredindex of EF.


J Sex Med 2008;5(suppl 2):45–68

Results: Thirteen and 17 patients were found assigned to the placeboand sildenafil group, respectively. Their mean ages were 55 ± 3 and 56± 4 years, respectively. Baseline penile blood flow was 4.6 ± 0.6 and5.6 ± 0.4 ml/min/dl for placebo and sildenafil, respectively (p = 0.2).Forearm blood flow was 4.2 ± 0.4 and 3.8 ± 0.3 ml/min/dl, respectively(p = 0.50). Baseline penile AUC was 370 ± 55 and 407 ± 40 (p = 0.58),and in the forearm 430 ± 40 and 420 ± 40 (p = 0.95) for placebo andsildenafil, respectively. After one month on the assigned drug, penileblood flow increased to 9.2 ± 1.3 ml/min/dl tissue in sildenafil group(p = 0.02) and remained unchanged in placebo group. Penile AUCincreased to 660 ± 95 in sildenafil group and remained unchanged inplacebo group. Both, placebo and sildenafil did not affect the forearmblood flow and AUCs.Conclusion: The preset study shows for the first time that chronictreatment with sildenafil improves significantly both penile endothe-lial function and penile rest blood flow, without having any effect onthe systemic one.Policy of full disclosure: None

P-04-038

Intrafascial nerve sparing technique improves the rateof erectile function recovery after retropubic radicalprostatectomy, compared to standard techniqueBriganti, A.1; Gallina, A.2; Salonia, A.1; Deho, F.1; Zanni, G.1; Sozzi, F.1;Strada, E.1; Capitanio, U.1; Suardi, N.1; Rigatti, P.1; Montorsi, F.1

1Vita Salute University, Urology, Milan, Italy; 2Reparto di Urologia,Ospedale San Raffaele, Milano, Italy

Objective: To test the role of bilateral nerve-sparing technique (BNS)(intrafascial vs. interfascial) on the recovery of erectile function (EF)after radical retropubic prostatectomy (RRP).Methods: From January 2004 to December 2006, 257 fully potentpatients treated with BNSRRP for clinically localized prostate cancerwere prospectively included in the study. All patients were invited tocomplete the International Index of Erectile Function (IIEF-EF) theday before surgery. The patients were stratified according to nerve-sparing technique (intrafascial vs. interfascial). All patients were eval-uated every 3 months by the attending urologist and all informationregarding EF and urinary continence (UC) were recorded. Post-op EFwas assessed using the erectile domain of IIEF (IIEF-EF). Post-op UCwas assessed using the International Consultation on Incontinence(ICI) questionnaire. The EF recovery was defined as IIEF-EF ≥ 17,while UC recovery was defined as ICI-Q ≤ 6. Kaplan-Meier curvesand Cox regression model assessed the time to EF recovery accordingto the nerve-sparing technique (Intrafascial vs. Interfascial), afteradjusting for age, time to continence recovery and pre-op IIEF-EF.Results: Mean (median) age was 60.4 (60.1) yrs. The pre-op IIEF-EFwas 1–10 in 22.7%, 11–16 in 6.7%, 17–21 in 2.6%, 22–25 in 17.5%and ≥26 in 50.5%. Mean (median) post-op follow-up was 12.3 (11.0)months. In Kaplan-Meier analyses, intrafascial technique was associ-ated with higher probability of EF recovery, albeit borderline signifi-cance (log rank p = 0.09; Fig. 1). After adjusting for age, time to UCrecovery and pre-op IIEF-EF, BNS was an independent predictor ofEF recovery after RRP, where intrafascial technique was associatedwith a 1.49-fold increase in the rate of EF recovery, compared to inter-fascial technique.Conclusion: Intrafascial technique during BNSRRP seems to be asso-ciated with a higher rate of EF recovery, independently from age andpre-op erectile function.Policy of full disclosure: None

P-04-039

Time to continence recovery is an independentpredictor of erectile function recovery after bilateralnerve sparing radical prostatectomyBriganti, A.1; Gallina, A.1; Salonia, A.1; Deho, F.1; Zanni, G.1; Pellucchi, F.1; Capitanio, U.1; Sozzi, F.1; Suardi, N.1; Rigatti, P.1; Montorsi, F.11Vita Salute University, Urology, Milan, Italy

Objective: To test the role of continence recovery on the erectile func-tion (EF) of patients treated with bilateral nerve sparing radical retrop-ubic prostatectomy (BNSRRP).Methods: From January 2004 to December 2006, 257 fully potentpatients treated with BNSRRP for clinically localized prostate cancerwere prospectively included in the study. All patients were invited tocomplete the International Index of Erectile Function (IIEF-EF) theday before surgery. All patients were assessed every 3 months by theattending urologist and all information regarding EF and urinary conti-nence (UC) were recorded. Post-op EF was evaluated using the erectiledomain of IIEF (IIEF-EF). Post-op UC was assessed using the Interna-tional Consultation on Incontinence (ICI) questionnaire. The EFrecovery was defined as IIEF-EF ≥ 17, while UC recovery was defined asICI-Q ≤ 6. Time to UC recovery was considered as both a continuousvariable and a categorical variable. Kaplan-Meier curves assessed thetime to EF recovery according to time to UC recovery. MultivariableCox regression models tested the association between time to UCrecovery and EF recovery, after adjusting for age and pre-op IIEF-EF.Results: Mean (median) age was 60.4 (60.1) yrs. The pre-op IIEF-EFwas 1–10 in 22.7%, 11–16 in 6.7%, 17–21 in 2.6%, 22–25 in 17.5%and ≥26 in 50.5%. Mean (median) post-op follow-up was 12.3 (11.0)months. In Kaplan-Meier analyses, a shorter time to UC recovery wasassociated with a higher probability of EF recovery (Figure 1; all p ≤0.04). After adjusting for age and pre-op IIEF-EF, time to UC recov-ery (continuously and categorically coded) was an independent pre-dictor of EF recovery after RRP (p ≤ 0.007).Conclusion: Time to UC recovery is a strong and independent pre-dictor of EF recovery after BNSRRP.Policy of full disclosure: None

P-04-040

Two years follow-up with low-dose sildenafil forrehabilitation of erectile function after nerve-sparingradical prostatectomyBannowsky, A.1; Schulze, H.2; van der Horst, C.2; Hautmann, S.2; Jünemann, K.-P.2

1Ev.-Luth. Diakonissen Hospital, Dept. of Urology, Flensburg, Germany;2University hospital Kiel, Dept. of Urology, Germany

Objective: Several treatment regimens for rehabilitation of erectilefunction after nerve-sparing radical prostatectomy (nsRP) are cur-rently discussed. In previous prospective studies we showed nocturnalpenile tumescense and rigidity (NPTR) in 95% of the patients in theearly phase after nsRP.Methods: 43 sexual active patients were operated by nerve-sparingretropubic radical prostatectomy. All patients completed an IIEF-5questionnaire concerning erectile function preoperatively. A measure-ment of NPTR (Rigi-Scan®) was carried out in the following nightafter catheter removal. 23 patients with preserved nocturnal erectionsdetected during NPTR-recordings received sildenafil 25 mg/d atnight. A control of 18 patients underwent follow up without PDE-5-inhibitors. IIEF-5 questionnaire was performed 6, 12, 24, 36, 52, 78and 104 weeks after operation.Results: 41 of 43 patients (95%) showed 1–5 erections during the firstnight after catheter removal. In the group of daily sildenafil the IIEF-5 score decreased from preoperative 21.2 mean score to 3.6 at 6 weeks,3.9 at 12 weeks, 6.1 at 24 weeks, 10.4 at 36 weeks, 14.5 at 52 weeks,19.4 at 78 weeks and 21.0 mean score at 104 weeks after prostatec-tomy. In the control group preoperative IIEF-5 mean score 21.2decreased to 3.8 at 6 weeks, 3.9 at 12 weeks, 5.3 at 24 weeks, 6.1 at 36weeks, 9.3 at 52 weeks, 13.4 at 78 weeks and 14.8 at 104 weeks. Sta-tistical evaluation showed a significant difference in IIEF-5 score andtime to recovery of erectile function (p < 0.05).Conclusion: The measurement of NPTR after nsRP showed erectilefunction even at the “first” night after catheter removal. In case of earlypenile erections the cavernous nerve was well preserved during surgeryproviding good neuronal integrity. Daily low dose PDE-5 inhibitorslead to a significant improvement of recovery of erectile function andis supportive to the organic rehabilitation.Policy of full disclosure: None


J Sex Med 2008;5(suppl 2):45–68

Tuesday, 27 November 200714.30–16.00 Auditorium VI/VIIP-05 Ejaculatory disordersChairs: M. D. Waldinger, The Netherlands

N. Monteiro Pereira, Portugal

P-05-041

Involvement of cortical serotonergic pathways insexual behaviour in the male ratPozzato, C.1; Hedou, G.1; Heidbreder, C.1; Gerrard, P. A.1; Arban, R.1;Melotto, S.11GSK SpA, PsyCEDD-Biology, Verona, Italy

Objective: A large body of evidence supports the hypothesis of anoverall inhibitory role of the serotonergic system on male sexualbehaviour. In the present study the role of serotonin in appetitive andconsummatory phase was explored. Monoamine levels in the medialprefrontal cortex (mPFC) of male rats, exposed to an unreachablereceptive female, were also measured. The respective effects of inhi-bition of serotonin (5-HT) reuptake, 5-HT1A receptor agonism andantagonism, and 5-HT1B receptor antagonism were investigated toassess therapeutic potential of these mechanisms.Methods: Sexually experienced male Wistar rats, implanted with aguide cannula in the mPFC, were exposed to an empty cage and eitherto a receptive female or a non receptive female. Micodialysates werecollected and analysed for norepinephrine (NE), dopamine (DA) and5-HT concentration. The effects of acute treatment with the SSRIcitalopram, citalopram plus the 5-HT1A receptor antagonist WAY-100,635, the 5-HT1A receptor agonist 8-OH-DPAT and the 5-HT1Breceptor antagonist SB-616234, were evaluated on sexually experi-enced male Wistar rats. Subjects were submitted first to a sexual incen-tive motivation test for the evaluation of sexual desire, followed by acopulatory session.Results: 5-HT levels were increased in the mPFC of male rats exposedto a receptive female. However, sexual appetitive behaviour was notaffected by any drug treatment. Citalopram (3, 10, 30 mg/kg p.o.) didnot affect the ejaculation latency (EJL), whereas the co-administrationof citalopram (10 mg/kg p.o.) with WAY-100,635 (0.1 mg/kg s.c.) sig-nificantly increased EJL. 8-OH-DPAT (0.025, 0.05, 0.1 mg/kg s.c.)and SB-616234 (3, 10 mg/kg p.o.) induced a dose-dependent facilita-tory effect of ejaculatory patterns.Conclusion: These data indicate that activation of the serotonergicpathway in the mPFC parallels the appetitive phase of sexual behav-iour in the male rat and support that selective serotonergic modula-tion may provide new opportunities to modify the ejaculatory pattern.Policy of full disclosure: All authors are employees of GlaxoSmithKline.

P-05-042

Oxytocin receptor antagonist acts at the brain level toinhibit ejaculation in anaesthetised ratsClement, P.1; Peeters, M.2; Bernabe, J.2; Laurin, M.2; Giuliano, F.31Pelvipharm Laboratories, Gif sur Yvette, France; 2Pelvipharm Laborato-ries, Neuropharmacology, Gif sur Yvette, France; 3Hopital de Bicetre, Dept.of Urology CHU de B, Le Kremilin Bicetre, Cedex, France

Objective: The involvement of the neuropeptide oxytocin (OT) in thecontrol of male sexual responses is documented although its exactmechanisms of action, and especially the site(s) of action, are not fullydelineated. In order to clarify this issue, we tested the effects of an OTantagonist (OT antag) delivered through different routes on sexualresponses elicited, in anaesthetised rats, by intracerebroventricular(i.c.v.) 7-hydroxy-2-(di-N-propylamino)tetralin (7-OH-DPAT), adopamine D3 preferential agonist.Methods: Male Wistar rats sexually naive (n = 100) were anaesthetisedwith urethane and implanted with a cannula for i.c.v. injection. Seminalvesicle pressure and bulbospongiosus muscle (BS) electromyogramwere recorded as physiological markers of respectively emission and

expulsion phases of ejaculation and intracavernosal pressure was meas-ured as physiological marker of erection. A peptidergic selective OTantag (d(CH2)51,Tyr(Me)2,Orn8)-Oxytocin) was delivered i.v., i.c.v.,or intrathecal (i.t.; 13th thoracic; T13 or 6th lumbar; L6 segments)prior to i.c.v. 7-OH-DPAT.Results: When injected i.v., the OT antag did not impair 7-OH-DPAT-induced erection and ejaculation. When delivered i.c.v., the OTantag dose-dependently inhibited 7-OH-DPAT-induced erection andejaculation. When delivered i.t. at L6 but not T13 level, the OT antagsignificantly reduced the duration of BS responses and the occurrenceof ejaculation without impairing erectile response.Conclusion: We conclude that, in the 7-OH-DPAT model, brain OTreceptors mediate ejaculation and L6 spinal OT receptors have a mod-ulating role on ejaculation whereas peripheral OT receptors are notinvolved. The present data support the existence of functional rela-tionships between dopaminergic and oxytocinergic pathways in thecentral control of ejaculation.Policy of full disclosure: None

P-05-043

Prevalence of premature ejaculation in chronic pelvicpain syndromeCho, I. R.1; Cho, S. Y.1

1Inje University Ilsanpaik Hosp, Urology, Koyang/Gyunggido, Republic ofKorea

Objective: The premature ejaculation is a common male sexual dys-function. Also CPPS is a common and serious health problem affect-ing the QoL. Both CPPS and premature ejaculation are commondisorder, but their etiopathogenesis are not well understood. We inves-tigated the prevalence of premature ejaculation in CPPS patients andcompared them with healthy control subjects, and the influence ofpremature ejaculation on erectile function in the patients with CPPS.Methods: 638 CPPS patients and 102 healthy controls were enrolledin this study. A questionnaire consisting of 3 parts-demographic dataand Korean version of the NIH-CPSI (National Institutes of Healths-Chronic Prostatitis Symptom Index) and IIEF (International Index ofErectile Function was administered to all patients. Premature ejacula-tion was defined as intravaginal ejaculation latency of less than 3minutes with the same partner for at least 6 months.Results: 303 patients with CPPS and 83 healthy controls were eligi-ble for the analysis. Of 303 patients with CPPS, 217 had prematureejaculation (71.62%). The rate of premature ejaculation was higher inthe patients with CPPS than healthy controls (22.89%), and this dif-ference was statistically significant (p < 0.01). in the patients withCPPS, the frequency of sexual intercourse per month during the last3 months was 4.79 ± 3.43. in the patients with CPPS, the mean scoreof IIEF-EF (erectile function), IIEF-IS (intercourse satisfaction),IIEF-OF (orgasmic function), IIEF-SD (sexual desire) and IIEF-OS(overall satisfaction) were 21.7 ± 6.4, 8.5 ± 2.9, 7.4 ± 2.5, 5.3 ± 2.0 and5.2 ± 2.1 respectively. These each mean IIEF domain score was lowerthan healthy controls. and this difference was statistically significant.But in the patients with CPPS, who grouped by category IIIa and IIIb,the frequency of sexual intercourse and each IIEF domain scoreshowed no difference.Conclusion: The rate of premature ejaculation was higher in thepatients with CPPS than healthy controls.Policy of full disclosure: None

P-05-044

Association between premature ejaculation and LUTSseverityDemir, O.1; Akgül, K.2; Akar, Z.3; Cakmak, O.4; Ozdemir, I.1; Bolukbasi, A.4; Can, E.5; Gumus, B.3

1Dokuz Eylul University, Urology, Izmir, Turkey; 2Tepecik Training Hospi-tal, Izmir, Turkey; 3Celal Bayar University, Urology, Manisa, Turkey;4Ataturk Training Hospital, Urology, Izmir, Turkey; 5Tepecik Training Hos-pital, Urology, Izmir, Turkey


J Sex Med 2008;5(suppl 2):45–68

Objective: Lower urinary tract symptoms (LUTS) and sexual dys-function are common in older men. Men with LUTS have beenreported to experience sexual dysfunction, including ejaculatory loss,painful ejaculation, and erectile dysfunction. In our study we aim toinvestigate the association between LUTS severity and prematureejaculation in patients who admitted to urology clinics with complaintsof LUTS.Methods: The study population consisted of 182 male patients withlower urinary tract symptoms (International Prostate Symptom Score-IPSS > 7) were seen at the urology clinics of four different institutions.International Index of Erectile Function (IIEF) and InternationalProstate Symptom Score (IPSS) were replied by all the patients. Meanduration of intravaginal ejaculation latency time (IELT) and occur-rence of premature ejaculation (IELT < 120 sec) were asked. MeanIELT were compared between groups according to LUTS severity(Group I; moderate LUTS, Grup II; severe LUTS).Results: Mean IPSStotal, IPSSstorage and IPSSvoiding scores of theGroup I and II were; 12.3 ± 3.5 vs 24.1 ± 3.6, 5.7 ± 3.5 vs 12.3 ± 9.4and 7.1 ± 3.9 vs 14.8 ± 3.0, respectively. Mean age, IELT duration andIIEF-erectile function domain scores of the groups were 59.7 ± 8.4 vs59.6 ± 7.4 year (p > 0.05), 220.4 ± 176.9 vs 165.7 ± 145.9 sec (p = 0.05)and 19.2 ± 9.3 vs 16.2 ± 9.5 (p = 0.049), respectively. The prevalenceof premature ejaculation was found 42.3% in Group I and 51.9% inGroup II. The correlation analyzis revealed that IELT was slightlynegative correlated with IPSStotal (p = 0.014, r = −0.182) andIPSSstorage (p = 0.008, r = −0.196) scores.Conclusion: The presence and severity of LUTS are independent riskfactors for premature ejaculation in older men. The prevalence of pre-mature ejaculation was increased with LUTS severity. We recommendthat patients with LUTS should be questioned for prescence of premature ejaculation might take part in the evaluation of sexual functions.Policy of full disclosure: None

P-05-045

Interrelationships among outcomes related topremature ejaculation: Analyses from a Europeanobservational studyGiuliano, F.1; Patrick, D.2; Rothman, M.3; Berlin, J.4

1Hopital de Bicetre, Dept. of Urology CHU de B, Le Kremilin Bicetre, Cedex,France; 2University of Washington, Department of Health Services, Seattle,USA; 3Johnson & Johnson, Raritan, USA; 4Johnson & Johnson, Pharma-coepidemiology, Titusville, USA

Objective: To use path analysis, a form of regression analysis, to eval-uate relationships among variables describing premature ejaculation(PE), including intravaginal ejaculatory latency time (IELT) and thesingle-item measures of the Premature Ejaculation Profile (PEP;control over ejaculation, satisfaction with sexual intercourse, personaldistress related to the timing of ejaculation, and interpersonal difficultyrelated to ejaculation).Methods: Data were from an 8-week, multicenter, European obser-vational study of men (n = 201) ≥18 years of age, diagnosed with PEby clinicians using the DSM-IV-TR criteria and who reported at leastmoderate ejaculation-related personal distress and/or interpersonaldifficulty. Outcome measures included stopwatch-measured IELT(each intercourse episode) and the PEP (baseline and Weeks 4 and 8).In the path analysis, statistical significance (P ≤ 0.05) of regression (β)coefficients was evaluated based on a critical ratio (estimate/standarderror) of >1.96.Results: IELT had a moderately strong (β = 0.453) and statisticallysignificant (P ≤ 0.05) direct effect on perceived control over ejacula-tion, and a weak (β = 0.141) but statistically significant (P ≤ 0.05) directeffect on ejaculation-related personal distress; however, stepwiseregression revealed that IELT accounted for only 1.6% of the variancein ejaculation-related personal distress. IELT did not have a directeffect on satisfaction with sexual intercourse. Perceived control overejaculation had statistically significant (P ≤ 0.05) and moderatelystrong (β = 0.301 and 0.463) direct effects on satisfaction with sexualintercourse and ejaculation-related personal distress, respectively. Sat-

isfaction with sexual intercourse and ejaculation-related personal dis-tress had significant (P ≤ 0.05) and moderately strong (β = 0.343 and0.336, respectively) direct effects on interpersonal difficulty related toejaculation.Conclusion: These results suggest that the man’s perception of lowcontrol over ejaculation mediates whether he also reports low satis-faction with sexual intercourse and elevated personal distress relatedto ejaculation, consistent with previous findings based on data from asimilarly designed US observational study.Policy of full disclosure: F. Giuliano is an investigator and consult-ant for Johnson & Johnson.

P-05-046

DA8031, a selective and potent serotonin transporterinhibitor, inhibits p-chloramphetamine-inducedejaculation in ratsAhn, B.1; Kang, K. K.1; Lee, Y. G.1; Choi, S. M.1; Kim, D. S.1; Yoo, M.1

1Dong A Pharm, Research Lab., Yongin, Republic of Korea

Objective: DA8031 is a new isobenzofuran derivative showing selec-tive and potent inhibition of serotonin transporter (Ki = 1.6 nM).Selectivity of DA8031 on serotonin transporter against adrenergic,dopaminergic, muscarinic receptors is more than 5,000-fold. Thisstudy was conducted to investigate the effect of DA8031 on p-chloramphetamine (PCA)-induced ejaculation in anesthetized rats.Methods: Male Wistar rats were anesthetized and DA8031 or dapox-etine was administered intravenously (1 and 3 mg/kg) or orally (12.5and 25 mg/kg), followed by intraperitoneal administration of PCA (5 mg/kg). The proportion of number of rats ejaculating was observedfor 30 minutes after PCA injection.Results: DA8031 inhibited PCA-induced injection in a dose-depend-ent manner. After oral dose of 12.5 and 25 mg/kg of DA8031, 33%and 0% of rats showed ejaculation, compared to 86% of control rats.After intravenous administration, 33% and 20% of rats receiving 1 and3 mg/kg of DA8031 exhibited PCA-induced ejaculation. The efficacyof DA8031 was comparable with that of dapoxetine in both routes.Conclusion: These results warrant further investigation of this com-pound for therapy of premature ejaculation.Policy of full disclosure: This work was supported by Dong-A Phar-maceutical Company.

P-05-047

Improvements in premature ejaculation outcomes in“responders” to dapoxetineBuvat, J.1; Giuliano, F.2; Bull, S.3; Tesfaye, F.4; Rothman, M.5; Rivas, D.4

1CETPARP/Le grand Hunier, Lille, France; 2AP-HP, Neuro-Urology-Andrology, Raymond Poincaré Hospital, Le Kremlin Bicetre Cedex, France;3ALZA Corporation, Clinical Development, Mountain View, CA, USA;4Johnson & Johnson, Pharmaceutical Research and De, Raritan, NJ, USA;5Johnson & Johnson, Pharmaceutical Services, Raritan, NJ, USA

Objective: To evaluate differences between “responders” and “nonre-sponders” to treatment for premature ejaculation (PE) with dapoxe-tine or placebo in a 22-country phase III clinical trial.Methods: Men ≥18 years of age (N = 1162), diagnosed with PEaccording the DSM-IV-TR criteria, with intravaginal ejaculatorylatency time (IELT) ≤2 min in ≥75% of intercourse episodes, were ran-domized to receive placebo, dapoxetine 30 mg, or dapoxetine 60 mgon demand (1–3 hours prior to sexual intercourse) for 24 weeks following a 4-week baseline period. Outcomes included stopwatch-measured IELT (each episode); perceived control over ejaculation, satisfaction with sexual intercourse, and personal distress and interpersonal difficulty related to ejaculation (5-point scales) at base-line and Weeks 12 and 24; and patient-reported global impression ofchange (PGI; 7-point scale) at Weeks 12 and 24. “Responders” weredefined based on stringent criteria of a ≥2-category increase in per-ceived control over ejaculation and a ≥1-category decrease in personaldistress related to ejaculation.


J Sex Med 2008;5(suppl 2):45–68

Results: At Week 24, responder rates were 13.0% with placebo,25.3% with dapoxetine 30 mg, and 37.1% with dapoxetine 60 mg.Nearly 3 of 4 responders reported that their PE was “better” or “muchbetter” on the PGI (Table) at Week 24. Further, all PE measuresassessed, including IELT, perceived control over ejaculation, personaldistress related to ejaculation, satisfaction with sexual intercourse, andinterpersonal difficulty related to ejaculation, were improved amongresponders in comparison with baseline and nonresponders (Table).Outcomes achieved by “responders” approached the response level ofmen without PE in an EU observational study (Table). The mostcommon adverse events associated with dapoxetine were nausea,headache, dizziness, and diarrhea.Conclusion: “Responders” to treatment of PE with dapoxetine orplacebo reported better outcomes for all PE parameters than “nonre-sponders” in this study, confirming that the benefits of dapoxetinetreatment for men with PE include the overall sexual and relationalexperience.Policy of full disclosure: This study was funded by Johnson &Johnson Pharmaceutical Research and Development. S.B. is anemployee of ALZA Corporation. F.T., M.R., and D.R. are employeesof Johnson & Johnson.

placebo (1.5) p = 0.0108. Control over ejaculation score at the 2 mgVR776 (p = 0.0082). There was a dose related incidence of adverseevents characterised by local irritation; for the 2 mg group cough 70%,throat irritation 70%) and respiratory tract irritation (35%).Conclusion: Inhaled VR776 (2 mg) showed a statistically significantincrease in IVELT and improved control over ejaculation. Plasmalevels of VR776 were variable between patients but AUC0-30increased proportionally between doses. The median Tmax for inhaledVR776 was 1–2 minutes, consistent with rapid clinical efficacy for thisformulation. Inhaled VR776 was safe although was associated withdose related local irritation in the majority of patients at the high dose.Policy of full disclosure: The study was funded by Vectura plc. MarkMain is an employee of Vectura plc. Drs Leaker, Kell, Ralph are inde-pendent clinical investigators who apart form this study have no otherrelationship with Vectura and do not hold shares in the company.

P-05-049

Effects of vardenafil in young men with idiopathicpremature ejaculationPili, M.1; Bruzziches, R.2; Greco, E. A.2; Francomano, D.2; Spera, G.2;Aversa, A.2

1Sapienza Università di Roma, Rome, Italy; 2Sapienza Università di Roma,Dip. Fisiopatologia Medica, Rome, Italy

Objective: Premature ejaculation (PEj) is the most common sexualdisorder in young males attending outcoming andrologic visits. Thestudy was aimed to evaluate the efficacy and safety of fixed dose of var-denafil (VAR) on intravaginal ejaculatory latency time (IELT) and onpost-ejaculatory refractory time (PERT) in men with idiopathic PEj.Methods: In a double-blind, placebo-controlled parallel design, 20patients (18–35 ys old) with idiopathic PEj as evaluated by a PEDTscore >11 (Symonds et al, 2007; Eur Urol) were enrolled into the study.After a run-in period receiving a loading dose of VAR (10 mg) for 4weeks, patients were then randomized to receive either VAR-10 mgfor 8 weeks or placebo (5–20 min before sex intercourse) for 8 weeks.The IELT and PERT were measured by the stop-watch technique and then patients filled in the Index of Premature Ejaculation (IPE)questionnaire.Results: Mean IELT increased after 4 weeks (from 0,7 ± 0,2 min to2,1 ± 1,1 min, p < 0,05) with concomitant reduction in PERT (from16,7 ± 4,6 min to 8 ± 2,5 min, p < 0,01). At study end, VAR improvedboth IELT and PERT when compared with placebo (IELT 3,3 ± 1,4min, p < 0,05; PERT 4,3 ± 1,5 min, p < 0,01 vs. IELT 1,3 ± 0,7 min,PERT 16,8 ± 2,2 min). Significant increases in scores regarding ejac-ulatory control and overall sexual satisfaction were found at IPE ques-tionnaire when compared with placebo (IPE-Ej control score from 7± 1,2 AU to 13,5 ± 2,2; IPE-sexual satisfaction from 7,8 ± 1,8 AU to14,1 ± 2,6, p < 0.01 vs. 7 ± 1,2 to 8,5 ± 1,9; IPE and 8 ± 2 to 9 ± 2,respectively). No differences between the number of sex intercourseswere found in respective groups. Common side effects of vardenafilwere transiently reported by 10% of subjects.Conclusion: Vardenafil is superior to placebo in improving IELT,PERT and IPE scores with good overall safety profile in young menwith idiopathic PEj.Policy of full disclosure: None

P-05-050

Comparison of fluoxetine vs. fluoxetine+tadalafil inthe treatment of premature ejaculation—a doubleblind, placebo control studyCulha, M.1; Ozkan, L.1; Ozkurkcugil, C.1; Gokalp, A.1

1Kocaeli University, Urology, Turkey

Objective: The efficacy of SSRI and PDE 5 treatment for prematureejaculation (PE) has been speculated for years. A randomized double-blind, placebo controlled study was conducted to evaluate efficacy,safety and tolerability of fluoxetine+tadalafil treatment in PE.Methods: 180 men (mean age 26 range 19–47 years) suffering PE wereenrolled for the study. Patients were randomly treated with either flu-

P-05-048

A double blind, placebo controlled, randomisedcrossover study to investigate the effect of inhaleddoses of VR776 on intravaginal ejaculatory latency inpatients with premature ejaculationLeaker, B.1; Kell, P.2; Main, M.3; Ralph, D.4

1Nephro-Urology Clinical Trials, Queen Anne St Medical Centre, London,United Kingdom; 2Unversity Cllege Lndon, Uology and Sexual Health,United Kingdom; 3Vectura plc, Medicine, Chippenham, United Kingdom;4Institute of Urology, London, United Kingdom

Objective: VR776 is a novel inhaled formulation of chlomipraminewhich has the potential for rapid systemic delivery and early onset ofclinical effect using lower doses. Patients with PE were treated witheither 1 mg or placebo (cohort 1) or 2 mg VR776 or placebo (cohort2) and the effect on IVELT sexual satisfaction score & ejaculatorycontrol recorded.Methods: Patients (aged 18–65 yrs) diagnosed with PE with a con-firmed mean IVELT of 2 minutes measured during a run in period ofthe study were randomised to receive either receive 1 mg or placebo;2 mg or placebo in a an intermittent dose cross over design.Results: Patients were instructed to use the Aspirair® inhaler beforeintercourse on a maximum of five occasions per dose leg. IVELT wasrecorded by stopwatch by the patient’s partner, IVELT & mean levelof satisfaction after each attempted intercourse was assessed by pair-wise comparison of active treatment versus placebo using ANOVA ornon-parametric tests 39 patients completed ITT population; 20 in the1 mg cohort; 19 in the 2 mg cohort group. IVELT; 1 mg VR776 (1.88min) and placebo (1.79 min) p = n.s; 2 mg VR776 (2.2 min) and


J Sex Med 2008;5(suppl 2):45–68

oxetine 20 mg/day and fluoxetine 20 mg/day+tadalafil 20 mg twice aweek and placebo during 10 weeks. Each patient had sufficient erec-tion. Patients were evaluated using self administered questionnariesbefore and after each treatment including International index of ejac-ulatory control (IIEC), PE question of Center for marital and sexualhealth (CMASH) questionnarie, specially designed visual scale ejacu-latory latency time questionnarie(ELTQ) and IIEF.Results: 158 men evaluated after 10 weeks. Significant improvementwas observed in most scores of IIEC in both study groups comparedto placebo. Score of CMASH PE question increased significantly instudy groups also with no change using plasebo. ELTQ score alsoincreased significantly in both study groups compared to placebo.Patients who were treated with fluoxetine+tadalafil had better scoreswith both of the questionnaries and PE question of CMASH but dif-ference was not significant compared to fluoxetine group. No signifi-cant improvement was observed in the IIEF score in all groups andminor side effects due to tadalafil and fluoxetine were temporary.Conclusion: Multicenter studies will propably demonstrate the sig-nificant improvement between SSRI and SSRI+PDE 5 treatment inPE patients.Policy of full disclosure: None

Tuesday, 27 November 200716.30–18.00 Room 3P-06 PharmacologyChairs: I. Eardley, United Kingdom

P. Hedlund, Sweden

P-06-051

Phase IIb efficacy and safety of bremelanotide in the treatment of nondiabetic males with erectiledysfunctionAlthof, S. E.1

1West Palm Beach, USA

Objective: To evaluate the dose-related efficacy and safety ofintranasal bremelanotide, a novel, centrally acting, melanocortin-agonist, in non-diabetic patients with erectile dysfunction (ED).Methods: This was a 12-week, double-blind, placebo-controlled,phase IIb clinical trial. After a 4-week run-in period, 726 nondiabeticmen with ED were randomized to receive either placebo or one of fivedoses of bremelanotide (5, 7.5, 10, 12.5, and 15 mg). The primary effi-cacy endpoint was the change in erectile function (EF) domain scoreof the International Index of Erectile Function (IIEF) at 12 weeks orthe last observation carried forward. Secondary endpoints includedend-of-treatment changes in other IIEF domains; responses to SexualEncounter Profile (SEP) Questionnaires, Self-Esteem and Relation-ship (SEAR) questionnaire, and Global Assessment Questionnaire(GAQ); and safety.Results: There was an even distribution of patients (mean age: 56years; average duration of ED: 6 years) with mild, moderate, and severeED. At week 12, bremelanotide doses above 5 mg produced significantimprovements in IIEF EF scores compared with placebo (Table).Bremelanotide treatment also resulted in meaningful improvements inSEAR major (sexual relationship, confidence) and minor (self-esteem)domain scores. There was moderate correlation between significantimprovement in the IIEF EF and SEAR scores. Further, bremelan-otide at doses above 5 mg significantly improved the ability to achieveand maintain an erection for successful intercourse (SEP Questions 2and 3). The most common adverse events included nausea, vomiting,blood pressure increases, flushing, headache, spontaneous erection,and nasal symptoms. The major adverse events leading to discontinu-ation were dose-related and included nausea, emesis, and blood pres-sure increases, which ranged from 4% (placebo) to 53% (15-mggroup).Conclusion: Bremelanotide treatment at all doses above 5 mg led tosignificant improvements in erectile function and quality-of-life innon-diabetic patients as assessed by the primary and secondary end-point measures.Policy of full disclosure: King Pharmaceuticals/Palatin Techno-logies; Auxilium Pharmaceuticals; Lilly ICOS; Johnson & Johnson;Pfizer; Sanofi-Aventis; Schering-Plough; Boehringer Ingelheim;BioSante.

P-06-052

Safety and efficacy of orally inhaled apomorphine(VR004) in the treatment of erectile dysfunctionMorgan, F.1; Riley, A.2; Main, M.11Vectura Group plc, Development, Chippenham, United Kingdom; 2VecturaGroup PLL, Chippenham, United Kingdom


J Sex Med 2008;5(suppl 2):45–68

Objective: Two Phase IIb double-blind, randomised, parallel-groupstudies evaluating the safety and efficacy of VR004 in 600 men withmild to severe erectile dysfunction (ED), of various aetiologies.Methods: After a 4-week no-treatment baseline period, patients wererandomized to placebo or one of three VR004 fine particle doses deliv-ered via the Aspirair® inhaler. No restriction was imposed upon pre-vious ineffectiveness or adverse reaction with PDE V inhibitors. Everypatient received their first study dose in-clinic and underwent anorthostatic challenge. Following successful completion of this proce-dure patients returned home to use treatment as-needed for up to 12weeks. Efficacy was assessed via the Sexual Encounter Profile ques-tions 2/3 and the International Index of Erectile Function.Results: See table.DemographicsStudyVR004/003 VR004/008No. randomised 211 389Mean age (yrs) 56 55ED severity (%)Mild 17 17Moderate 62 61Severe 21 22EfficacyVR004 fine particle dose (mcg)100 150 200 250 300 PlaceboSEP2Proportion of positive responses71 68 83 89 79 60Change in proportion from baseline to last 4 weeks13* 8* 14* 31* 25* −3SEP3Proportion of positive responses49 46 62 60 62 35Change in proportion from baseline to last 4 weeks23* 16* 29* 24* 28* 3* p < = 0.002 compared to placeboApproximately 10%, 50% and 85% of patients reported an onset oferection within 1, 5 and 10 minutes of dosing respectively. No safetyconcerns arose from the use of VR004 at-home and only 8/600 patientsreported symptomatic postural hypotension during the stringentorthostatic challenge.Conclusion: These studies confirm the safety, efficacy and very rapidonset of VR004 in the treatment of ED.Policy of full disclosure: Consultant to pharmaceutical companies.

P-06-053

Long-term safety and efficacy of 5 mg tadalafil dosedonce daily in men with erectile dysfunctionPorst, H.1; Rajfer, J.2; Casabe, A.3; Feldman, R.4; Ralph, D.5; Vieiralves, L.6;Esler, A.7; Klise, S.8

1Private Urological Practice, Hamburg, Germany; 2Harbor-UCLA MedicalCenter, Department of Urology, UCLA Sc, Torrance, USA; 3InstitutoMedico Especializado, None, Buenos Aires, Argentina; 4Connecticut ClinicalResearch, Urology, Middlebury, USA; 5Institute of Urology, St. Peter’sAndrology Centre, London, United Kingdom; 6Hospital Naval MarcilioDias, Urology, Rio de Janeiro, Brazil; 7ICOS Corporation, Biometrics,Bothell, USA; 8Eli Lilly and Company, Indianapolis, USA

Objective: Tadalafil’s 17.5-hour half-life would allow once-dailyadministration, such that patients need not temporally link dosing withsexual activity. Two randomized, placebo-controlled, double-blindstudies in men with erectile dysfunction (ED) showed that 2.5–10 mgtadalafil once daily is well-tolerated and significantly improves erectilefunction, compared with placebo, after 12 or 24 weeks (Eur Urol2006;50:351–9; IJIR 2007;19:95–103). We present long-term safetyand efficacy data from these studies’ open-label extensions and a sub-sequent tadalafil-free period.Methods: Patients ≥18 years old with ED of any severity or etiologyreceived 5 mg tadalafil once daily for one (N = 234) or two (N = 238)years. Patients in the one-year extension concluded with a four-week

tadalafil-free period. Baseline was prior to receiving study drug. End-point was the final study visit or last observation carried forward.Results: There were no deaths or serious adverse events (AEs) con-sidered by investigators to be tadalafil-related. Treatment-emergentAEs (not necessarily tadalafil-related) that occurred in ≥5% of patientswere as follows: one-year extension and tadalafil-free period: dyspep-sia (9.4%), headache (9.4%), back pain (7.3%), and influenza (5.6%);two-year extension: hypertension (6.3%), nasopharyngitis (5.9%),sinusitis (5.9%), and back pain (5.0%). Mean International Index ofErectile Function (IIEF) domain scores improved from baseline toendpoint in the one- and two-year extensions, respectively: ErectileFunction, +9.6 and +8.4; Intercourse Satisfaction, +3.6 and +3.0; andOverall Satisfaction, +2.7 and +2.8. Mean IIEF-Erectile Functiondomain score declined markedly to a near-baseline level following thetadalafil-free period. In the two-year extension, 78.9% and 74.9% ofpatients reported positive responses to Global Assessment Questions1 (improved erectile function) and 2 (improved ability to engage insexual activity) at endpoint.Conclusion: Tadalafil 5 mg once daily for one or two years was well-tolerated, safe, and effective.Policy of full disclosure: The presenter, Hartmut Porst, is a con-sultant, study investigator, and lecturer for the following companies:Bayer-Schering, Eli Lilly and Company, Johnson & Johnson, andPfizer.

P-06-054

What characteristics are associated withphosphodiesterase type 5 inhibitor adverse events?Classification and regression tree analyses in 3488tadalafil-treated men with erectile dysfunctionBrock, G.1; Glina, S.2; Moncada, I.3; Watts, S.4; Xu, L.4; Kopernicky, V.51University of Western Ontario, Surgery/Urology Division, London,Ontario, Canada; 2Instituto H. Ellis, Urology, Sao Paulo, Brazil; 3HospitalGregorio Maranon, Urology/Andrology, Madrid, Spain; 4Eli Lilly andCompany, Indianapolis, USA; 5Eli Lilly and Company, Vienna, Austria

Objective: Phosphodiesterase 5 (PDE5) inhibitors have been shownto be effective and safe for men with erectile dysfunction (ED) acrossa broad spectrum of disease conditions. Nevertheless, adverse events(AEs) remain among the major causes of treatment discontinuationand failure. Moreover, the risk of AEs is still a treatment impedimentfor many naïve patients and their partners. As such, improved patientoutcomes may result from knowing what demographic factors, comor-bidities, and concomitant medications are associated with an increasedor decreased likelihood of PDE5 inhibitor-associated AEs.Methods: We reviewed safety data from 3488 tadalafil-treated patientswho participated in 18 placebo-controlled clinical trials of tadalafiltaken on demand for ED. We defined 3 categories of PDE5 inhibitor-associated AEs: vasodilatory (headache, flushing, nasal congestion,nasopharyngitis, dizziness); musculoskeletal (back pain, myalgia); andgastrointestinal (dyspepsia). We then used classification and regressiontree (CART) analyses to determine the characteristics most likely tobe associated with a change (either an increase or a decrease) in thelikelihood of these types of AEs.Results: Characteristics associated with a change in the likelihood ofany PDE5 inhibitor-associated AE were diabetes, geographic region(where the patient resides), and statin use. Characteristics associatedwith a change in the likelihood of any vasodilatory PDE5 inhibitor-associated AE were antihypertensive medication use, geographicregion, diabetes, ethnicity, age, and body mass index. No characteris-tics associated with a change in the likelihood of musculoskeletal orgastrointestinal AEs were identified, due to relatively low rates of thesetypes of AEs.Conclusion: CART analyses are one approach to determine what char-acteristics are associated with a change in the likelihood of AEs. Resultsof CART analyses such as those presented herein may help physiciansrefine their management approach to patients at greater risk for AEsand also define those patients least likely to experience any AEs.Policy of full disclosure: The presenter, Gerald Brock, serves as anadvisor, has done speakers bureau work for, has stock in, and has per-


J Sex Med 2008;5(suppl 2):45–68

formed research for Eli Lilly and Company, Pfizer, Bayer, Johnson andJohnson, AMS, and Palatin Pharma.

P-06-055

Efficacy and safety of oral mirodenafil in thetreatment of men with erectile dysfunction: a multi-center, randomized, double blind, placebo-controlled,fixed dose, parallel group clinical trial.Paick, J.-S.1; Choi, H.-K.2; Kim, S.-C.3; Suh, J.-K.4; Ahn, T.-Y.5; Kim, J.-J.6; Park, J.-K.7; Chung, W.-S.8; Park, K.-S.9; Lee, S.-W.10; Yang, D.-Y.11; Kim, S.-W.12; Min, K.-s.13; Moon, K.-H.14; Park, N.-C.15

1Seoul National University, Urology, Republic of Korea; 2Yonsei UniversityYongdong Sev, Urology, Seoul, Republic of Korea; 3Chung-ang UniversityYongsan H, Urology, Seoul, Republic of Korea; 4Inha University Hospital,Urology, Incheon, Republic of Korea; 5University of Ulsan Asan Medic,Urology, Seoul, Republic of Korea; 6Korea University Anam Hospital, Urology,Seoul, Republic of Korea; 7Chonbuk National University Ho, Urology, Chonju,Republic of Korea; 8Ewha Woman’s University mokdong, Urology, Seoul, Republic of Korea; 9Chonnam National University Ho, Urology, Gwangju, Republic of Korea; 10Sungkyunkwan University Samsun, Urology,Seoul, Republic of Korea; 11Hallym University Kangdong Sac, Urology, Seoul,Republic of Korea; 12Catholic University St. Mary’s, Urology, Seoul, Republicof Korea; 13Inje University Pusan Paik Hos, Urology, Busan, Republic ofKorea; 14Yeungnam University medical ce, Urology, Daegu, Republic of Korea;15Pusan National University Hosp, Urology, Busan, Republic of Korea

Objective: Mirodenafil hydrochloride is a new phosphodiesterase type5 inhibitor developed by SK Chemicals Co., Ltd. for the treatment oferectile dysfunction (ED). This Study was designed to evaluate the effi-cacy, safety and tolerability of mirodenafil.Methods: 223 patients with ED were participated in a double-blind,fixed dose, controlled trial and randomized to receive placebo (n = 75),50 mg (n = 74) or 100 mg (n = 74) of mirodenafil for 12 weeks.Results: All of mirodenafil groups demonstrated significantly higherefficacy over the placebo group. The changes from baseline for 50, 100mg mirodenafil (1.16, 1.64 respectively) were significantly improvedover placebo (0.68) (p = 0.0001, p < 0.0001 respectively) for primaryendpoints, International Index of Erectile Function (IIEF) Q3 and the changes for Q4 (1.84, 2.62 respectively) were similarly improvedcompared to placebo (0.80) (all p < 0.0001). The changes in the IIEF-erectile function (EF) domain score from baseline for 50, 100 mgmirodenafil (7.62, 11.58 respectively) were all improved over placebo(3.37) (all p < 0.0001). During treatment, successful Sexual EncounterProfile (SEP) Q2 rates increased after 50, 100 mg mirodenafil, reach-ing 80.64%, 91.95% at 12 weeks vs. 60.60% reaching placebo. Also,all doses of mirodenafil improved successful SEP3 rate, reaching52.83%, 73.20% compared to 26.77% for placebo. Up to 89.04% ofpatients for mirodenafil 100 mg achieved improved erections asassessed by the Global Assessment question (GAQ). Treatment withmirodenafil resulted in improvements from baseline in life satisfactionand amelioration of specific sexual life, relationship with partner andwhole life dimensions (all p < 0.0001). Notably the 62.16% of miro-denafil 100 mg group recovered a normal erectile function (score ofIIEF EF domain ≥ 26) at 12 weeks compared to 17.33% of placebogroup (p < 0.0001). The most common treatment-emergent adverseevents were mild facial flushing and headache.Conclusion: Mirodenafil was an effective and well tolerated treatmentfor men in Korea with ED.Policy of full disclosure: This study was funded by SK ChemicalsCo., Ltd.

P-06-056

Efficacy and safety of fixed-dose Udenafil(Zydena®)in men with diabetes and erectile dysfunctionKim, J. J.1; Yang, D. Y.2; Lee, C. H.1; Ahn, T. Y.3; Min, K. S.4; Park, K.5;Park, J. K.6; Lee, C. H.7

1Korea University Hospital, Urology, Seoul, Republic of Korea; 2Hallym Uni-versity Hospital, Urology, Seoul, Republic of Korea; 3Ulsan University Hos-pital, Urology, Seoul, Republic of Korea; 4Inje University Hospital, Urology,Seoul, Republic of Korea; 5Chonnam University Hospital, Urology, Seoul,Republic of Korea; 6Cheonbuk University Hospital, Urology, Seoul, Republicof Korea; 7KyungHee Hospital, Urology, Seoul, Republic of Korea

Objective: To evaluate the safety and efficacy of oral udenafil in thetreatment of erectile dysfunction (ED) in men with diabetes.Methods: In this multicenter, double-blind, placebo-controlled,double-dummy, fixed dose, parallel-group phase III trial, patients withdiabetes and ED were randomized to take udenafil 100 mg (N = 58)or 200 mg (N = 59) or placebo (N = 57). Efficacy responses wereassessed by erectile function (EF) domain score of the InternationalIndex of Erectile Function (IIEF), questions 2 and 3 of the SexualEncounter Profile (SEP2 and SEP3), and a Global Assessment Ques-tion (GAQ).Results: Compared with placebo, udenafil treatment significantlyimproved the EF domain score. The change from baseline to endpointin IIEF EF domain was 7.00 for udenafil 100 mg and 8.21 for udenafil200 mg, versus 1.20 for placebo (p < 0.0001). These scores were unaf-fected by stratification into distinct subsets according to the level ofHbA1C (HbA1C < 7.0%, good glycemic control; HbA1C 7.0–9.5%,moderate glycemic control; HbA1C > 9.5%, poor glycemic control).Both udenafil doses also significantly improved rates of successful“Yes” responses to SEP2 (76.88% udenafil 100 mg and 86.67% ude-nafil 200 mg versus 48.99% placebo, p < 0.001), SEP3 (53.13% ude-nafil 100 mg and 63.00% udenafil 200 mg versus 22.60% placebo, p <0.0001). GAQ were 65.5% (udenafil 100 mg), 83.9% (udenafil 200mg) and significantly (p < 0.0001) higher compared to 30.9% inplacebo. Both udenafil doses were well tolerated. The most commonlyreported treatment-emergent adverse events were flushing, headacheand nausea and were all mild.Conclusion: Oral udenafil significantly improved erectile functionand was generally well tolerated in diabetic patients with ED.Policy of full disclosure: This study was funded by Dong-a Phar-maceutical Co., Ltd.

P-06-057

Varenicline combined with on demand sildenafil 100mg in heavy smokers complaining of difficult-to-treaterectile dysfunction. Preliminary results at a singlemajor tertiary academic centreBriganti, A.1; Salonia, A.2; Pellucchi, F.1; Matloob, R.1; Gallina, A.1; Deho, F.1; Zanni, G.1; Raber, M.1; Rigatti, P.1; Montorsi, F.1

1Vita Salute University, Urology, Milan, Italy; 2IRCCS San Raffaele, Urolo-gia, Milano, Italy

Objective: Varenicline is a selective nicotinic acethylcholine receptorpartial agonist expressively developed for smoking cessation. Aim ofthe study is to assess the acute effect of smoking cessation in heavysmokers with phosphodiesterase type 5 inhibitor (PDE5-I) non-responsive erectile dysfunction (ED), treated with varenicline com-bined with on-demand sildenafil 100 mg.


J Sex Med 2008;5(suppl 2):45–68

Methods: From May to July 2007, 21 heavy smokers with either mod-erate or severe ED scarcely responsible to high dose PDE5-Is enteredthis study. Pre-treatment workup included a detailed medical andsexual history, including a semi-structured interview on recreationalhabits, and the self administration of the International Index of Erec-tile Function (IIEF). Patients were randomly segregated into Group 1(n = 11), who were administered varenicline (e.g. 0.5 mg once a dayfor the first three days, followed by 0.5 mg twice a day for the nextfour days, and then 1 mg twice a day for 11 consecutive weeks) coupledwith prn sildenafil 100 mg, and Group 2 (n = 10), who were treatedwith prn sildenafil 100 mg alone. A follow-up assessment was done atthe 12-week of treatment, when pts completed both the IIEF and theErectile Dysfunction Inventory of Treatment Satisfaction (EDITS).Results: Baseline characteristics. Groups were comparable for mean± SD age (Group 1 vs. Group 2: 52.3 ± 7.3 vs. 50.0 ± 3.5 yrs, P = 0.39)and ED-severity—as defined with the mean ± SD IIEF-EF domainscore (i.e., 8.9 ± 3.2 vs. 10.9 ± 5.2, P = 0.35). At the 12-week assess-ment, complete data collection was available for 9 and 10 pts in Group1 and 2, respectively; 2 (18.2%) men in Group 1 discontinued vareni-cline because they did not quit smoking. In contrast, the 9 remainingpts in Group 1 ceased smoking at the 12-week assessment. Moreover,Group 1 pts reported a significantly higher IIEF-EF score (15.9 ± 4.2vs. 12.2 ± 2.1, P = 0.02), and a higher EDITS (66.5 ± 6.2 vs. 50.6 ±2.2, P < 0.0001) as compared with Group 2 men. Mild and transientnausea, headache and insomnia were reported respectively by 2(22.2%), 1 (11.1%) and 1 (11.1%) pts in Group 1. Group 2 ptsreported flushing in 2 (20%) and headache in 2 (205) patients, respec-tively.Conclusion: The results of this study suggest that the combination ofvarenicline-induced acute smoke cessation and highest dose of prnsildenafil may promote a greater response rate in heavy smokers suf-fering from either moderate or severe ED.Policy of full disclosure: None

P-06-058

Comparable efficacy of once-daily vs on-demandvardenafil in men with mild or mild-to-moderate ED:The RESTORE studyZumbe, J.1; Porst, H.2; Sommer, F.3; Grohmann, W.4; Beneke, M.5; Ulbrich, E.6

1Klinikum Leverkusen, Klinik fur Urologie, Germany; 2Private UrologicalPractice, Neuer Jungfernstieg, Hamburg, Germany; 3University MedicalCentre of C, Department of Urology, Cologne, Germany; 4Private Urologi-cal Practice, Daphnestr, Munich, Germany; 5Bayer Vital GmbH, BV-PH-BSP MED-BM, Leverkusen, Germany; 6Bayer Vital GmbH, Bayer VitalGmbH, Leverkusen, Germany

Objective: Phosphodiesterase type-5 (PDE-5) inhibitor therapy forerectile dysfunction (ED) is currently administered ‘on demand’ priorto sexual activity. It has been suggested that once-daily dosing mayoffer benefits to patients, such as allowing ‘spontaneous’ sexual activ-ity, and daily dosing of PDE-5 inhibitors such as vardenafil has beenshown to improve erectile function in men with ED. However, nostudies have investigated whether daily administration of PDE-5inhibitors offers clinical benefits to patients compared with on-demanddosing. This study compared the efficacy of once-daily vardenafil withvardenafil administered on-demand, in men with mild or mild-to-moderate ED.Methods: This was a randomised, explorative, double-dummy, multi-centre parallel-group study conducted in 19 centres across Germany.Following a 4-week treatment-free run-in period, eligible patientswere randomised to either 12 weeks’ treatment with once-daily 10 mgvardenafil plus on-demand placebo (‘12-weeks od’); 24 weeks’ treat-ment with once-daily 10 mg vardenafil plus on-demand placebo (‘24-weeks od’); or 24 weeks’ treatment with once-daily placebo pluson-demand vardenafil (‘24-weeks prn’). The primary efficacy variable

of the study was the baseline-adjusted difference in the InternationalIndex of Erectile Function-erectile function domain (IIEF-EF) scoresbetween treatment groups after a 4-week washout period at the end ofthe study, at week 16 or week 28.Results: There were no statistically significant differences in baseline-adjusted least squares mean (SE) IIEF-EF scores between treatmentgroups at the end of the study (12 weeks od: 2.02 (0.93); 24-weeks od:2.29 (0.94); 24-weeks prn: 2.63 (0.96)). IIEF-EF scores at study endwere statistically significantly higher than those at baseline in all treat-ment groups.Conclusion: Once-daily vardenafil shows comparable efficacy to on-demand vardenafil in mild to moderate ED. Once-daily dosing ofPDE-5 inhibitors does not appear to improve clinical outcomes inpatients with ED, compared with on-demand dosing.Policy of full disclosure: Professor Porst is a speaker and consultantfor Bayer Schering Pharma, Pfizer and Lilly ICOS. Drs Zumbe,Sommer and Grohmann have acted as clinical study investigators forBayer Schering Pharma. Drs Beneke and Ulbrich are both employeesof Bayer Vital GmbH.

P-06-059

Efficacy and safety of a new testosterone-in-adhesivematrix patch applied every two days for one year tohypogonadal menRaynaud, J.-P.1; Legros, J.-J.2; Rollet, J.3; Auges, M.4; Bunouf, P.5; Sournac, M.6; Fiet, J.7

1Univers. Pierre et Marie Curie, Paris, France; 2CHU Sart-Tilman,Endocrinologie, Liège, Belgium; 3Institut Rhône Alpin, Endocrinologie, Bron, France; 4Institut de Recherches Pierre, Recherche Clinique, Boulogne-Billancourt, France; 5Institut de Recherches Pierre, Biométrie, Boulogne-Billancourt, France; 6Institut de Recherches Pierre, Recherche Galénique,Boulogne-Billancourt, France; 7CHU Henri Mondor, Centre de RechercheClinique, Créteil, France

Objective: To study long term efficacy and safety of a novel testos-terone-in-adhesive matrix patch, in which testosterone is dissolved ina non-alcoholic drug solvent (diethyltoluamide) to avoid skin irrita-tion, and incorporated in a pressure sensitive adhesive for applicationon intact non-scrotal skin.Methods: Randomised, open label, multi-centre, 1-year study. 224hypogonadal patients were included. 188 received 2 patches of 60 cm2every 48 hours and 36 patients had testosterone enanthate intramus-cular injection every 3 weeks. Blood samples were collected in themorning at 0, 3, 6 and 12 months. Total Testosterone (TT), Bioavail-able Testosterone (BT) (after sulphate precipitation), Dihydrotestos-terone (DHT) were assayed using validated time resolved fluoroimmunoassays after separation by chromatography. Routine RIA kitswere used for Estradiol (E2) LH, FSH and Sex Hormone BindingGlobulin (SHBG) Clinical symptoms were assessed with validatedquestionnaires (AMS and MSF-4).Results: In the patch group, T serum levels were above 3 ng/ml in85% of patients and remained stable over time. BT, DHT and E2levels were restored within physiological range. A significant correla-tion was found between T, BT and the MSF-4 changes. BT levels weresignificantly related to total AMS score. PSA values showed a mean(SD) increase of 0.13 (0.38), 0.23 (0.79) and 0.30 (1.47) ng/mL at Week14, 27 and 53 respectively. The patch was well tolerated with no neg-ative impact either on lipid profile, or red blood cells. Administrationsite reactions occurred in 35 patients (18.8%). Adhesiveness was good(375%) in more than 90% patients over the 1-year application period.Conclusion: Two 60 cm2 patches delivering 4.8 mg testosterone/day,allowed stable physiological levels of sexual hormones over time. Thepatch was well tolerated, easy to use, well accepted by the patients anddisplayed a good adhesiveness. Clinical efficacy was more related toBT than to T.Policy of full disclosure: Consultant;Pierre Fabre Médicament.


J Sex Med 2008;5(suppl 2):45–68

P-06-060

Late-onset hypogonadism in the aging male: Effectsof treatment with a 1% testosterone gel (Testogel) onhealth-related quality of lifeBouloux, P.-M.1; Kelly, J.2; Hiemeyer, F.21RF & UCMS, Centre for Neuroendocrinology, London, United Kingdom;2Bayer Schering Pharma AG, Men’s Healthcare, Berlin, Germany

Objective: The European Testogel® study is the largest randomised,double blind, placebo-controlled study of late-onset hypogonadism(LOH) to be conducted in Europe. Deficient serum testosterone levelsin aging males with LOH are associated with reductions in health-related quality of life (HRQoL) including reduced libido, depressedmood and fatigue. The six-month randomised, double-blind, placebo-controlled phase of the European Testogel® study investigated theeffects of a once-daily transdermal hydroalcoholic 1% testosterone gel(Testogel®) on HRQoL, assessed using the aging males’ symptoms(AMS) rating scale.Methods: Men aged 50–80 years who fulfilled the clinical and bio-chemical criteria for symptomatic LOH were recruited for the study.Patients received either placebo or testosterone gel (5.0–7.5 g/day;equivalent to 50–75 mg/day testosterone). HRQoL was assessed using the AMS rating scale. This self-administered scale includes 17symptom-related items evaluated on a 5-point scale (1 = no symptoms,5 = very severe symptoms). Total AMS scores and scores for the psy-chological, somatic and sexual subscales were calculated. HRQoL datawas analysed using appropriate statistical methods.Results: Testosterone therapy was associated with a significantlygreater decrease in the mean (SD) total AMS score at 6 months com-pared with placebo (testosterone—10.8 (10.1), placebo—6.9 (10.5); p< 0.05). Analysis of the AMS subscales also revealed a significantdecrease in sexual subscale scores following testosterone therapy(testosterone—3.4 (4.2), placebo—1.8 (3.8); p < 0.05), and no signifi-cant differences between treatment groups for the psychological orsomatic subscale scores.Conclusion: In men with LOH, testosterone therapy was associatedwith significant improvements in HRQoL. Analysis of the AMS sub-scales revealed a particular improvement in sexual HRQoL. To ourknowledge, this is the first reported use of the AMS rating scale in alarge, randomised, placebo-controlled, clinical study.Policy of full disclosure: Professor Pierre-Marc Bouloux served asthe Principal Investigator and a consultant on the design and execu-tion of this study, and has delivered oral presentations in this area forBayer Schering Pharma. Drs Judy Kelly and Florian Hiemeyer areemployees of Bayer Schering Pharma AG.

Wednesday, 28 November 200711.00–12.30 Auditorium VI/VIIP-07 Surgery, Peyronie’s disease, and priapismChairs: S. Richter, Israel

J. I. Martinez-Salamanca, USA

P-07-061

Genital flaps combined with buccal mucosa graft forurethral reconstruction in female transsexualsStanojevic, D.1; Kojovic, V.2; Bizic, M.3; Majstorovic, M.3; Perovic, S.3;Djordjevic, M.3

1School of Medicine, Gynecology, Belgrade, Serbia; 2School of Medicine, Uni-versity, Urology, Belgrade, Serbia; 3University Children’s Hospital, Urology,Belgrade, Serbia

Objective: Metoidioplasty is a variant of phalloplasty in female trans-sexuals allowing voiding while standing. Urethroplasty presents themost difficult part in this reconstruction. We evaluated using of buccal mucosa graft combined with the local skin flap for urethralreconstruction.Methods: Between July 2003 and March 2007, metoidioplasty wasperformed in 54 patients (aged 18 to 55 years). The buccal mucosa wasgrafted on the tunica albuginea of the clitoris. The distal part ofmucosa was sutured to the glans, and the proximal end was sutured tothe native urethral meatus. Well vascularized fasciocutaneous flap washarvested from labia minora or dorsal clitoral skin and sutured to thebuccal mucosa to form the neourethra. Proximal part was anastomosedto the native urethral meatus. Distally, new urethral meatus wascreated using double faced technique. New urethra was covered withwell vascularized subcutaneous flaps harvested from remaining labiaminora and both labia maiora. Reconstruction of the lengthened andstraightened clitoris was performed using available clitoral skin. Labiamaiora with testicle implants were joined to create normal scrotalappearance.Results: Urinary stream and penile shape were satisfactory in 47 cases.Urethral fistula occurred in 10 cases, closing spontaneously in threecases. The other seven cases required secondary repair 6 months later.Urethral stricture occured in two patients; one of them was cured byperiodic urethral dilation during a three months period and the otherone required surgical repair.Conclusion: Combined buccal mucosa graft and local flaps representgood choice for urethral reconstruction, especially due to complica-tion rate less than previously reported results.Policy of full disclosure: None

P-07-062

Factors affecting the degree of penile deformity inPeyronie’s disease: Analysis of 1001 patientsAkman, T.1; Sanli, O.1; Atar, M.1; Mut, T.1; Kücükdurmaz, F.1; Kadioglu, A.2

1University of Istanbul, Department of Urology, Turkey; 2Istanbul Univer-sitesi, Dept. of Urology, Capa, Istanbul, Turkey

Objective: To report the relationship between the degree of curvaturewith the clinical parameters investigated in Peyronie’s disease (PD)patients.Methods: A total of 1001 patients with a diagnosis of PD were eval-uated retrospectively in terms of penile deformity, erectile status andrisk factors for systemic vascular diseases. The degree of curvature wasmeasured with a protractor during maximum erection in response toCIS test and/or vacuum device. A modified Kelami classification wasused to categorize penile deformities as: patients with deformitieswithout curvature (notching, hourglass and swan neck deformity,group 1) mild-curvature (≤30°, group 2), moderate-curvature (31–60°,group 3) and severe curvature (>60°, group 4). The clinical parame-ters of patients in 4 groups were compared with each other with chi-square test. In addition, one-way Anova and multiple regressionanalysis tests a where appropriate.


J Sex Med 2008;5(suppl 2):45–68

Results: Overall, mean age of the patients and duration of the diseasewas 53.3 ± 10.6 years and 20.0 ± 30.3 months respectively. 58.8% (589)and 41.2% (412) of the patients were in acute and chronic phases,respectively. Penile deformity without curvature was detected in 12.3%of the patients, while curvature was <30 in 39.5%, 30–60 in 34.5% and>60 in 13.5% of the patients. Clinical parameters for all 4 groups werepresented in the table.Conclusion: The results of multiple regression analysis revealed thatpatients’ age, side of deformity (mainly lateral) and erectile functionsignificantly affect the degree of curvature. However, no significantrelationship was observed between degree of penile deformity andother factors such as coexistence of systemic vascular risk factors, painon erection, response to CIS test and duration of disease.Policy of full disclosure: None

Synthetic materials’ merit is simplicity of storage and use. Their bio-mechanical qualities are optimal for successive grafting.Policy of full disclosure: None

P-07-064

Treatment of penile curvature with only 1 or 2plication suturesAkkus, E.1; Onal, B.1; Ozkara, H.1; Alici, B.1; Hattat, H.1; Oner, A.1

1Cerrahpasa School of Medicine, Urology-Andrology, Istanbul, Turkey

Objective: Tha aim of the study is to investigate the results of minimal(1–2) plication sutures to minimalize shortening of the penis in thetreatment of penile curvature in congenital or Peyronie’s Diesae (PD)cases.Methods: 36 cases (14 congenital and 22 PD) who were candidates ofplication surgery were included. Two symmetrical plication sutureswere performed in only dorsal or ventral curvatures and only one plication suture was performed in cases with lateral curvatures. 2x0 Ti-cron (non-absorbable) sutures were used for plication.surgery.Controls were performed in 3–6 months post-operatively.11 of the 14congenital cases had ventral and 3 had lateral curvatures. 12 of PDcases had dorsal and 3 had ventral and 7 had dorsolateral curvatures.The angle of the curvatures were <90 degrees. The lengths of thepenises were measured pre and post-operatively. Also patients’ reportsof shortening of the penis were evaluated post-operatively.Results: 34 of the 36 cases (94.5%) had straight or almost straight(<10 degrees) penis post-operatively which were satisfactory for thepatients. Only two cases (5.5%) with dorso-lateral curvature due to PDhad recurrence which needed re-operation. Minor and temporarycomplications of numbness,echhymosis, and edema were observed in7 cases (19%). None of the cases had >1.5 cm of shortening. Eventhough they were pre-informed before the operations only 11 of thecases (30%) reported that they had shortening.Conclusion: Only One or two plication sutures seems to be sufficientto minimize the shortening of the penis due to plication surgery.Policy of full disclosure: No affiliation to any funding agency

P-07-065

Penile extender device in the treatment of penilecurvature due to Peyronie’s disease. results of a phaseii prospective studyMondaini, N.1; Di Marco, M.2; Giubilei, G.1; Pappgallo, G.3; Gontero, P.4

1Florence, Urology, Firenze, Italy; 2Roma, Urology, Italy; 3Noale, Oncology,Italy; 4Novara, Italy

Objective: Tension forces exerted by a penile extender may reduce penile curvature due to Peyronie’s disease. We tested thishypothesis in a phase II study using a commonly marketed brand ofpenile extender.Methods: Peyronie’s disease patients with a curvature not exceeding50° with mild or no erectile dysfunction were eligible. Fifteen patientswere required to test the efficacy of the device assuming an effect sizeof >0.8, consistent with an “important” reduction in penile curvature.Changes in penile length over baseline, tolerability, IIEF constitutedsecondary end points. Patients were counselled on the use of the penileextender for at least 4 hours per day for 6 months. Photographic pic-tures of the erect penis and measurements were carried out at base-line, at 1, 3, 6 and 12 months (end of study). Treatment satisfactionwas assessed at end of study using an institutional 5 item questionnaire.Results: Penile curvature decreased from an average of 31° to 27° at6 months without reaching the effect size (p = 0.056). Mean stretchedpenile length increased of 1.4 cm at 6 months. Resultes were curva-ture maintained at 12 months. Treatment results were subjectivelyscored as acceptable in spite of curvature improvements comprisedbetween no changes and mild improvements.Conclusion: Penile extender provides only minimal improvements inpenile curvature but a reasonable patients’ satisfaction, likely to beattributed to the increased in penile length.Policy of full disclosure: None

P-07-063

Grafting with auto-, xeno- and heterotransplants inPeyronie’s disease treatmentScheplev, P.1; Danilov, I.2; Gvasaliya, B.2; Garin, N.2; Kolotinskiy, A.21Moscow, Russia; 2RMAPE, Endourology, Moscow, Russia

Objective: To identify the best grafting material for Peyronie’s diseasetreatment.Methods: During 2004–2006 in our clinic there were 123 plaque inci-sions performed followed by corporoplastic and grafting. It must besaid that the research included patients with similar degree of defor-mity. Patients’ mean age was 38,5 years. None of the patients had erec-tile dysfunction according to ultrasound doppler. Tunical defects weregrafted using autotransplants—autovein in 45 (36,59%) patients, xeno-transplants—SIS in 41 (33,33%), and heterotransplants—hortex (poly-tetrafluorothylen) in 37 (30,08%). As postoperative assessment patientwere examined and surveyed in 6 and 12 months periods. Residualdeformity, development of erectile dysfunction and penile shorteningconsidered to be operation’s negative results.Results: Patients underwent grafting with autovein developed resid-ual penile deformity in 3 (6,66%) cases, erectile dysfunction in 2(4,44%), penile shortening in y 3 (6,66%). Thus, total number of neg-ative results was 17,76%. After using SIS mentioned parameters were:3 (7,31%); 2 (4,87%); 0 respectively with the negative total number of12,18%. Hortex showed following results: deformity—1 (2,7%); erec-tile dysfunction—2 (5,4%); shortening—1 (2,7%) and 10,08% in total.Neither tissue reactions no tearing complications were observed incase of synthetic grafting.Conclusion: Data gained from the study gives evidence that autoveinis much inferior to modern synthetic materials in grafting. Its low elas-ticity causes penile deformity and shortening. Besides, autovein graft-ing requires extra incision and lengthens the operation’s time.Xenotransplants, being comfortable in use, take intermediate position.


J Sex Med 2008;5(suppl 2):45–68

P-07-066

Penile prosthesis insertion in acute ischaemicpriapism: Long-term follow-upGaraffa, G.1; Kumar, P.1; Christopher, N.1; Ralph, D.1

1Unversity College London, St Peters Hospital, United Kingdom

Objective: The long term results of the immediate penile prosthesisinsertion in patients with ischaemic priapism are presented.Methods: A penile prosthesis was inserted into 53 patients (mean age42 y; range 26–73) who presented with ischaemic priapism of a meanduration of 171 hours (24–408). All patients had failed aspiration andinstillation of alpha-agonists and 28 patients had had unsuccessfulshunt surgery performed prior to referral. The diagnosis was con-firmed by cavernosal blood-gas-analysis, colour-Doppler-ultrasonog-raphy and cavernosal smooth muscle biopsy in 39 patients.Results: The aetiology of the priapism was related to medications (n= 17), haemaglobinopathy (n = 10) and idiopathic in 26 patients. Amalleable prosthesis was inserted initially in 49 patients, 10 of whichwere later electively revised to a 3-piece-inflatable device, and 4patients a 3-piece-inflatable prosthesis placed in the acute setting. Aftera mean follow-up of 17 months, 5 patients needed revision surgery dueto infection (n = 4) or curvature (n = 1). All patients are currently ableto have sexual intercourse and the satisfaction rate is of 98%.Conclusion: The immediate insertion of a penile prosthesis inischaemic priapism is simple to perform with higher satisfaction andlower complication rates when compared to a delayed insertion.Policy of full disclosure: None

P-07-067

Patient satisfaction and surgeon experience with thenew AMS 700TM MS inflatable penile prosthesisOhl, D.1; Henry, G.1; Culkin, D.1; Wilson, S.1; Delk, J.1; Otheguy, J.1;Shabsigh, R.1; Knoll, L. D.11University of Michigan, Urology, Ann Arbor, USA

Objective: We examined the intraoperative impressions of experi-enced implant surgeons, as well as patient experience and satisfactionwith the new AMS 700TM MS inflatable penile prosthesis, designedwith enhanced features to improve both ease of surgical placement andpatient operability.Methods: 69 patients underwent implantation in a single-armed,prospective multicenter study at 7 US sites. Mean age was 60 years(range, 27–82). Twenty-four percent had post-prostatectomy erectiledysfunction. The surgeons were asked about their intraoperativeimpressions of prosthesis insertion, specifically examining the impactof modifications of the rear tip extenders (RTE’s) and new MSpumpTM. Patients were asked about satisfaction and autoinflation rates.Results: Surgeons: In 96% of cases, new snap-on RTE’s were used.Compared to the old design, surgeons reported satisfaction with: thedesign (63%), ease of insertion (72%) stability (71%), and 1/2 cmincrements (71%). In 64% of cases, the RTE design was deemed animprovement. In all cases, placement of the pump was the same oreasier than prior designs, and in 49% of cases, was deemed animprovement. Patients: At 6 months, patients reported it was easy tofind/hold the pump (94%/88%); 78% felt it was easy to inflate; 88%were happy with the rigidity; 96% had no problem finding the deflatebutton, and 89% felt it was easy to deflate the device, with 69% ableto deflate it with one hand. 94% were satisfied with the flaccidity.Autoinflation was seen in 8%. Overall, 86% of subjects were satisfiedwith the device.Conclusion: Surgeons rate the new AMS 700TM MS design as a sig-nificant improvement over the previous device. This device gives highpatient satisfaction rates, a low rate of autoinflation, and improved easeof deflation, allowing one-hand operation in the majority of cases.Policy of full disclosure: This study was funded by American MedicalSystems.

P-07-068

Short penis syndrome following penile prosthesissurgerySedigh, O.1; Paradiso, M.1; Liberale, F.11San Giovanni Battista Hospital, Urology, Torino, Italy

Objective: Define the impact of penile prosthesis on penile length.Methods: 82 patients were evaluated preoperatively and 6 monthsafter first time penile inflatable penile implant surgery. Patients hadthe penile length measured serially prior to device implantation(stretched flaccid length and after pharmacologic erection) and 6months postoperatively. Length was measured from the pubic bone tomeatus. Patients completed the IIEF-5 questionnaire before and afterimplant. Patients were also asked to offer a subjective assessment ofpenile length changes 6 months after surgery.Results: 40% of the 82 patients had previous radical prostatectomy.90% of the implants were three-piece and 10% were two-piece. Therewere no statistically significant differences in penile length aftersurgery compared to preoperative measurements. 70% of patientsreported a decrease in penile length. Penile length loss was morecommon in patients with previous radical prostatectomy. HoweverIIEF scores were high no matter with complaints of length loss.Conclusion: Patients often complain of penile length loss after penileimplant despite an absence of measurable penile length changes.Length loss is more common among penile implant recipients afterradical prostatectomy. Patients probably have in mind their penilelength before the onset of ED. Treatment satisfaction does not mainlydepend on subjective penile length but patients should be counselledthat the prosthesis cannot restore the full length once obtained withnatural erections.Policy of full disclosure: None

P-07-069

Augmentation phalloplasty: “Apical andpericavernousal penile implant”Salhi, J.1; Del Prete, M.1

1Androclinic, Dept. of Andrology, Roma, Italy

Methods: The implant is comprised of three parts: the first is insertedat the tip of the cavernous bodies under the glans and for this is called“apical”, the other two are specular lateral parts, right and a left, called“pericavernouse”. The implant is constituted of a hemicilinder cres-cent section with flattened distal extremity. The apical portion of theimplant is “bean-shaped” and it is inserted between the distal surfaceof the cavernous bodies and the glans projecting it forward and later-ally adding as well a certain increase to the length of the penis. Thestructure of this implant is composed from an external wrap (multi-layer) in biocompatible material filled by highly cohesive silicon gel.There are different sizes that can accomodate greate anatomical vari-ations for total length, width, and thickness. The surgery is performedin day-hospital using regional anaesthesia, with two small transversalincisions at the base of the glans, bilaterally. A pocket of subglandularlodging is prepared proceeding from the sides so as not to injure thedorsal neurovascular bundle and the urethra. After the insertion of theimplant the glans is sutured to the corpora by interrupted stiches. Forthe pericavernous implant, a subfascial tunnel is prepared bilaterallyfor the whole length of the penis down to its root. The pericavernousprosthesis is fixed to the corpora cavernosa only distally.Results: From January 2002 up to December 2005, 52 patientsbetween the ages of 21 and 54 have undergone augmentation phallo-plasty with this new pericavernous implant. Only 7 of these patientsreceived the apical implant in addition to the pericavernousal one, andin 3 cases the surgery was limited to the apical implant to resolve theproblem of primary disproportion of glans and the volume of the penis.


J Sex Med 2008;5(suppl 2):45–68

Infection occurred in tow patients and was treated by explantation-reimplantation after six months.Conclusion: This pericavernous implant responds to a demand for asimple and rapid procedure that can provide good and lasting aesthet-ical results without jeopardizing penile function.Policy of full disclosure: None

P-07-070

Surgical treatment of congenital glans tiltPerdzynski, W.1; Adamek, M.2

1Warsaw, Poland; 2Damian’s Hospital, Reconstr. Surgery of Male Geni,Warsaw, Poland

Objective: Aim of a paper is to present the way of treatment of rareanomaly as well as results.Methods: From 1998 to 2006 authors operated on 11 patients withglans tilt. Downward curvature was detected in 7 of them, upward in2, lateral (leftsided) also in 2. In 9 patients glans tilt was accompaniedwith curvature of penile shaft and in 5 with hypospadias. In all patientsNesbit method was used. In patients with downward glans tilt dorsal

neurovascular bundle was mobilized just behind and, if necessary,under the glans (after separating part of glans from corporeal heads).During the same procedure in 9 men reconstruction of penile shaftwas done, in 2 patients with penile hypospadias distal urethra wasreconstructed, in 3 patients with stenosed urethra (after failure of pre-vious hypospadias operations done in other departments) was recon-structed with vascularized skin flap transfer. In patients with dorsalglans tilt elliptic fragments of tunica albuginea were excised on bothsides of urethra just below glans, in lateral glans tilts excisions weredone on concave side of penis. Result of reconstruction was alwaysconfirmed by artificial erection.Results: In all patients straightening of glans and penile shaft wasachieved. In no patients disorders of sensation on the glans nor erec-tile dysfunction were detected.Conclusion: 1. In downward glans tilt for straightening of penispartial separation of the glans from the apex of penile shaft is some-times necessary. 2. Glans tilt may be associated with other anomaliesas penile shaft curvature or hypospadias. That is why treatment ofthese anomalies should be done by surgeon with great experience inpenile reconstructive surgery.Policy of full disclosure: None

69

J Sex Med 2008;5(suppl 2):69–93

Monday, 26 November 200711.00–12.30 Room 3MP-01 Female sexual healthChairs: J. Chen, Israel

J. Bitzer, Switzerland

MP-01-071

Sexual problems through the adult life cycle in asample of Portuguese womenVieira, R.1; Pechorro, P.11Faculty of Medicine of Lisbon, Sexology, Lisboa, Portugal

Objective: The purpose of this study was to investigate changes insexual function and in couples sexual satisfaction across the adult lifespan in a group of Portuguese women and determine the prevalenceof sexual problems.Methods: The work consisted of a sample of 154 women living inLisbon (range 26–70 years) divided into three groups according totheir ages: 26–35 years (n = 66), 40–49 years (n = 45) and 54–70 years(n = 43). The evaluation was carried out with a sexual behaviour andhealth questionnaire and two psychometric instruments: ISS (Hudsonet al., 1981) that measures couples sexual satisfaction and FSFI (Rosenet al., 2000) and its six domaines of desire, arousal, lubrication, orgasm,satisfaction and pain.Results: No differences were found between the 26–35 years groupand the 40–49 years group regarding the ISS and the FSFI and its sixdomaines. However, when comparing the first two groups with thethird one (54–70 years), statistically significant differences were foundin the ISS total score and FSFI total score and in its five domains (nodifferences were found in pain domaine). The found prevalence ofsexual difficulties in the sample was elevated. At least one sexualproblem was reported by 65%of the women and 18% had also a clin-ical level of sexual dissatisfaction.Conclusion: Although this investigation is cross-sectional and was not designed to unequivocally separate age-related declines frommenopause-related declines, it corroborate the latest data ofmenopause and sexual function population-based studies, namely thatthere is a dramatic decline in female sexual functioning and in sexualsatisfaction with natural menopausal transition.Policy of full disclosure: None

MP-01-072

Evaluation of sexual function in women attending anoutpatient urological clinic; a survey study of 436patientsElzevier, H. W.1; Beck, J.1; Pelger, R. C.1; Laan, E.2; Putter, H.3; Lycklama a Nijeholt, A. A.1

1LUMC, Urology, Leiden, The Netherlands; 2Academic Medical CenterUniver, Department of Sexology, Amsterdam, The Netherlands; 3LUMC,Medical Statistics, Leiden, The Netherlands

Objective: Recent studies have demonstrated the relation betweenurogynecological complaints and female sexual dysfunction. Evalua-tion of female sexual function in an urological outpatient clinic has yetnot been undertaken. The aim of this study was to determine theprevalence of female sexual function in an outpatient urological clinicrelated to a variety of urological complaints.Methods: We have evaluated 436 female patients who primarilyvisited an outpatient urological clinic using the Female Sexual Func-tion Index (FSFI).Results: A total of 436 patients could be included in the study. 129patients of these (29.5%) refused to fill in the questionnaire. Of the

remaining 307 patients, 102 (33,4%) were sexually inactive and 203(66.6%) patients were sexually active. Two patients did not fill in thequestionnaire correctly. The major reasons for sexual inactivity wererelated to having no partner, and to partner and patient related healthissues. The total FSFI score of the sexually active patients was 27.9(1.2–36) and of these 42.2% had sexual complaints (FSFI < 26.55).Female patients with urological complaints like lower abdominal pain(median FSFI 24.4) and LUTS (urgency and frequency, median FSFIof 24.7) were prone to have female sexual dysfunction.Conclusion: Female sexual function is a common problem in the uro-logical practice and should therefore be routinely evaluated.Policy of full disclosure: This study was initiated by the Pelvic Floor& Sexuality Research Group Leiden supported by an unrestrictedgrant from Pfizer and Stichting Amsterdam 98 No conflict of interest.

MP-01-073

Evaluation of sexual function and quality of life inwomen with overactive bladder.Sahin, A.1; Demir, O.2; Bulut, V.1; Sicramaz, H.2; Mertoglu, O.1; Can, E.1;Esen, A.21Tepecik Training Hospital, Urology, Izmir, Turkey; 2Dokuz Eylul Univer-sity, Urology, Izmir, Turkey

Objective: Overactive bladder (OAB) is a syndrome that is character-ized by symptoms of urgency, with or without urge urinary inconti-nence, usually with frequency and nocturia. It is a highly prevalentcondition affecting 17% of the general population, with a significantnegative effect on quality of life, impairing several areas with physical,social, emotional and sexual limitations. The prevalence of OABincreases with age in both men and women. In this study we aimed togain a thorough understanding of OAB’s impact on sexual function andquality of life.Methods: Sexually active women with continent or incontinent OABwere recruited from two different urology clinics. Twenty patients withOAB symptoms were evaluated using the Female Sexual FunctionIndex (FSFI) for sexual function, Beck Anxiety Symptom Question-naire for anxiety symptoms and Incontinence Quality of Life Instru-ment (I-QOL).

MODERATED POSTER SESSIONS ABSTRACTS

70 Moderated Poster Sessions Abstracts

J Sex Med 2008;5(suppl 2):69–93

Results: The mean age was 54.2 ± 9.5 years. Mean FSFI, I-QOL, andBeck Anxiety Symptom Questionnaire scores were 17.8 ± 8.3, 41.0 ±23.0, and 21.8 ± 14.8, respectively. In this sample, 85% of patients hadurge incontinence, 70% postmenopausal, and 98% in a long-term rela-tionship. The correlation analysis revealed that there was significantassociation between OAB questionnaire score and I-QOL score (figure1, p < 0.05, r = −0.513).Conclusion: Overactive bladder with or without incontinence nega-tively affects women’s quality of life. However, the extent of symptombother did not predict aspects of female sexual dysfunction. In thisgroup the affects of OAB on sexual functions and anxiety status mayhindered due to advanced age and menopause.Policy of full disclosure: None

MP-01-074

Impact of BPS/IC (bladder pain syndrome/interstitialcystitis) on sexual functions and partnerships of female patientsLazar, D.1; Daha, L.2; Pflueger, H.2

1Vienna, Austria; 2Vienna Community Hospital Hiet, Urology and Androl-ogy, Austria

Objective: To assess sexual function and partnership issues in BladderPain Syndrome/Interstitial Cystitis (BPS/IC) female patients beforeand after the outbreak of the disease and efficacy of treatments on theseissues. Methods: The Sexological Questionnaire for Chronic Disease(SQCD) developed by Charité Berlin focuses on impacts of chronicdisease on sexual functions and partnerships but also includes socialvariables. We adapted the questionnaire for our purpose with an endversion of 137 items and placed it on the websites of German andBritish self help groups for over a year.Results: 78 German and 37 English patients responded and were com-pared with 87 age-matched healthy controls. Age of patients rangedfrom 17 to 72 years, median age 44 years. Low desire was mainy preva-lent among menopausal and post-menopausal patients even beforeoutbreak of disease. After outbreak of disease a significant increase inhypoactive disorder was reported by individuals younger than 50.Sexual activity with partners decreased considerably in all age groupsafter outbreak of disease. Treatments applied for BPS/IC did not sig-nificantly improve sexual disorders. Cultural, educational and religiousbackground proved of no significance on the results. Relationship topartners remains close despite disease and sexual disorders. Thoughtsof separation are no more frequent than in control group. Overall lifecontentment of control was significantly higher than of BPS/ICpatients even before outbreak of disease.Conclusion: The outbreak of BPS/IC seriously affects all aspects ofsexual functions in female patients but does not dramatically unsettlepartnerships. Treatments administered to ease BPS/IC have so far notlead to improvement of sexual disorders.Policy of full disclosure: 1) ICA-Deutschland e. V.”—gemeinnützigeGesellschaft und Förderverein Interstitielle Cystitis 2) Ludwig Boltz-mann-Institut für Andrologie und Urologie Wien The two organisa-tions helped to fund the placement of the questionnaire on thewebsites. I have no other relationship to these agencies.

MP-01-075

Pelvic floor evaluation in an outpatient setting.Female patients with complaints of micturition,defecation and sexual dysfunction are more likely tohave a history of sexual abuseBeck, J.1; Elzevier, H.1; Voorham—van der Zalm, P.1; Putter, H.2; Pelger, R.1

1Leiden University Medical Ctr., Urology, The Netherlands; 2Leiden Uni-versity Medical Cent, Medical Statistics, The Netherlands

Objective: The purpose of this study was to document the prevalenceof sexual abuse in a pelvic floor physiotherapy department. Also the

number of complaints of micturition, defecation and sexual functionin the abused versus non-abused female patients was evaluated.Methods: 175 Female patients with pelvic floor complaints were eval-uated. In the anamnesis three domains of the pelvic floor (urological,defecation and sexual function) were structurally evaluated with thePelvic Floor Leiden Inventories (PelFIs) administered by a pelvic-floorclinician. The number of domains with complaints of patients with ahistory of sexual abuse were compared to the number of domains withcomplaints of patients without sexual abuse. The data was analysedusing SPSS version 13. Statistical analysis was performed in collabo-ration with our department of medical statistics. Differences were eval-uated using Pearson’s chi-square test. A two-sided P-value < 0,05 wasconsidered statistically significant.Results: Twenty-four percent (42/175) of the patients reported ahistory of sexual abuse. Female patients with a history of sexual abusehave significant more often complaints of micturition and complaintsof defecation and sexual dysfunction (35/42) compared to not abused(65/133). (83% vs 49%, p = 0.001).Conclusion: Twenty-four percent of the female patients in a pelvicfloor physiotherapy department reported a history of sexual abuse.Female patients with complaints of micturition, defecation and sexualdysfunction related to the pelvic floor dysfunction are significantlymore likely to have a history of sexual abuse.Policy of full disclosure: None

MP-01-076

Psychosexual issues in the child-bearing couplePapaharitou, S.1; Nakopoulou, E.1; Skentou, H.2; Tzortzis, V.3; Melekos, M.3; Messinis, I.2

1Aristotle University, Center Sex. and Reprod. Health, Thessaloniki, Greece;2University of Thessaly, School, Obstetrics and Gynaecology, Larissa, Greece;3University of Thessaly, School, Urology, Larissa, Greece

Objective: To asses women’s sexual function (SF) during pregnancyand factors (personal and partner’s) that might influence their sexuality.Methods: A prospective study was conducted including couples whoattended the Outpatient Gynecological Clinic of the Univ. Hospital inLarissa. Scales used were the General Health Questionnaire (GHQ-28) measuring psychological health, the Female Sexual Function Index(FSFI) and the International Index for Erectile Function (IIEF). Theywere administered to women in their 1st (group A) and 2nd (group B)trimester of pregnancy and after 3 months at a follow-up. Partner’squestionnaires were administered only at the initial visit. Paired t-testand Pearson’s correlation coefficient were conducted to detect differ-ences on scales’ scores and factors relating to SF.Results: The study employed 50 women aged 20–40 years old (21 ingroup A, 29 in group B) and their partners reporting having sexualactivity. Based on the FSFI’s cut-off score (<26), 9 (42.9%) women ingroup A and 11 (37.9%) in group B had a sexual dysfunction (SD) withthe later showing a significant decline (p < 0.05) in SF between 2ndand 3rd trimesters. Among women in group B, high scores on anxiety,social dysfunction and total GHQ related significantly (p < 0.01) withdecrements in SF. It should also be noted that female’s increased GHQscore in group B related with partner’s increased anxiety, depressionand overall GHQ scores (p < 0.05). Partner’s erectile problems weresignificantly related with women’s lower scores in desire, orgasm, sat-isfaction, pain and overall FSFI (p < 0.05) in both groups.Conclusion: Couples’ sexual health appears to be affected duringpregnancy with female problems becoming prominent at the 3rdtrimester. Women’s sexual function is also associated with their psy-chological health. Therefore, health professionals should not neglectthe existence of psychosexual issues but adopt interventions helpingthe childbearing couple.Policy of full disclosure: None

MP-01-077

Sexuality in the third trimester of pregnancyQueiros, A.1; Conde, P.1; Cunha, V.1; Serrano, F.1

1Maternidade Alfredo da Costa, Maternal and Fetal Medicine, Lisbon, Portugal

Moderated Poster Sessions Abstracts 71

J Sex Med 2008;5(suppl 2):69–93

Introduction: Pregnancy is an opportunity for partners to search forways to maintain mutual emotional bond and close physical affinity.Nevertheless in the last trimester of gestation women are often littleinterested in sex, report more dyspareunia and impose some restric-tions on sexual life. Although some authors concluded that pregnantwomen prefer other types of sexual behaviour than intercourse, littleis known about the Portuguese pregnant women’s preferences.Objective: to evaluate women’s sexual experience in the thirdtrimester of pregnancy.Methods: Cross-sectional study in a tertiary care obstetric hospital.One hundred pregnant women with low risk pregnancy, who were notrestricted in their sexual lives by their physicians. Pregnant womenanonymously completed self-administered questionnaires regardingsexual communication (Dyadic Sexual Communication Scale, JosephCatania, 1994 short version), sexual activity and behaviour duringpregnancy. Responses were summarised using descriptive statistics,and comparisons were made between social-economic groups andreproduction variables.Results: Most women reported a decrease in sexual desire and activity and some of them find difficult to communicate with theirpartners.Conclusion: A reduction in sexual activity, vaginal intercourse andsexual desire occurs in most women as pregnancy progresses.Policy of full disclosure: None

MP-01-078

Evaluation of sexual function, quality of life anddepressive aspects in women affected by type 1diabetes mellitusGottero, C.1; Tomelini, M.2; Trento, M.3; Tagliabue, M.1

1Division of Endocrinology, Internal Medicine, Turin, Italy; 2University ofTurin, Internal Medicine, Italy; 3University of Turin, Italy

Objective: Sexual function in diabetic women has received little atten-tion from clinical researchers, as documented by the little number ofpublications about this matter. Scientific data seem rule out a correla-tion between severity of the disease and sexual alterations. In thesewomen a key role is played by the capacity to accept their pathologyin relationship with their sexual function; moreover, it is important toconsider that they often have a worsened quality of life and increasedincidence of depression. Aims of our study were: a) to define which isthe most impaired sexual phase; b) to study the role of biological, psy-chological, social and relational factors in a population of type 1 dia-betic females.Methods: We evaluated clinical and glyco-metabolic factors as well asthe following psycho-cognitive and social variables: Zung DepressionScale (20 items), Diabetes Quality of Life (46 items, and 4 majordimensions: treatment satisfaction, treatment impact, worry aboutlong-term complications, and worry about social issues), Body ImageScale (9 items), Female Sexual Function Index (19 items, and 6domains evaluating sexual functioning), Multidimensional Scale ofPerceived Social Support (12 items, 3 subscales: family, friends, andsignificant other support). Inclusion criteria: type 1 diabetes mellitus,age >18 years, stable heterosexual relationship for at least 1 year. Exclu-sion criteria: neoplasm, drugs or alcohol abuse, depression or otherpsychiatric disorders, severe neurological diseases.Results: We enrolled 77 women (age [mean ± SD]: 39.0 ± 10.1 yr;duration of the disease: 17.5 ± 9.6 yr) affected by type 1 diabetes mel-litus. In diabetic women we found a significant correlation betweenquality of life and depressive aspects (p < 0.05), and between qualityof life and body perception (p = 0.001). Moreover we found an asso-ciation between metabolic control (expressed as levels of HbA1C) andpain during sexual activity (p < 0.05).Conclusion: In women with type 1 diabetes mellitus psychologicalfactors seem to be predominant with respect to somatic ones.Policy of full disclosure: None

MP-01-079

Are all types of orgasm mentally represented alike in awoman’s brain? An event-related fMRI studyBianchi-Demicheli, F.1; Ortigue, S.2

1Sexology Unit, Psychiatry, Geneva, Switzerland; 2UCSB4D Brain Electro-dyn. lab, Brain Imaging Center, Santa Barbara, USA

Objective: Women’s sexual pleasure has been of interest throughoutthe ages, although it remained repressed during most of history.Several philosophers, anthropologists, anatomists, psychiatrists andsexologists have tried to decipher the sense, the mechanisms and thefunction of a woman’s orgasm. During the last years a growing bodyof evidence demonstrates that the brain is a master organ in sexualfunction. We recently demonstrated a specific left anterior insula-related network correlating exclusively with the subjective satisfactionof women’s orgasm. Does it mean that the psychological dynamicsunderlying respectively clitoral and coital orgasm are mentally repre-sented likely in the mind/brain? The aim of this presentation is toassess this particular question.Methods: Using a 3T Phillips MRI scanner, we assessed brain activ-ity elicited when 29 healthy female volunteers (20.41 ± 3.42 years) wereunconsciously exposed to stimuli representing their significant sexualpartner (Bianchi-Demicheli et al., 2006, Ortigue et al., 2007) and cor-related it with individual scores obtained from different sexual dimen-sions (Female Sexual Functioning Index, FSFI, Rosen et al., 2000) andorgasm typologies.Results: Imaging results showed a strong correlation between FSFI’sorgasm scores and insula ctivation, irrespective of reported mental rep-resentation of orgasm type. Scores of orgasm in women who reportedto have experienced orgasms with clitoral stimulation correlated withresponses in the left insula (Pearson’s coefficient, r = 0.87; P < 0.001).Scores of orgasm in women who reported to have experienced coitalorgasms correlated with insula, the right superior temporal gyrus(Pearson’s coefficient, r = 0.71; P < 0.001), thalamus (Pearson’s coeffi-cient, r = 0.70; P < 0.001) and right frontal gyrus (Pearson’s coefficient,r = 0.76; P < 0.001).Conclusion: We discuss the role of these cerebral networks in themental representation of women’s orgasm response.Policy of full disclosure: None

MP-01-080

Differentiating four cognitive-behavioral types ofwomen with decreased sexual desireDennerstein, L.1; Pyke, R.2

1University of Melbourne, Department of Psychiatry, Victoria, Australia;2Boehringer Ingelheim, Inc, Director Clinical Research, Ridgefield, USA

Objective: Decreased sexual desire is frequently reported amongwomen. However, little is known about how women feel about theirloss of desire. We conducted a study to look at the characteristics ofwomen with decreased sexual desire.Methods: 8,000 women in the USA, Germany and Italy, aged 18–65and in a relationship, were identified from an existing database. Thewomen were screened for decreased sexual desire using a SIDI-F1-derived telephone questionnaire. Women in the USA (n = 600), Italy


J Sex Med 2008;5(suppl 2):69–93

(n = 400) and Germany (n = 402), identified as having decreased sexualdesire, were surveyed using a 60-minute face-to-face questionnaire.Cluster analysis based on self-perception, sexual attitudes and sexualbehavior was used to define 4 clusters, which were validated using con-vergent cluster analysis.Results: Clusters were distinct in concern about decreased sexualdesire, its impact on their relationship, and whether they would seekmedical help: INSERT TABLE *Women were asked to rate how muchthey agreed with the statement, on a scale of 1 (disagree strongly) to6 (agree strongly). P-value represents the probability of a certaincluster being different from all other clusters.Conclusion: This study indicated that there are four groups of womenwith decreased sexual desire, and that women’s feelings towardsdecreased sexual desire and attitudes toward seeking help differmarkedly within the population and across countries. Reference 1. SillsT, Wunderlich G, Pyke R et al. The Sexual and Desire Inventory-Female (SIDI-F): Item Response Analyses of Data from Women Diagnosed with Hypoactive Sexual Desire Disorder. J Sex Med2005;2:801–18.Policy of full disclosure: This study was funded by Boehringer Ingelheim.

MP-01-081

Cyclic AMP- and cyclic GMP-binding protein kinasesin the human vagina: Expression and co-localizationwith eNOS, VIP and PGP 9.5Ückert, S.1; Waldkirch, E.1; Sonnenberg, J.1; Sonnenberg, J.2; Seidler, M.1;Jonas, U.1; Hedlund, P.31Hannover Medical School, Dept. of Urology, Germany; 2Institute for Bio-chemical Research, Sexual Function Research Unit, Hannover, Germany;3Lund University Hospital, Department of Clinical & E, Sweden

Objective: Very much in contrast to research findings describing thelocalization of nitric oxide synthases (NOS), guanylyl cyclases andcyclic AMP (cAMP)- and cyclic GMP (cGMP)-degrading phosphodi-esterases (PDE) in the human vagina, up until today, the distributionof proteins known as major targets for cyclic nucleotides has not beenevaluated. cAMP- and cGMP-dependent protein kinases (cAK, cGKI)have been identified important cyclic nucleotide receptors downstreamthe respective signaling cascades. The aim of the present study was toinvestigate by means of immunohistochemistry the expression of cAKand cGKI in relation to endothelial nitric oxide synthase (eNOS),vasoactive intestinal polypeptide (VIP) and protein gene product 9.5(PGP 9.5) in the human vagina.Methods: Immunohistochemical techniques were applied to sections ofhuman vaginal full wall specimens in order to evaluate the presence ofthe cAK and cGKI (isoforms cGKIa and cGKIß) in relation to VIP, PGP9.5 and eNOS, respectively. Visualization of double-labelled stainingswas commenced by means of laser fluorescence microscopy. In addition,Western-Blot analyses were conducted using cytosolic supernatants ofhomogenized specimens of the vaginal wall and epithelium.Results: Immunostaining specific for cGKIß was observed in vascularand non-vascular smooth muscle of the vagina. In the endothelial layer,cGKIß was found co-localized with eNOS. In contrast, no signals indi-cating cGKIa were registered. cAK-positive supepithelial vessels werefound to be innervated by a dense meshwork of PGP-containing vari-cose nerve fibres of which some presented expression of VIP. Theexpression of cAK and cGKIß was confirmed by Western blotting.Conclusion: Our results, for the first time, demonstrate the expres-sion of cAK and cGKIß in the human vagina. The co-localization withVIP and eNOS underlines the significance of both the cAMP- andGMP-pathway in the control of human vaginal vascular and non-vascular smooth muscle.Policy of full disclosure: None

MP-01-082

Vardenafil enhances proceptive and receptive sexualbehaviour in the female ratTinel, H.1; Sandner, P.2

1Bayer Healthcare AG, GDD, Cardiology, Wuppertal, Germany; 2BayerHealthcare AG, GDD, Common Mechanism and Bran, Wuppertal,Germany

Objective: PDE5 inhibitors have been shown to relax the vaginal andclitoral tissue in female rat (Tinel et al, J Sex Med 3, Suppl 5: 399,2006) which is one of the important prerequisites for sexual arousal.The aim of the study was to investigate whether the improvement ofgenital arousal induced by vardenafil may influence the sexual behav-iour of female rat.Methods: Ovariectomised female Wistar rats were primed withoestrogen (15 µg/kg, 24 h prior to the test) and with progesterone (400 µg/kg, 4 h prior to the test). The sexual receptivity of female ratswas quantified using a score described by Hawcock et al. (J. Sex. Med.ESSM 2007). Briefly, the sexual active male was allowed to mount thetest females 10 times and the female sexual behaviours like rejection,hopping, ear wiggling, and lordosis were observed and scored.Results: Vardenafil applied orally 30 min prior to the test increasedthe receptivity score dose dependently. At the dose of 10 and 30 mg/kgvardenafil enhanced significantly the score from 0.98 ± 0.11 up to 1.76± 0.14 and 2.08 ± 0.21 respectively. The lordosis quotient was also sig-nificantly increased by vardenafil. After the application of 10 and 30 mg/kg vardenafil the lordosis score was 54.2 ± 7.5% and 75.0 ± 11.6respectively. A high dose of estradiol (50 µg/kg) and progesterone(1250 µg/kg) used as positive control reached a receptivity score of 2.5± 0.2 and a lordosis quotient of 86.7 ± 7.6%.Conclusion: Vardenafil showed positive effect on the proceptive andreceptive behaviour of female rats. It increased dose dependently thereceptivity score and the frequency of lordosis. Thus, a therapy withPDE5 inhibitors could be of benefit for women suffering from femalearousal disorder.Policy of full disclosure: The authors are employees of Bayer Health-care AG.

MP-01-083

The impact of male erectile dysfunction on femalesexual function in GreeceZahariou, A.1; Karagiannis, G.1; Karamouti, M.1; Tyligada, E.1; Papaioannou, P.1

1Elpis Hospital, Urology, Volos, Greece

Objective: To investigate the impact of male erectile dysfunction (ED)on their partners and to compare sexual functioning between womenwith male partners who have ED and women without partners withED in Greece.Methods: The study included 92 men and their female partners. Wedivided the women into two groups: Group ED, 47 women with mencomplaining of erectile dysfunction and Control Group, 45 womenwith men who have no ED. We evaluated all the men with the Inter-national Index of Erectile Function (IIEF), physical examination, andcolor penile Doppler ultrasound. All women were investigated inaccordance with the Female Sexual Function Index (FSFI). Womenyounger than 18 or sexual inactive were excluded, while the two groupswere matched to age, parity, menopause status and hormonal replace-ment therapy usage.Results: We compared female sexual function scores between thewomen of the male partners with and without ED. According to FSFIand using as a cut off score the value of 26.5, sexual dysfunction wasdiagnosed in 59% of women in ED Group compared to 22% among


J Sex Med 2008;5(suppl 2):69–93

healthy controls. The FSFI median values in both groups scored asfollows (patients versus controls; median value): desire: 3,9 vs. 4,1;arousal: 3,0 vs. 5,1; lubrication: 3,5 vs. 4,9; orgasm: 3,5 vs. 5,0; sexualsatisfaction: 3,2 vs. 5,0; sexual pain: 3,4 vs. 4,9 and full scale 20,5 vs.29,0 (P < 0,001). All scores were highly significantly lower in the EDgroup than in the control group, although sexual desire did not differbetween the two groups.Conclusion: Women with partners suffering from ED complained ofsexual dysfunction in a considerably higher number than a general,healthy female population with partners who have no ED.Policy of full disclosure: None

MP-01-084

Quality of sexual life changes in female partner ofmen with erectile dysfunction treated with viagra,measured by index of sexual life (ISL).Chevret-Measson, M.1; Cuzin, B.2; Jeanpetit, J.3; Jaudinot, E.3; Lavallee, E.3

1Lyon, France; 2Hopital Ed Herriot, Urologie, Lyon cedex03, France;3Pfizer-France, Urology, Paris, France

Objective: To investigate treatment responsiveness of the quality ofsexual life specific questionnaire: Index of Sexual Life (ISL) for femalepartners of men with erectile dysfunction (ED).Methods: The ISL questionnaire was completed at baseline and at theend of the study by 57 female partners of 57 patients with erectile dys-function enrolled in a 14 week, open label, multicentre, flexible dosesildenafil (50 mg, adjustable to 25 or 100 mg) study. The men wereclinically diagnosed with ED using the International Index of ErectileFunction (IIEF) recruited at 12 centres in France in 2006. Changesfrom the baseline score were analyzed using the paired t test. Corre-lations between the changes from baseline on the ISL and the Erec-tile Function domain of the IIEF and on the Sexual Relationshipdomain of the Self-Esteem and Relationship Questionnaire (SEAR)were examined. The statistical analysis of EDITS in men and femalepartners were presented.Results: There was a statistically great increase (p < 0.0001) in theprimary domain partner Sexual Life Satisfaction score from baselineto Week 14. These data indicate moderate correlations betweenimprovements in male erectile function (EF/IIEF) and female partnerSexual Life Satisfaction (SLS/ISL) with a Spearman coefficient = 0.527and between improvements in male self esteem (SE/SEAR) and femalepartner sexual life satisfaction (SLS/ISL) with a Spearman coefficient= 0.519.Conclusion: The ISL questionnaire is responsive to effective treat-ment of erectile dysfunction. These data suggest that the ISL ques-tionnaire is a valid instrument for detecting sexual gains in femalepartners from beneficial intervention. Couples in a long-standing rela-tionship should benefit from including partners in discussions of EDtreatment for better treatments outcomes and continuation.Policy of full disclosure: Pfizer Study

MP-01-085

Partners’ Preference Study: An examination ofpreference for tadalafil or sildenafil from theheterosexual partners’ perspectiveConaglen, H.1; Conaglen, J.2

1University of Waikato, Psychology, Cambridge, New Zealand; 2Universityof Auckland School, Waikato Clinical School, Cambridge, New Zealand

Objective: Introduction. Several preference studies comparing a shortacting with a longer acting PDE5 inhibitor have been conducted withmen. In most studies more men preferred tadalafil over sildenafil andseveral factors have been associated with treatment preference. Noprospective studies have investigated the female partner’s perspective.Aim. This study investigated the treatment preference of women whowere partners of men using oral medications for erectile dysfunctionduring a single centre open label crossover study.Methods: Methods. 100 heterosexual couples in stable relationships,with the male partner experiencing ED based on the EF sub-scale of

the International Index of Erectile Function (IIEF), were randomlyassigned to receive sildenafil or tadalafil for a 12-week phase, followedby a further 12-week period using the alternate drug. All participantscompleted sexual event diaries during both phases of the study and thewomen were interviewed at baseline, mid-point and end of study.Outcome Measures. Primary outcome data were the final interviewswith women during which they were asked which drug they preferredand the reasons for that preference.Results: Results. 79% of the women expressed a preference for theirpartners using tadalafil rather than sildenafil, while 16% preferredsildenafil over tadalafil. Preference was not affected by age or treat-ment order randomization. Women preferring tadalafil reportedfeeling more relaxed, experiencing less pressure, and enjoying a morenatural or spontaneous sexual experience as reasons for their choice.Mean number of tablets used, events recorded, average number ofevents per week, and mean number of days between events were notsignificantly different during each phase of the study.Conclusion: Conclusion. Women expressed a pattern of preferencesimilar to that reported for men when using these two drugs, but theirreasons for that preference related more to the effect the experiencesafforded by the medications had on their whole relationship, ratherthan focusing on the efficacy relating to erectile function alone.Policy of full disclosure: H Conaglen: Advisory Board Member:Pfizer NZ; Eli Lilly NZ. J Conaglen: Advisory Board Member: PfizerNZ; Eli Lilly NZ, GSK Bayer NZ.


J Sex Med 2008;5(suppl 2):69–93

Monday, 26 November 200714.30–16.00 Room 3MP-02 Pharmacology, hormonesChairs: E. Akkus, Turkey

G. Corona, Italy

MP-02-086

Intravenous administration of 7-hydroxy-2-(di-N-propylamino)tetralin induces sexual responses inanaesthetised male ratsPeeters, M.1; Clement, P.1; Bernabe, J.2; Caisey, S.2; Giuliano, F.31Pelvipharm Laboratories, Gif sur Yvette, France; 2Pelvipharm laboratories,Neuropharmacology, Gif sur Yvette, France; 3Hopital de Bicetre, Dept. ofUrology CHU de B, Le Kremilin Bicetre, Cedex, France

Objective: The primary role of D3 receptor subtypes in mediating thepro-ejaculatory effect of dopamine receptor agonists has been recentlyconfirmed in anaesthetised rats (Clement et al, Neuroscience, 2007).The aim of this study was to further characterise the effect of periph-erally-administered 7-hydroxy-2-(di-N-propylamino)tetralin (7-OH-DPAT), a preferential D3 receptor agonist, on sexual responses.Methods: Male Wistar rats (n = 25) were anaesthetised with isoflu-rane and the jugular vein was catheterised to allow i.v. delivery of 7-OH-DPAT (0.1, 1 and 10 mg/kg). Additionally, in 5 rats anaesthetisedwith urethane, acute spinal transection at the T8 level was performedand sexual responses were recorded. The simultaneous analysis ofseminal vesicle pressure (SVP) rises together with synchronised bul-bospongiosus (BS) electromyogram activity and intracavernous pres-sure (ICP) increases was performed.Results: Intravenous administration of 7-OH-DPAT dose-depend-ently induced ejaculation in anaesthetised rats (2 out of 5 for 0.1 mg/kgand 4 out of 5 for both 1 and 10 mg/kg doses). Coordinated increasesin SVP and BS contractile activity (physiological markers of, respec-tively, the emission and the expulsion phases of ejaculation) followedby an increase in ICP (physiological marker of erection) were observedfor all responses leading to ejaculation. Surprisingly, conversely towhat should be expected, in our experimental conditions, erectileresponses occurred after ejaculation-related responses. Acute spinali-sation at the T8 level totally abolished both ejaculatory and erectileresponses elicited by i.v. 7-OH-DPAT.Conclusion: Our results indicate that i.v. 7-OH-DPAT, a preferentialD3 receptor agonist is capable to activate synchronously emission andexpulsion phases of ejaculation in anaesthetised rats by acting at asupraspinal level. In addition, it is suggested that erection observed inthis experimental model is reflexive. We propose i.v. injection of 7-OH-DPAT as a valuable experimental paradigm of pharmacologically-induced ejaculation.Policy of full disclosure: None

MP-02-087

FK506 and erectile function preservation in thecavernous nerve injury model: Optimal dosing and timingMüller, A.1; Donohue, J.2; Tal, R.2; Kobylarz, K.3; Sulser, T.1; Scardino, P.2; Mulhall, J.3

1University Hospital Zurich, Urology, Switzerland; 2Memorial Sloan-Kettering Cance, Urology, New York, USA; 3Weill Medical College of Corne,Urology, New York, USA

Objective: The immunophilin-ligand FK506 has been shown to ame-liorate erectile function and preserve cavernous nerve (CN) architec-ture in short-term-studies using rat models of CN-injury. The aim ofthis series was to ascertain the optimal dose and timing of FK506administration in this animal model.Methods: Rats underwent bilateral CN crush and were treated withFK506 at different time points. There were control (C) and shamgroups for each time point. Based on preliminary experiments, the CN

crush rats had no treatment (C) or either FK506 1 mg/kg (BL) or 3.2 mg/kg (BH) for 3 days prior to and the day of CN crush (PRE),on day of and for 3 days following CN crush (POST) and for 3 dayspre, day of and 3 days post-CN crush (PP). All animals had measure-ment of ICP/MAP ratios at 28 days post-CN crush. Structural analy-sis was conducted in the POST-groups. Penile tissue was assessed forapoptosis with TUNEL assay and immunohistochemically for neuralfactors (GAP-43, NGF, nNOS). The CN architecture was examinedby transmission electron microscopy (TEM).Results: Sham animals had an ICP/MAP ratio of 70%. Only the BH-POST-group revealed improved ICP/MAP ratio compared to C (50 ±9% vs. 32 ± 8%, p < 0.01). nNOS staining was significantly restoredreaching sham levels in BL-POST- and BH-POST-groups vs. C (p <0.05). NGF and GAP43 staining displayed no significant differencesbetween C and treatment groups (p > 0.05). Apoptosis was significantlyreduced in BL-POST- and BH-POST-groups compared to C (16 ±4%, 21 ± 9%, 63 ± 7%, p < 0.001). TEM exhibited preservation ofCN architecture for BH-POST compared to C.Conclusion: These results suggest that short-term treatment withdoses of FK506 higher than previously utilized preserves erectile func-tion in the rat CN-injury-model. Pre-treatment appears to offer noadvantage. However, FK506 administration just prior to CN injuryand for a short time post-injury achieves the best functional and struc-tural preservation outcomes.Policy of full disclosure: None

MP-02-088

Bilateral cavernous neurotomy induceshypogonadotropic hypogonadism in rat: Effect oftestosterone and tadalafil supplementationFilippi, S.1; Morelli, A.2; Vignozzi, L.2; Mancina, R.2; Silvestrini, E.2;Chavalmane, A.2; Marini, M.3; Vannelli, G. B.3; Maggi, M.2

1University of Florence, Department of Pharmacology, Italy; 2University ofFlorence, Department of Clinical Physiop, Italy; 3University of Florence,Anatomy, Histology and Forensic, Italy

Objective: In a previous study we found that chronic tadalafil admin-istration (2 mg/Kg/day) was able to prevent some, but not all, penilealterations induced by long-term (3 months) bilateral cavernous neu-rotomy (BCN) in the rat. In particular, “in vitro” acetylcholine respon-siveness and reduced eNOS and nNOS expression were not preserved,while ETB up-regulation and PDE5 down-regulation, along withmuscle/fiber ratio and hypoxygenation (hypoxyprobe) were signifi-cantly restored by chronic tadalafil (JSexMed 3:419–31, 2006). Duringthe course of the study a reduction of testis weight from BCN rats wasnoticed. Aim of this study is to clarify the role of androgens in BCN.Methods: Sprague-Dawley (SD) rats were divided in 5 groups: a) sham-operated, b) BCN, c) BCN+tadalafil (2 mg/Kg/day), d)BCN+testosterone (T, 30 mg/Kg/week), e) BCN+tadalafil + T andparameters were recorded as before (JSexMed 3:419-31, 2006), includ-ing hormonal values. Castrated SD rats was used as control.Results: BCN reduced testis weight, number of Leidyg cells, geneexpression of the sterodogenetic enzyme 3β-HSD, prostate weight andcirculating T, while LH concentration resulted unchanged, suggestingBCN-induced hypogonadotropic hypogonadism. Hypoxygenation,still present in some cavernous endothelial cell in BCN+tadalafil, wascompletely absent in T-substituted rats. T alone or in combinationwith tadalafil rescued PDE5 gene level up to sham and normalizedhyper-sensitivity to the nitric oxide donor SNP. More importantly, Ttreatment restored eNOS expression and acetylcholine responsiveness.Conversely, nNOS gene expression resulted still down-regulated in T-treated (w or w/o tadalafil) BCN rats.Conclusion: We described for the first time the presence of hypogo-nadotropic hypogonadism in long-term BCN, and demonstrated thatT substitution can ameliorate the positive effect of chronic tadalafiladministration fully restoring penile oxygenation and responsivenessto acetylcholine. The possibility that hypogonadism complicate theradical prostatectomy-associated deleterious effect on penile activity inhumans should be tested in forthcoming studies.Policy of full disclosure: None


J Sex Med 2008;5(suppl 2):69–93

MP-02-089

Cyclic AMP-dependent protein kinase-I alpha isinvolved in the relaxation of human cavernous arteriesexerted by PDE5 inhibitorsWaldkirch, E.1; Ueckert, S.1; Sonnenberg, J.1; Imkamp, F.1; Seidler, M.1;Sohn, M.2; Jonas, U.1; Sonnenberg, J. E.3; Hedlund, P.41Hannover Medical School, Urology, Germany; 2St. Markus Academic Hos-pital, Urology, Frankfurt, Germany; 3Institute for Biochemical Research,Sexual Function Research Unit, Hannover, Germany; 4Lund UniversityHospital, Pharmacology, Sweden

Objective: To evaluate the role of cAMP-dependent protein kinase-I(cAK-I) in the relaxation of human cavernous arteries (HCA) exertedby the PDE5 inhibitors sildenafil, tadalafil or vardenafil, as cAK-I isconsidered a key enzyme in the tonus regulation of vascular smoothmusculature and animal experiments have shown that flow-mediatedvasodilation (FMD) is not only dependent on the NO-signalingpathway, but is also facilitated by cAK-I mediated mechanisms.Recently published results have demonstrated the expression of thecAK-I alpha, but not of the cAK-I beta isoform in HCA.Methods: HCA circular segments were microsurgically excised fromfull cavernous specimens and immediately mounted in organ baths.Tension was induced by the addition of 1 mikroM norepinephrine(NE). Increasing concentrations of sildenafil, tadalafil or vardenafil(0.001, 0.01, 0.1, 1 and 10 mikroM) were added in a cumulativemanner, and isometric responses of the tissue recorded. In another set-up, HCA segments were exposed to 10 mikroM of the cAK inhibitorRp-8-Br-cAMPS for 20 min. Thereafter, the effects of the PDE5inhibitors on the NE-induced tension were recorded. Relaxing effectsof the compounds were expressed as percentage of the maximum NE-induced contraction.Results: Cumulative addition of sildenafil, tadalafil or vardenafil dose-dependently reversed the NE-induced tension of the isolated vascularsegments. Sildenafil, tadalafil or vardenafil produced relaxant responseswith a maximal relaxation of (R max) 59%, 46%, or 100% at 10mikroM, respectively. The relaxing effects of the PDE5 inhibitors weresignificantly attenuated by the cAK inhibitor Rp-8-Br-cAMPS.Conclusion: Our findings support a significant role of the cAK-I alphamediated signaling pathway in the relaxation of the smooth muscletone of human cavernous arteries exerted by the PDE5 inhibitorssildenafil, tadalafil or vardenafil. Further studies are needed in orderto define structural and functional changes in men with cardiovascu-lar diseases and ED.Policy of full disclosure: None

MP-02-090

Mechanisms of the relaxant effect of vardenafil in ratpenile arteriesSanchez, A.1; Villaba, N.2; Monroy, M.2; Garcia Sacristan, A.2; Hernandez, M.2; Prieto, D.2

1Complutense University, Madrid, Spain; 2Complutense University, Physi-ology, Pharmacy School, Madrid, Spain

Objective: Sildenafil, vardenafil and tadalafil are the three phospho-diesterase 5 (PDE5) inhibitors currently used in the treatment of erec-tile dysfunction and these drugs differ in their selectivity, efficacy, sideeffects and pharmacokinetics data. The aim of the present study wasto investigate the mechanisms underlying the vasorelaxation inducedby vardenafil in rat penile small arteries.Methods: Segments of the rat dorsal penile artery were mounted inmicrovascular myographs for isometric tension recording. Concen-tration-response curves for vardenafil and other PDE inhibitors (sildenafil, rolipram and milrinone) were constructed by adding cum-mulative concentrations of the drugs to arteries precontracted withphenylephrine, and selective blockers of the nitric oxide (NO)/cGMPpathway and K+ channels were evaluated on the vardenafil relaxantresponses.

Results: Vardenafil was the most potent of the four PDE inhibitorstested, pD2 and maximum relaxation being (6.97 ± 0.09 and 97 ± 1%,n = 33). Blockade of guanylate cyclase with ODQ, mechanical removalof the endothelium and inhibition of NO synthase with L-NOARGmarkedly reduced vardenafil-induced relaxations. Inhibitors of boththe cGMP-dependent (PKG) and the cAMP-dependent (PKA) proteinkinases, Rp-8-Br-PET-cGMPS and Rp-8-CTP-cAMPS, respectively,both reduced vardenafil responses and the later abolished the responseto rolipram. Vardenafil relaxations were reduced by the selectiveinhibitor of the large-conductance Ca+ activated K+ channels (KCa)iberiotoxin and also by inhibitor of the ATP-sensitive K+ channel(KATP) glibenclamide.Conclusion: The present results demonstrate a potent relaxant effectof vardenafil in penile small arteries, due in part to cGMP accumula-tion and to the increased effects of basally-released endothelial NOacting through activation of PKG and PKA. Moreover, vardenafilrelaxant effect involves activation of both KCa and KATP channels.Supported by grants PR1/106-14441-A and SAF2006-09191.Policy of full disclosure: None

MP-02-091

Validation of electronic stopwatch measurements oferection duration against responses to the sexualencounter profile and international index of erectile functionShaw, J.1; Reardon, G.2; Sandor, D.3; Rosen, R.4; Ferguson, D.5

1Univ. of Illinois at Chicago, Pharmacy Administration, USA; 2Informa-genics, LLC, NA, Worthington, USA; 3Schering-Plough Corporation,Global Health Outcomes, Kenilworth, USA; 4New England Research Insti-tute, NA, Watertown, USA; 5Clinical Research Services Con, NA, GrandMarais, USA

Objective: To assess the validity and reliability of stopwatch-measurederection duration against responses to SEP items 2 (SEP-2) and 3(SEP-2) and IIEF scale scores.Methods: Data were taken from the US arm of the ENDURANCEtrial. Men with erectile dysfunction were randomized in a double-blind, crossover fashion to fixed-dose vardenafil 10 mg or placebo for4 weeks. Patients kept an electronic diary of their sexual attempts. Foreach attempt resulting in erection, they recorded the duration of erec-tion using a stopwatch and responded to SEP-2 and SEP-3. The IIEFwas completed at the end of each treatment period. Convergent anddivergent validity were assessed via correlations of median erectionduration with mean SEP item success rates and IIEF scale scores. Relative validity (RV) statistics were used to gauge the comparativeresponsiveness of erection duration to treatment.Results: Analyses were restricted to the 191/201 (95%) randomizedpatients included in the intent-to-treat sample. Median erection dura-tion during baseline, placebo, and active treatment was 1.8, 3.4, and9.7 minutes, respectively. At baseline, rank correlations of median erec-tion duration with IIEF scale scores ranged from 0.06 (Sexual Desire)to 0.53 (Erectile Function), while correlations with mean SEP-2 andSEP-3 success rates were 0.66 and 0.49, respectively. These associa-tions persisted when multiple regression models were fit to the SEPand IIEF outcomes. Compared with the IIEF Erectile Function scale,SEP-2, and SEP-3, RV statistics for differences among the baseline,placebo, and active-treatment periods were 0.81, 0.96, and 0.71,respectively. Estimated intraclass correlations for raw and ranked stop-watch measurements made during the baseline period were 0.34 and0.54, respectively.Conclusion: This analysis provides evidence for the validity and reli-ability of stopwatch-assessed duration of erection and establishes itssuitability for use as a primary endpoint in randomized, double-blind,placebo-controlled treatment efficacy trials.Policy of full disclosure: Funding for this research was provided bySchering-Plough Corporation and GlaxoSmithKline.


J Sex Med 2008;5(suppl 2):69–93

MP-02-092

A comparison of vardenafil and sildenafil: Efficacyamong men with erectile dysfunction and relatedcomorbiditiesRubio-Aurioles, E.1; Porst, H.2; Eardley, I.3; Goldstein, I.4

1AMSSAC, Tlalpan, Mexico; 2Private Urological Practice, Neuer Jungfern-stieg 6a, Hamburg, Germany; 3St James’s University Hospital, PyraDepartment of Urology, Leeds, United Kingdom; 4Alvarado Hospital, SexualMedicine, San Diego, USA

Objective: Erectile dysfunction (ED) is often accompanied by car-diovascular comorbidities such as hyperlipidaemia, diabetes and hyper-tension. This analysis was performed to compare the efficacy ofvardenafil and sildenafil, in men with ED and related comorbidities.Methods: This was a pooled analysis of two randomised, double-blindcrossover studies performed in the USA, and in Europe/Mexico. Bothstudies comprised two 4-week treatment periods with either vardenafil20 mg or sildenafil 100 mg, separated by a 1-week washout period.Men aged ≥18 years with ED for > 6 months and hyperlipidaemia, diabetes mellitus and/or hypertension were eligible to participate. Efficacy assessments included the erectile function domain of theInternational Index of Erectile Function (IIEF-EF) and responses tothe Sexual Encounter Profile (SEP) diary questions regarding pene-tration (SEP2) and successful intercourse completion (SEP3).Grouped results for the whole comorbidity population have been pub-lished previously. In the current analysis, efficacy was assessed acrosscomorbidity subgroups. As these are post-hoc analyses, statisticalmethods were not used to assess significance.Results: A total of 1,057 men were randomised to treatment, and 931 were included in the intention-to-treat population. Vardenafiltreatment was associated with numerically greater improvements from baseline in mean IIEF-EF scores among patients with ED andhyperlipidaemia (vardenafil vs sildenafil, 10.23 vs 9.44), diabetes (8.68 vs 8.09), hypertension (9.75 vs 9.39), or ≥2 of these comorbidi-ties (9.36 vs 8.82). The proportion of patients responding positively to the SEP2 and SEP3 questions was consistently higher for vardenafilvs sildenafil across comorbidity subgroups (SEP2: hyperlipidaemia,82.83% vs 80.66%; diabetes, 76.28% vs 75.76%; hypertension,81.61% vs 80.16%; ≥2 of these comorbidities, 78.91% vs 77.32%;SEP3: 72.68% vs 70.02%; 65.28% vs 63.03%; 72.20% vs 68.74%;67.86% vs 65.10%).Conclusion: Among men with ED and related comorbidities, treat-ment with vardenafil was associated with greater improvements inerectile function, and improved penetration and successful intercourserates compared with sildenafil.Policy of full disclosure: This study was sponsored by Bayer Scher-ing Pharma AG. Dr Rubio-Aurioles has acted as a paid consultant andspeaker for Bayer Schering Pharma and Lilly-ICOS. Professor Porstand Mr Eardley have acted as paid consultants and speakers for BayerSchering Pharma, Pfizer and Lilly-ICOS. Professor Goldstein hasacted as a lecturer and paid consultant for Bayer Schering Pharma,Pfizer, Lilly ICOS, Auxillium, Mentor, and Surface Logix.

MP-02-093

Relationship between successful sexual intercourse andthe erection hardness scoreMulhall, J.1; Goldstein, I.2; Bushmakin, A.3; Cappelleri, J.4; Hvidsten, K.5;Symonds, T.61Weill Medical College of Corne, Urology, New York, USA; 2Sexual Medi-cine, Alvarado Hosp, Sexual Medicine, San Diego, USA; 3Pfizer Inc, GlobalResearch & Developm, Groton, USA; 4Pfizer Inc, Biostatistics, Groton, USA;5Pfizer Inc, Global Outcomes Research, New York, USA; 6Pfizer Ltd, GlobalResearch & Developm, Sandwich, United Kingdom

Objective: To determine whether erection hardness as determined bythe validated Erection Hardness Score (EHS) directly impacts thesuccess of sexual intercourse.Methods: The data set (n = 307) was from a multinational, double-blind, placebo-controlled trial (with open-label extension) of sildenafil

citrate in erectile dysfunction. A random-effects logistic model thatused every event (intercourse attempt) as a separate observation andthe EHS as a categorical variable estimated the odds ratio of success-ful sexual intercourse (SSI) between adjacent EHS categories. A modelthat used mean EHS per patient as a continuous variable determinedits relationship to percentage of SSI attempts. A mediation model thatused mean EHS and mean percentage of SSI attempts over the double-blind phase estimated the indirect effect of sildenafil treatment on SSIvia erection hardness.Results: The odds of having SSI increased 41.9 times (95% CI,33.0–53.2; P < 0.0001) for EHS 3 (hard enough for penetration butnot completely hard) vs EHS 2 (hard but not hard enough for pene-tration), and 23.7 times (95% CI, 19.5–28.9; P < 0.0001) for EHS 4(completely hard and fully rigid [highest possible score]) vs EHS 3.The percentage of SSI attempts increased curvilinearly with theincrease in mean EHS: from almost 60% at EHS 3 to 78.5% at EHS3.25–3.75, and to 93.1% at EHS ≥3.75. The indirect effect of silde-nafil treatment on SSI via erection hardness accounted for almost 90%of the total effect on SSI (P < 0.0001).Conclusion: The results show a close and direct relationship betweenerection hardness and SSI. Because the EHS successfully reflects suc-cessful sexual intercourse, the EHS should be incorporated into clin-ical practice as a tool for routine in-office screening assessment and forhome monitoring of erectile hardness treatment strategies.Policy of full disclosure: Pfizer Inc, Consultant/Advisor.

MP-02-094

Vardenafil treatment of erectile dysfunction indepressive and nondepressive men (VALOR study)—pilot results from 958 Polish patientsDarewicz, B.1; Kudelski, J.2; Chlabicz, M.2; Wronka, M.3; Kozlowska-Boszko, B.3

1Medical University of, Bialystok, Poland; 2Medical University of Bialystok,Department of Urology, Bialystok, Poland; 3Bayer, Medical Department,Warsaw, Poland

Objective: The majority of studies in the field of erectile dysfunction(ED) was focused on therapy eficiency, but less attention has been paidto psychological aspects of ED treatment. To our knowledge, VALORis the first non-interventional study to asses both, vardenafil efficacyand influence on depressive symptomatology in the Polish male pop-ulation with ED.Methods: In this multicenter, non-interventional, flexible-dose study,3600 patients were planned to attend initiating and control visit overapproximately one month. Hereby the pilot results from 958 Polishpatients are presented. Depression symptoms were assessed by volun-tarily completed self-reported CES-D questionnaires (Center for Epi-demiologic Studies Depression Scale). Patients were assessed asdepressive when CES-D score > 16pts. Erectile function was assessedby SEP-2, SEP-3 (penetration and maintenance parameters) based onpatient diary.Results: At the initiating visit, mean CES-D score for the whole study population was 18,9. The improvement of depressive sympto-matology after one month of vardenafil treatment was reflected by the decrease of the mean CES-D score to 15,6. After one month ofvardenafil therapy, the percentage of depressive patients decreasedfrom 60% to 45%. The highest impact of vardenadfil treatment was seen in the group of initially depressive patients (CES-D changedfrom 24,5 to 18,8). Before application of vardenafil treatment, meanSEP-2 and SEP-3 values were 31% and 7% in depressive and 65% and 12% in non-depressive men, respectively. The SEP-2 andSEP-3 scores after one month of vardenafil treatment increased to 95,5% and 84% in depressive and 95,1% and 87,8% in non-depressive patients.Conclusion: Irrespectively of the manifestation of depressive symp-toms at baseline, flexible dose regimen of vardenafil associated with animprovement of erectile function (SEP-2,SEP-3) in all ED patients.Vardenafil treatment improved on depressive symptoms in the wholeinvestigated population, although changes were more pronounced inmore depressive men.


J Sex Med 2008;5(suppl 2):69–93

Policy of full disclosure: M.Wronka and B.Kozlowska-Boszko areemployees of Bayer-Poland.

MP-02-095

A comparison of vardenafil and sildenafil: Treatmentpreference and satisfaction among men with ED andrelated comorbiditiesRubio-Aurioles, E.1; Porst, H.2; Eardley, I.3; Goldstein, I.4

1AMSSAC, Tlalpan, Mexico; 2Private Urological Practice, Neuer Jungfern-stieg, Hamburg, Germany; 3Pyra Department of Urology, St James’s Uni-versity Hospital, Leeds, United Kingdom; 4Alvarado Hospital, SexualMedicine, San Diego, USA

Objective: Erectile dysfunction (ED) patients often have related car-diovascular comorbidities, such as diabetes, hypertension and hyper-lipidaemia. This analysis assessed treatment preference and satisfactionin men with ED and related comorbidities following treatment withvardenafil and sildenafil.Methods: This was a pooled analysis of two randomised, double-blindcrossover studies performed in the USA, and Europe/Mexico. Menaged ≥18 years with ED for >6 months and diabetes mellitus, hyper-tension, and/or hyperlipidaemia were eligible to participate. Studiescomprised two 4-week treatment periods with either vardenafil 20 mgor sildenafil 100 mg, separated by a 1-week washout period. Groupeddata for the whole comorbidity population have been published pre-viously. In the current analysis, treatment preference and satisfactionare assessed across comorbidity subgroups. Preference was assessedbased on responses to the question “Overall, which medication do youprefer?”. Patients expressed a preference for either treatment, or nopreference. The Treatment Satisfaction Scale (TSS) was completed bypatients and their partners. As these are post-hoc analyses, statisticalmethods were not used to assess significance.Results: In total, 1,057 men were randomised to treatment. The per-centage of men expressing overall preference for vardenafil was higherthan sildenafil among men with ED and hyperlipidaemia (40.1% vs31.4%), ED and diabetes (38.6% vs 34.5%); ED and hypertension(37.9% vs 34.1%); and ED plus ≥2 of these comorbidities (39.2% vs33.3%). Vardenafil was shown to be numerically superior to sildenafilfor the majority of patient TSS questions, regardless of comorbiditysubgroup (greater changes from baseline vs sildenafil in ≥16/19 ques-tions). Additionally, a similar trend in favour of vardenafil treatmentwas observed in partner TSS questions, across all comorbidity sub-groups (≥15/18 questions).Conclusion: Among men with ED and related comorbidities, varde-nafil was preferred by greater proportions of patients than sildenafil.Analysis of the TSS revealed numerically higher satisfaction with var-denafil versus sildenafil in the majority of questions.Policy of full disclosure: This study was sponsored by Bayer Schering Pharma AG. Dr Rubio-Aurioles has acted as a paid con-sultant and speaker for Bayer Schering Pharma and Lilly-ICOS. Pro-fessor Porst and Mr Eardley have acted as paid consultants andspeakers for Bayer Schering Pharma, Pfizer and Lilly-ICOS. Profes-sor Goldstein has acted as a lecturer and paid consultant for BayerSchering Pharma, Pfizer, Lilly ICOS, Auxillium, Mentor, and SurfaceLogix.

MP-02-096

A double-blind, randomized, placebo-controlled,crossover study to evaluate changes in retinal functionin healthy males after multiple doses of thephosphodiesterase type-5 inhibitor vardenafilBrucker, A.1; Scheraga, D.1; Boxley, S.1; Dupont, J.1; Gausas, J.1; Al-Banna, M.2

1University of Pennsylvania, Ophthalmology, Philadelphia, PA, USA;2GlaxoSmithKline, Philadelphia, PA, USA

Objective: To evaluate the effects of multiple doses of the phospho-diesterase type-5 inhibitor vardenafil (20 mg) on retinal function via

changes in color discrimination (Farnsworth Munsell-100 [FM-100])and electroretinography (ERG).Methods: Healthy subjects were randomized to either vardenafil(15–18 doses) or placebo over 8 weeks per session. FM-100 and ERGtests were performed at baseline and following completion of the 14th-17th, and 15th-18th doses, respectively, with assessments being con-ducted at 2, 6, and 24 hours post-dose. Safety was assessed by adverseevents.Results: 63 subjects were randomized; 52 were evaluable (mean age38.2 years). FM-100 at 2 hours post-vardenafil showed no statisticallysignificant changes compared with placebo (P > 0.05). ERG at 2 hourspost-vardenafil resulted in a significant (P < 0.05) reduction in cone b-wave amplitude and increase in oscillatory potential amplitude vsplacebo. At 6 and 24 hours post-dose, differences between vardenafiland placebo in terms of FM-100 and ERG were not statistically sig-nificant and not clinically relevant. The only other significant (P <0.05) finding was a reduction in cone b-wave amplitude in the left eyeat 6 hours post-vardenafil. Drug-related treatment-emergent adverseevents were 34.1% with vardenafil and 3.8% with placebo.Conclusion: In healthy men multiple doses of vardenafil at the highestapproved dosage did produce statistically significant but not clinicallyrelevant short-term retinal effects compared with placebo. Vardenafilis safe to the retina based on ERG and FM-100 measurements when20 mg is taken twice per week over approximately 8 weeks.Policy of full disclosure: Funding for this study and statistical supportwas provided by GlaxoSmithKline. No author has any financial inter-est in the sponsor. M. Al-Banna is an employee of GlaxoSmithKline.

MP-02-097

Tadalafil 5 mg or sildenafil citrate 50 mg administereddaily for up to 6 months does not affect visual safetyCordell, W. H.1; Maturi, R. K.2; Costigan, T. M.3; Marmor, M. F.4; Weleber, R. G.5; Coupland, S. G.6; Danis, R. P.7; McGettigan, Jr, J. W.8;Antoszyk, A. N.9; Klise, S.3; Sides, G. D.3

1Eli Lilly and Company, Six Sigma Team GBD, Indianapolis, USA;2Indiana University School of M, Department of Ophthalmology, Indi-anapolis, USA; 3Eli Lilly and Company, Lilly Research Laboratories, Indi-anapolis, USA; 4Stanford University Medical Ce, Department ofOphthalmology, Palo Alto, USA; 5Oregon Health & Science Un, Casey EyeInstitute, Portland, USA; 6Ottawa Hospital, University of Ottawa Eye Insti,Canada; 7University of Wisconsin—Madiso, Fundus Photograph ReadingCent, Madison, USA; 8Quality of Life Medical &, Medical Director, Tuscon,USA; 9Charlotte Eye, Ear, Nose and T, Ophthalmology, USA

Objective: To assess the visual safety of tadalafil and sildenafil citratewhen administered daily.Methods: Randomized, double-masked, placebo-controlled clinicaltrial at 15 US sites. 245 healthy men or men with mild ED were ran-domized to receive tadalafil 5 mg, sildenafil 50 mg, or placebo oncedaily for up to 6 months. Ophthalmologic assessments were performedat baseline, treatment months 3 and 6, and 4–6 weeks post-treatment.Assessments included electroretinography (ERG), intraocular pressure(IOP), testing of visual function (visual acuity, color discrimination byFM-100 test, and Humphrey 24–2 static perimetry), and examinationof ocular anatomy (anterior chamber, cataract grading, and dilated funduscopy).Results: For the primary outcome, the dark-adapted combined stan-dard ERG b-wave amplitude, there were no clinically relevant differ-ences between tadalafil and placebo or between sildenafil and placebo.There were also no differences for the secondary outcomes, compris-ing other ERG variables (including implicit times), IOP, measures ofvisual function, and anatomic assessments. Both tadalafil and sildenafilwere well tolerated.Conclusion: Daily administration of tadalafil 5 mg or sildenafil 50 mgfor up to 6 months did not result in any clinically relevant changes (vs placebo) in any of the comprehensive ophthalmologic tests. There were no treatment-related findings or treatment-emergentadverse events suggestive of drug toxicity to the retina, lens or on visualfunction.Policy of full disclosure: I am an employee of Eli Lilly and Company.


J Sex Med 2008;5(suppl 2):69–93

MP-02-098

Combination of alfuzosin and tadalafil exerts anadditive relaxing effect on precontracted humancorpus cavernosumOger-Roussel, S.1; Behr-Roussel, D.1; Gorny, D.1; Tremeaux, J.-C.2; Combes, M.3; Bernabe, J.1; Alexandre, L.1; Giuliano, F.41Pelvipharm, Gif sur Yvette, France; 2Clinique Sainte Marthe, CliniqueSainte Marthe, Dijon, France; 3Clinique Pasteur, Clinique Pasteur, Royan,France; 4Raymond Poincare Hospital, Department of Neurological Reh.,Garches, France

Objective: Alpha1-adrenergic blockers are considered the most effec-tive monotherapy for lower urinary tract symptoms (LUTS) sugges-tive of BPH and phophodiesterase 5 inhibitors are the first linetreatment of erectile dysfunction (ED). LUTS and ED are highlyprevalent in aging men and are strongly linked. Co-prescription ofboth drugs is likely to increase. A recent placebo-controlled studyshowed no clinically relevant hemodynamic interaction between alfu-zosin (ALF) and tadalafil (TAD). We have evaluated the effect of ALF,TAD or a combination of both on precontracted human cavernosalstrips.Methods: Cavernosal strips were obtained from patients undergoingsurgery for penile implant. Strips were mounted in organ baths filledwith Krebs buffer. (1) Strips were incubated with either vehicle, ALF,TAD, or a combination of both, and frequency response curves to elec-trical field stimulation (EFS,0–64 Hz,3 ms,10s,300 mA) were per-formed (N = 6). (2) Strips were preincubated with ALF or vehicle, andconcentration responses curves to TAD (from 10–10 to 10–5 M) wereconstructed on norepinephrine (NE, 1 to 10 microM)-induced con-tractions (N = 10). (3) The effect of vehicle, ALF, TAD or a combi-nation of both were examined on the nitrergic non-adrenergicnon-cholinergic relaxation induced by EFS (20 Hz,1 ms,10s,300 mM)on NE-precontracted strips (N = 8).Results: (1) The combination of ALF 3.10–8 M and TAD 10–7 M wasmore efficient to inhibit contractions induced by increasing EFS fre-quency than each compound alone. (2) Preincubation with ALF, 10–8or 10–7 M, significantly enhanced the relaxant effect of TAD on NE-contracted strips. (3) The effect of the combination of ALF 10–7 Mand TAD 10–6 M on relaxation induced by EFS on precontractedstrips with NE was more important than each compound alone.Conclusion: Alfuzosin and Tadalafil exerted an additive relaxant effecton precontracted human corpus cavernosum. The value of such a com-bination therapy in ED patients deserves further investigation inplacebo-controlled studies.Policy of full disclosure: This work was supported by Sanofi-Aventis.

MP-02-099

NS11021, a novel opener of large-conductance Ca2+-activated K+ channels enhances erectile responses inratsKun, A.1; Nardi, A.2; Demnitz, J.3; Simonsen, U.4

1University of Szeged, Dept. of Pharmacology and, Hungary; 2NeuroSearchA/S, Department of Chemistry, Ballerup, Denmark; 3NeuroSearch, Depart-ment of Chemistry, Ballerup, Denmark; 4University of Aarhus, Pharmacol-ogy, Denmark

Objective: It is thought that activation of large-conductance Ca2+-activated K+ (BKCa) channels by nitric oxide play an important rolefor relaxing corporal smooth muscle function during erection. Thepurpose of the present study was to investigate the in vitro and in vivoeffect of a novel BKCa channel opener, NS11021, in erectile tissue.Methods: Human erectile tissue was obtained from patients under-going penile surgery and human and rat penile small arteries andcorpus cavernosum strips were mounted in microvascular myographsor in tissue organ bath, respectively, for of isometric tension record-ing. Male Wistar rats were anaesthetized with phentobarbital and erec-tile function was evaluated by recording the intracavernosal pressurefollowing submaximal stimulation of the cavernosal nerve before andafter infusion of NS11021, vehicle, and sildenafil.

Results: In phenylephrine-contracted preparations, NS11021 (100nM-0.1 mM) induced concentration-dependent relaxations of rat andhuman penile small arteries and corpus cavernosum strips, and alsoinhibited neurogenic contractions in rat corpus cavernosum strips.NS11021 relaxations were equipotent to those induced by the phos-phodiesterase type-5 inhibitor, sildenafil, and NS11021 also relaxedcorpus cavernosum from diabetic patients. Relaxations induced byNS11021 were sensitive to high extracellular potassium solution. Ablocker of BKCa channels, iberiotoxin, inhibited both NS11021 andsildenafil-induced relaxations. In anaesthetized rats infusion of 0.1 and1 mg/kg NS11021 caused a sustained increase in erectile responses inanaesthetized rats. Infusion of vehicle did not change the erectileresponses.Conclusion: The findings of the present study suggest NS11021through opening of BKCa channels leads to relaxation of both intracavernous arteries and corpus cavernosum strips from rat andman. NS11021 is effective in facilitating erectile responses to cav-ernous nerve stimulation in anaesthetized rats. We suggest drug mod-ulation of BKCa channels as a new treatment modality for erectiledysfunction.Policy of full disclosure: The study was supported by a grant fromNeuroSearch A/S, Ballerup, Denmark.

MP-02-100

Atorvastatin ameliorates penile erection and sildenafilresponsiveness in two distinct animal models ofchemical diabetesMorelli, A.1; Filippi, S.2; Vignozzi, L.1; Zhang, X.-H.1; Mancina, R.1;Chavalmane, A.1; Silvestrini, E.1; Maggi, M.1

1University of Florence, Clinical Physiopathology, Italy; 2University of Flo-rence, Pharmacology, Italy

Objective: Diabetes mellitus (DM) strongly impairs penile erectionand sildenafil responsiveness. One of the proposed mechanisms isoveractivity of RhoA/ROCK signalling. Because statins decrease RhoAmembrane translocation and ROCK activation, we investigatedwhether atorvastatin might ameliorates DM-induced ED in two dis-tinct animal models of chemical diabetes.Methods: Erectile function was evaluated “in vitro” in corpora caver-nosa (CC) from alloxan (100 mg/Kg, 8 weeks) treated rabbits and “invivo” in streptozotocin (STZ, 50 mg/Kg) treated rats. A subgroup ofdiabetic animals received atorvastatin 5 mg/Kg/daily 2 weeks beforesacrifice.Results: In diabetic animals, atorvastatin treatment did not affect gly-caemia and cholesterol blood levels. As previously observed, diabeticrodents resulted hypogonadic, with reduced T plasma levels and maleaccessory gland weight. Atorvastatin did not correct the hypogonadalstate. In alloxan rabbits, atorvastatin did not ameliorate DM-inducedacetyilcholine hypo-responsiveness, while normalized DM-inducedhypersensitivity to the contractile effect of Endothelin-1 and to therelaxant effect of the ROCK inhibitor Y27632. In STZ-rats, ROCK1gene expression resulted increased, while nNOS and PDE5 decreased.Atorvastatin normalized PDE5 but not the other altered genes. Atorvastatin completely restored the DM-induced hypersensitivity to increasing concentrations (2–200 nmoles/Kg) of Y27632, intra-cavernously injected. In addition, atorvastatin ameliorated the DM-induced impairment in penile erection obtained by electrostimu-lation (ES, 1–32 Hz) of the cavernous nerve and normalized the sildenafil effect on ICP/MAP ratio, which was strongly decreased byDM.Conclusion: We confirmed that in chemical diabetes ROCK is over-expressed in the penis. Atorvastatin, most probably by inhibiting RhoAactivation, is able to decrease the DM-induced “in vitro” and “in vivo”penile hypersensitivity to Y27632. In addition, we report, for the firsttime, that atorvastatin restores ES-induced penile erection and silde-nafil responsiveness. This data are in keeping with clinical reportsshowing that atorvastatin ameliorates sildenafil-induced erections, inotherwise unresponsive subjects.Policy of full disclosure: None


J Sex Med 2008;5(suppl 2):69–93

Tuesday, 27 November 200711.00–12.30 Room 3MP-03 Physiology and pathophysiologyChairs: U. Simonsen, Denmark

J. Angulo, Spain

MP-03-101

Body image and sexuality in individuals self presentedas with and without sexual difficultiesPascoal, P.1; Beato, A.1

1Universidade de Lisboa, Faculdade de Psicologia e C.E., Portugal

Objective: Introduction: Cognitive models in human sexuality assumethat body image dissatisfaction plays an important role in sexual dys-function (e.g. Wincze, 2000; Nobre & Gouveia, 2006). Consequently,negative assumptions related to self-image may affect sexual responseof individuals with sexual difficulties (SD). The present study com-pared two groups—with and without sexual problems—according tosocio-demographic variables, socio-emotional adjustment, body dis-satisfaction and cognitive distraction centred on appearance duringsexual encounters.Methods: This is an exploratory, transversal and comparative studybased in a convenience sample of 46 men and 69 women. The Instru-ments used were: General Questionnaire, The Rosenberg Self-EsteemScale (Rosenberg, 1965), Body Image Perception (PIC- Pascoal,Narciso & Pereira, 2006), Global Measure of Body Satisfaction fromBody Attitudes Questionnaire (Probst et al, 1995), and Body Appear-ance subscale from Cognitive Distraction Scale (Dove & Wiedermann,2000).Results: Results showed that individuals with SD are older (p ≤ .05),less satisfied with their body image (p ≤ .01), and desire more to looseweight (p = .069) when compared with those who do not present SD.Conclusion: Evidence suggests that body dissatisfaction is associatedand may represent a risk factor for sexual dysfunctions. Further studiesusing clinical samples of subjects with SD are required. Cognitive andemotional implications of body exposure should be considered in theapplication of traditional therapeutic intervention protocols. Futurestudies should try to identify and explain the association between bodyimage dissatisfaction and avoidant behaviours related to sexuality andnudity. Future studies should also consider the role that specific bodyparts play in cognitive distraction during sexual activity.Policy of full disclosure: None

MP-03-102

The psychological impact of dermatological diseaseson sexual function in young menDimitriadis, F.1

1G Gennimatas Gen Hospital, Urology, Thessaloniki, Greece

Objective: Skin lesions can compromise the erogenic function of theskin which may adversely affect sexual life and relationships withothers. Since this component is often overlooked by clinicians, in thisstudy we aimed to investigate the sexual function of young male withpsoriasis, alopecia areata, vitiligo, or chronic urticaria, diseases thatdraw out important areas of psychological interest.Methods: 129 male subjects (18 to 40 year old) (20 with chronicurticaria, 31 with alopecia areata, 25 with psoriasis, 22 with vitiligo and31 healthy volunteers as a control group) were enrolled in the study.A Psoriasis Area and Severity Index (PASI) was applied to determinethe severity of psoriasis in the respective group of patients. The Der-matology Life Quality Index (DLQI) was used to measure the derma-tological distress related to vitiligo. The IIEF score was utilized forgrading male sexual function and Hamilton Depression Rate Scale(HDRS) was used to evaluate depression. An x2 test was used for com-paring proportions. Kruskal-Wallis and Mann-Whitney U-tests wereapplied for further statistical analyses.Results: IIEF score was found to be significantly decreased in patientssuffering from psoriasis or alopecia with or without depression. Among

these patients depression resulted in further decrease of IIEF score butit was statistically not significant (p > 0.05). Patients with vitiligo orchronic urticaria showed no or mild erectile dysfunction when com-pared with the control group but there was no statistical significance(p > 0.05).Conclusion: Sexual impairment is very frequent in patients with der-matologic diseases especially between those with psoriasis or alopeciaareata. Simple questionnaires provide a useful tool that should be usedin clinical dermatological practice to assess sexual function in thesepatients in order to furnish a better quality of life.Policy of full disclosure: None

MP-03-103

Characterization of vascular and smooth muscle cellstructure in human erectile tissueCosta, C.1; Soares, R.2; Hastert, V.3; Vendeira, P.4; Virag, R.3

1Faculty of Medicine of Porto, Lab for Molecular Cell Biology, Portugal;2Faculty of Medicine of Porto, Dep Of Biochemistry, Portugal; 3Centre d’Ex-ploration Traitement, Paris, France; 4Hospital S. Joao, Dep of Urology,Porto, Portugal

Objective: Our previous studies with animal models have suggestedthat loss of erectile tissue cell integrity may be a relevant mechanisminvolved in erectile dysfunction (ED). Using fragments of human erec-tile tissue, we aim at characterizing cavernosal vascular and smoothmuscle cell (SMC) structure and viability, and compare it to objectiveclinical data, as Penile Nitric Oxide release test (PNORT) andresponse to intracavernous medications.Methods: 40 erectile tissue samples were harvested during surgery,from diabetic impotent patients, individuals with vascular diseasewithout diabetes, veno-occlusive disease and 3 normal non-diabeticpotent controls. Structural evaluation of vascular and SMCs was per-formed by immunohistochemistry for von Willebrand Factor and—smooth muscle actin detection, respectively. Tissue integrity wasassessed by TUNEL assay, where cells undergoing apoptosis werelocalized in situ. An index of apoptotic cell density (ACD) was definedas number of apoptotic cells/tissue area (mm2). These results werecompared to each individual age, arterial risk factors and response tointracavernous injection of vasoactive drugs and PNORT.Results: Preliminary results showed that the normal non-diabeticpotent controls had a low ACD (6,5/mm2) as compared to diabetics(type 1 and 2), vascular and veno-occlusive disease. Diabetic men pre-sented the higher ACD (19,24/mm2), and cells undergoing apoptosiswere located mainly at the vascular and perivascular areas, mainly incavernous endothelium. Additionally, high apoptotic cell density cor-relates with low responses obtained by PNORT. Increased age andnumber of arterial risk factors may also play their role in decreasingendothelial function.Conclusion: Apoptotic cells are increased in diabetic vascular andperivascular cavernosal tissue, demonstrating that the programme ofcell death is one of the main mechanisms involved in endothelial dys-function in diabetic ED. PNORT appears to be a promising non inva-sive test to evaluate penile endothelial functioning.Policy of full disclosure: None

MP-03-104

Interrelationships of monocyte count with penilevascular damage, carotid intima-media thickness andaortic stiffness in patients with vasculogenic erectiledysfunctionIoakeimidis, N.1; Vlachopoulos, C.1; Rokkas, K.1; Dima, I.1; Aznaouridis, K.1;Tsokanis, A.1; Samentzas, A.1; Askitis, T.1; Stefanadis, C.11Athens Medical School, 1st Cardiology Department, Greece

Objective: Erectile dysfunction (ED) has been associated with bothsystemic inflammation and generalized vascular disease. Monocytecount (MNC) represents a sensitive marker for inflammatory activityin atherosclerosis. We examined the possible associations betweenMNC, penile vascular damage and subclinical atherosclerosis.


J Sex Med 2008;5(suppl 2):69–93

Methods: A total of 131 consecutive men (60 ± 11 years) with EDwere divided into three groups according to pharmacologically stimu-lated mean peak systolic velocity (PSV) values of cavernous arteries:Group A (PSV > 35 cm/s), group B (PSV = 25–35 cm/s, borderlinearterial function) and group C (PSV < 25 cm/s, arterial insufficiency).Ultrasound IMT of carotid arteries and carotid-femoral pulse wavevelocity (PWV) as an index of aortic stiffness were used to assess sub-clinical atherosclerosis.Results: Patients in group C (n = 36) compared to subjects in groupB (n = 38) and A (n = 57) had increased IMT (0.96 vs 0.93 vs 0.87 mm,respectively; P < 0.05 for all) and PWV (9.3 vs 8.9 vs 8.5 m/s respec-tively; P < 0.05 for all). Patients in group C exhibited higher MNC,compared to groups A and B (0.47 vs 0.44 vs 0.39 × 109/L respectively;P < 0.05 for all). Analysis of covariance revealed that MNC remainedsignificantly different between groups after adjustment for confound-ing factors (P < 0.05). In the total population, MNC correlated withIMT (r = 0.23, P < 0.05), PWV (r = 0.27, P < 0.01) and PSV (r =−0.26, P < 0.01, figure).Conclusion: Our study shows that there is an augmentation in MNCthroughout increasing penile vascular damage and subclinical athero-sclerosis. This finding provides further insights into the pathophysiol-ogy of vasculogenic ED.Policy of full disclosure: None

hsCRP was an independent predictor for presence of penile arterialinsufficiency (PSV < 25 cm/s). Odds ratios for second and third ter-tiles (1.42–2.18, > 2.18 mg/l) as compared to lowest tertile of hsCRP(<1.42 mg/l) were 4.0 (95%CI, 1.1–14.2; P = 0.03) and 7.7 (95%CI,2.1–28.4; P < 0.001), respectively. Using continuous variables thehazard ratio per 1 mg/l increase in hsCRP levels was 1.6 (95%CI,1.4–1.9; P < 0.001).Conclusion: Our data showed that hsCRP levels are associated withpenile Doppler parameters. Furthermore, elevation of hsCRP is astrong and independent predictor for the presence of arterial insuffi-ciency in men with ED. This finding underscores the interrelationshipbetween vasculogenic ED and subclinical inflammation.Policy of full disclosure: None

MP-03-105

Correlation between penile Doppler findings and C-reactive protein levels in patients with erectiledysfunction of vascular originRokkas, K.1; Vlachopoulos, C.1; Ioakeimidis, N.1; Samentzas, A.1; Alexopoulos, N.1; Tsokanis, A.1; Askitis, T.1; Stefanadis, C.11Cardiov. Dis. Sexual Health U., 1st Cardiology Department, Athens,Greece

Objective: Erectile dysfunction (ED) may a manifestation of general-ized vascular disease. We investigated the role of C-reactive protein(CRP) which is a marker and mediator of low-grade systemic inflam-mation in men with vasculogenic ED.Methods: A total of 120 consecutive men with ED (detected withSHIM-5 questionnaire), without clinical and exercise stress evidencefor coronary artery disease were studied. The flow parameters of thecavernous arteries including, peak systolic velocity (PSV), end-diastolicvelocity (EDV) and resistance index (RI) were obtained bilaterally.CRP was measured by high sensitivity immunonephelometry (hsCRP).Results: In univariate analysis, a negative relationship between hsCRPand mean PSV and a positive relationship for RI was observed (figure).The unadjusted correlation between hsCRP and EDV was not signif-icant (r = −0.15, P = 0.2). In multiple logistic regression analysis adjust-ing for age, BMI, Framingham risk score, mean pressure, cholesterol,HDL, and level of subclinical inflammation expressed by hsCRP,

MP-03-106

Flow-evoked vasodilatation is blunted in penilearteries from zucker obese diabetic ratsSchjoerring, O.1; Kun, A.1; Flyvbjerg, A.2; Kirkeby, H. J.3; Jensen, J. B.3;Simonsen, U.1

1Aarhus University, Dept. of Pharmacology, Aarhus C, Denmark; 2AarhusUniversity Hospital, Endokrinology, Aarhus C, Denmark; 3Aarhus Univer-sity Hospital, Urology, Aarhus N, Denmark

Objective: Flow-evoked vasodilatation is thought to play an impor-tant role in erectile function. The purpose of the present study was toinvestigate whether flow-mediated vasodilatation is altered in penilearteries from Zucker diabetic fatty rats (ZDF) suffering from type-2diabetes.Methods: From 20 to 22-weeks old ZDF (fa/fa) rats and Lean (fa/+)ZDF control rats, penile small arteries (internal lumen diameter170–295 µm) were isolated and mounted in a pressure myograph. Thesegments were contracted with U46619 and vasodilatation elicited byincreasing flow or by addition of acetylcholine. Statistical analysis wasperformed by use of two-way analysis of variance.Results: In Lean control and diabetic ZDF rats fasting blood glucosewas, respectively, 5.1 ± 0.2 mmol/l (n = 8) and 24.6 ± 0.9 mmol/l (n =9). A pressure-diameter curve revealed myogenic tone at pressuresabove 100 mmHg. Myogenic tone was abolished in the absence ofextracellular calcium and reduced in arteries from diabetic rats. InU46619-contracted dorsal penile arteries, both acetylcholine and flow(1 and 4 dynes/cm2) induced endothelium-dependent vasodilatation.In the presence of indomethacin an inhibitor of nitric oxide (NO) syn-thase, asymmetric dimethylarginine, inhibited vasodilatation to lowacetylcholine concentrations (≤100 nM), while high acetylcholine concentrations and flow evoked endothelium-derived hyperpolarizingfactor (EDHF)-type vasodilatation. In penile arteries from diabeticZDF rats, flow-evoked vasodilatation and dilatations to high acetyl-choline concentrations were significantly reduced.Conclusion: The present results suggest type-2 diabetes in diabeticZDF rats leads to endothelial dysfunction in the penile vasculature andmainly blunts EDHF-type vasodilatation mediating the responseevoked by increasing flow. The blunted endothelium-dependentEDHF-type vasodilatation to increasing flow in penile arteries maycontribute to erectile dysfunction in diabetic patients, and also explainthe requirements for new treatment approaches for erectile dysfunc-tion in diabetes.Policy of full disclosure: None


J Sex Med 2008;5(suppl 2):69–93

of brachial artery before and after forearm occlusion. Glycemic status:glycated hemoglobin (A1c). Blood pressure as a clinical expression ofendothelial function was also measured. End of the study: 2007(V2).Results: IIEF-5 score at V1: Gr. A = 15.3+/−3.12; Gr. B = 14.77+/−3.67 points. Prevalence of inefficient FMD at V2: Gr. A = 27.3% vs.Gr. B = 55.1%: p < 0.001. A1c: Gr. A 7.88+/−0.67% (V1) vs. 7.71+/−0.9% (V2): p = 0.7; Gr. B = 7.6+/−1.01% (V1) vs. 7.89+/−0.54% (V2):p = 0.3. Blood pressure: Gr. A = 133.4+/−12.7 (V1) vs. 139.6+/−22.5(V2) mmHg: p = 0.8; Gr. B = 141.08+/−19.2 (V1) vs. 169.8+/−30.1mmHg: p = 0.05.Conclusion: In stable glycemic evolution in T2DM, long termtadalafil usage can induce unaltered FMD and unchained blood pres-sure status suggesting pharmacological endothelial protection.Policy of full disclosure: None

MP-03-109

Gene transfer of ion channels reduce intracellularCa2+ in human corporal smooth muscle cellsLee, S. W.1; Chae, M. R.1; Jung, J. H.1; So, I.2; Park, J. K.3

1Samsung Medical Center, Urology, Seoul, Republic of Korea; 2SeoulNational University Coll, Physiology, Republic of Korea; 3Chonbuk NationalUniversity Me, Urology, Chonju, Republic of Korea

Objective: The modulation of corporal smooth muscle (CSM) tone iscritical to achieve penile erection. In the CSM of the penis, ion chan-nels such as potassium channels and transient receptor potentialchannel (TRPC) are important in determining SM tone. To investi-gate efficient methods modulating CSM tone, we compared the effectof reducing intracellular Ca2+ ([Ca2+]i) after transfection of KCachannel, KATP channel gene and TRPC6 dominant negative (DN)gene.Methods: We used the cultured human CSM and human embryonickidney (HEK 293) cell lines. The pDNAs of each channel were trans-fected transiently to CSM cells and the whole-cell patch clamp wereperformed. After gene transfer, [Ca2+]i was measured using the fura-2 loading method. The cytotoxicity of pDNA was also evaluated byMTT and Lactate dehydrogenase assay.Results: Gene transfer of pDNAs of each channel was confirmed byConfocal microscopy imaging. In addition, patch clamp study showedtransferred pDNAs of each channel (rslo-GFP, SUR2B plus Kir6.2 andTRPC6DN) functionally active in CSM and HEK cells. Gene trans-fer of all pDNAs reduced [Ca2+]i effectively but TRPC6DN was sig-nificantly more effective in reducing [Ca2+]i than the other pDNA(rslo-GFP : 66.3 ± 5.8%, SUR2B plus Kir6.2: 36.2 ± 2.7%,TRPC6DN : 78.2 ± 2.1%, n = 10). Any significant toxicity was notobserved in cells transfected with empty vector DNA or a plasmidexpression ion channel.Conclusion: Gene transfer of ion channels effectively reduced[Ca2+]i. Among these, transfer of TRPC6DN gene was most effec-tive. Such observations provide important data for searching new andbetter targets of gene therapy for the treatment of ED.Policy of full disclosure: None

MP-03-110

Human growth hormone (GH) interacts with thecyclic gmp signaling in isolated human penile erectile tissueBecker, A.1; Scheller, F.2; Jonas, U.3; Stief, C.1; Ückert, S.31LMU, University Hospital Grossh., Department of Urology, Munich,Germany; 2Hannover Medical School, Department of Nuclear Medicine,Germany; 3Hannover Medical School, Department of Urology, Germany

Objective: Human growth hormone (GH) has been suggested to playa role in male reproductive function. GH was shown to reverse thetension induced by norepinephrine (NE) of isolated human corpuscavernosum (HCC) and increase tissue levels of cyclic GMP. More-over, it was demonstrated that GH rose in the systemic and cavernousblood of healthy males with the initiation of penile erection (J. Urol.164: 2138–2142, 2000). Nevertheless, it still remains unclear which

MP-03-107

Association between arterial wave reflections andpenile Doppler findings in hypertensive men withvasculogenic erectile dysfunctionVlachopoulos, C.1; Ioakeimidis, N.1; Tsokanis, A.1; Rokkas, K.1; Bratsas, A.1;Samentzas, A.1; Tzannos, K.1; Leontis, S.1; Fassoulakis, C.1; Stefanadis, C.11Athens Medical School, 1st Cardiology Department, Greece

Objective: Hypertension is the most common comorbidity in patientswith erectile dysfunction (ED). Wave reflections (WR), an index ofarterial stiffness, is an important predictor of cardiovascular risk. Theassociation of ED with WR in hypertensive patients has not beeninvestigated.Methods: 88 consecutive non diabetic treated hypertensive patients(mean age: 61 ± 8 yrs) affected by non-psychogenic and non-hormonalED for more than 6 months were evaluated for penile vascular diseaseseverity by penile Doppler ultrasound. WR were studied using a vali-dated system (Sphygmocor®) that employs arterial tonometry andpulse wave analysis. Augmentation index (AIx) and augmented pres-sure (AP) were measured as an estimate of WR. Subendocardial-viability ratio (SVR) which is the ratio of diastolic pressure time interval/systolic pressure time interval was evaluated as a sensitivemeasurement of the adequacy of subendocardial muscle perfusion inresponse to myocardial oxygen demand.Results: In univariate analysis, a negative correlation between AIx, APand mean peak systolic velocity (PSV) of cavernous arteries (left plot)and a positive correlation between SVR and PSV was observed (rightplot). Furthermore, in a multiple regression model, AIx (b = −0.33, P< 0.01) was significantly associated with penile vascular disease sever-ity after controlling for age, heart rate, height, body-mass index, meanpressure, lipid profile, C-reactive protein, intensity of smoking (pack-years), antihypertensive agents and statines, (adjusted R2 of model:0.42).Conclusion: Our study shows that in hypertensive patients with ED,WR correlate significantly with increasing severity of penile vasculardisease as measured by penile Doppler. This finding provides furtherinsights into the pathophysiology of ED and may have implications forthe cardiovascular risk in these patients.Policy of full disclosure: None

MP-03-108

Ultrasound evaluation of possible systemic endothelialprotection induced by tadalafil long term usage indiabetes erectile dysfunctionCoca, V.1; Pop, S.2; Coman, I.3; Coca, M. C.4; Hancu, N.5

1Diabetes Clinical Centre, Sexual Medicine, Cluj-Napoca, Romania; 2Inter-nal Medicine, Ultrasound Evaluation, Cluj-Napoca, Romania; 3MunicipalHospital, Urology, Cluj-Napoca, Romania; 4Diabetes Clinical Centre, Lab-oratory, Cluj-Napoca, Romania; 5Diabetes Clinical Centre, Diabetes, Cluj-Napoca, Romania

Objective: Watching by ultrasound method if tadalafil (T) chronicusage could protect against endothelial dysfunction (EndD) progres-sion in type 2 diabetes mellitus (T2DM).Methods: Start of the study: 2003 (V1). Initially assessed: 80 men.Age: 43.6+/−3.46 years old. Inclusion criteria: 1)T2DM less than 5years history; 2)diabetes related erectile dysfunction (ED); 3)unmodi-fied flow mediated vasodilation (FMD) in brachial artery. Finally com-pared: 42 men (stable T2DM evolution). Groups: Gr. A = 22 cases (Tminimum 10 periods of minimum 30 days, 3–4 tb./week, in 3 years.Gr. B = 20 cases untreated for ED. ED assessment: IIEF-5 question-naire. FMD measurement: flow induced augmentation of the lumen


J Sex Med 2008;5(suppl 2):69–93

intracellular pathways mediate the physiological effects of GH on theHCC. The purpose of our study was to evaluate further the mecha-nisms of GH action on isolated human penile erectile tissue.Methods: Using the organ bath technique, the effects of GH on elec-trically (EFS)-induced relaxation of isolated HCC in the absence andpresence of the guanylyl cyclase inhibitor ODQ and nitric oxide syn-thase inhibitor L-NOARG (10 µM) were investigated. EFS parame-ters were set as follows: Frequency 10 Hz, supramaximal current, 0.8msec pulse, 5 sec train, train interval 120 sec. Effects of GH on theproduction of tissue cyclic GMP in the absence and presence of ODQand L-NOARG were also elucidated by means of a radioimmunoas-say (RIA).Results: ODQ and L-NOARG abolished the relaxation of the tissueinduced by EFS whereas amplitudes were increased by physiologicalconcentrations of sodium nitroprusside (SNP) and GH (1 nM–100nM). The attenuation of the EFS-induced amplitudes by L-NOARGbut not ODQ was in part reversed by GH. The production of cyclicGMP induced by 10 nM GH (3.76 ± 2.0 pmol cGMP/mg protein) wascompletely abolished in the presence of 10 µM ODQ. In contrast, the combination of GH (10 nM) + L-NOARG (10 µM) maintainedcGMP-production significantly above baseline (0.68 ± 0.36 versus 1.07± 0.48 pmol cGMP/mg protein).Conclusion: Our data provide evidence that GH may act on humanHCC by an NO-independent effect on guanylyl cyclase activity. Thismight explain how growth factors regulate male erectile function.Policy of full disclosure: None

MP-03-111

Influence of A5 Androstenediol decline in aging male.On bioavailable testosterone calculationRaynaud, J.-P.1

1Univers. Pierre et Marie Curie, Paris, France

Objective: Detection of androgen deficiency in adult men was cur-rently based on Total Testosterone (TT) and Bioavailable Testosterone(BT) determinations. With aging, Sex Hormone Binding Globulin(SHBG) serum levels increase and consequently BT decreases. Thusa good determination of BT is of paramount significance. Variousstudies used BT calculation (cBT) from the mass action law whenothers assayed it (aBT) by immunoassay or mass spectrometry(GC/MS), after sulphate precipitation. The aim of the study was toevaluate the influence on cBT of androgens that bind to SHBG.Methods: 503 healthy untreated men aged 20–74 years were recruited.Androgens were assayed in the same laboratory: Total Testosterone(TT), Dihydrotestosterone (DHT), and ∆5-androstenediol (∆5-A-diol) were assayed by GC/MS, BT after ammonium sulphate SHBGprecipitation or calculated according to the Mass Action Law. SHBGwas measured by radio immunoassay (RIA).Results: Aging brings on decrease in TT (slight), BT (moderate) and∆5-A-diol (significant), no variation in DHT and an increase in SHBGserum levels. Among the 142 men under 40 years, the lower normallimit was between 2.25–2.70 nmol/L for aBT and 8.5 nmol/L for TT.The lower cBT limit calculated using Vermeulen’s formula was twofoldhigher than aBT. Even if by optimising the affinity constants, cBTvalues close to aBT could be obtained, when young and old subjectswere paired for the same SHBG and TT levels, a statistically signifi-cant lower aBT in old subjects was found pointing out the role of lowerserum ∆5-A-diol levels in old men.Conclusion: The lower normal serum aBT level in normal men isbetween 2.25 and 2.70 nmol/L. The two fold higher serum cBT levelsin men recently reported could be misleading and is due to an inap-

propriate use of the law of mass action, not taking into account thepresence and variation of ∆5-A-diol.Policy of full disclosure: None

MP-03-112

Evaluating the relationship between lower urinarytract symptoms (LUTS) associated with benignprostatic hyperplasia (BPH) and erectile dysfunction:Role of autonomic hyperactivityUmul, M.1; Altay, B.1; Bademkiran, F.2; Turna, B.1; Semerci, B.1; Apaydin, E.1; Cikili, N.1

1Ege University Medical Faculty, Urology, Izmir, Turkey; 2Ege UniversityMedical Faculty, Neurology, Izmir, Turkey

Objective: In our study, we analyzed the potential causes for the rela-tionship between lower urinary tract symptoms (LUTS) associatedwith benign prostatic hyperplasia (BPH) and erectile dysfunction (ED)and the effects of several variables (serum free and total testosteronelevels, blood lipids, glucose level, weight and waist length) as well asof effect of autonomic hyperactivity. The alterations after treatmentwith two different alpha blockers (Tamsulosin 0,4 mg and Alfuzosin 10mg) were also analyzed.Methods: Twenty-four patients have been recruited in the study. Weperformed a complete physical examination including digital rektalexamination, urine analysis, uroflowmetry and postvoid residual urinevolume analysis for all patients. Serum lipid levels, blood glucoselevels, serum free and total testosterone levels and free and total PSAlevels were measured. We also measured weight and waist length forall patients. To evaluate the automic activity circumstances we per-formed an electromyographic assessment and electrocardiographicevaluation. Patients were also assessed by IPSS, IIEF, DAN-PSSsexand AMS questionnaires. For statistical analysis, we used chi squaretest, students T-Test, Repeated Measures Anova, Bonferroni test andco-variation analysis.Results: There was a negative correlation between IPSS, weight andwaist length measurements and erectile function (p < 0.05). There wasalso a negative correlation between free testosterone levels and EDsymptom scores and weight and waist length measurements. The elec-tromyographic assessment by genitofemoral and peripheral nerves andelectrocardiographic evaluation showed a marginal activity increase onsympathetic nervous system (p > 0.05). Free and total testosteronelevels increased significantly (p = 0.0068 and p = 0.0071 respectively).Maximum flow rate increased (p < 0.001) and postvoid residual urinevolume decreased (p < 0.001) significantly. There was single statisti-caly significant difference between the two treatment groups regard-ing the outcomes of the questionarrires (p = 0.047).Conclusion: Alpha blockers were associated with improved LUTSand sexual function. We havent found any significant inrease on sym-pathetic nervous system activity in our cohort.Policy of full disclosure: None


J Sex Med 2008;5(suppl 2):69–93

crush/no HBOT (C+/H−); no crush/no HBOT (C−/H−) and nocrush/HBOT (C−/H+). HBOT was delivered daily for 90 minutes at3 ATM for 10 days commencing the day of CN crush. 10 days afterCN injury, animals underwent CN stimulation measuring maximalintracavernosal pressure/mean arterial pressure (ICP/MAP) ratios.Corporal tissue was harvested pre-sacrifice and immunohistochemi-cally stained for NGF, eNOS and CD31. Histologic analysis was per-formed for Masson’s Trichrome (MT) to assess the smoothmuscle-collagen-ratio. TUNEL-assay was used to define apoptoticindices (AI).Results: The (C+/H−)-group had significantly lower ICP/MAP-ratioscompared to (C−/H−)-rats, (31% vs. 70%, p < 0.001). (C+/H+)-ratshad significantly higher ICP/MAP ratio recovery compared to the(C+/H−)-group (55 vs. 31%, p = 0.005). NGF and eNOS staining den-sities were higher in (C+/H+)-rats compared to (C+/H−)-rats (p < 0.05and p < 0.001, respectively). No difference was seen in CD31 expres-sion. Staining density for MT displayed a trend towards higher smoothmuscle preservation after HBOT. AI’s were significantly increased byHBOT (p < 0.05).Conclusion: Conclusion: HBOT following CN injury improved EFpreservation in this model supporting the cavernosal oxygenationconcept as protective mechanism for EF. The effects appear to bemediated via preservation of neurotrophic and endothelial factorexpression.Policy of full disclosure: None

MP-03-115

Pharmacological prophylaxis of erectile dysfunctionafter radical prostatectomy with vardenafilGamidov, S.1; Mazo, E.1; Guseinov, M.1

1RSMU, Urology, Moscow, Russia

Objective: Pelvic surgeries, especially radical prostatectomy, areamong the most common causes of organic sexual dysfunction in men.Although the most important pathophysiological mechanism of erec-tile dysfunction in this group of patients is sought to be the damage ofthe cavernosal nerves, a reduction of the arterial inflow to the corporacavernosa also plays a role. Both of this factors cause apoptosis andfibrosis in the corporeal tissue. One of possible ways to prevent thesedeleterious changes is the application of pharmacological regimensaimed at improving early postoperative corporeal blood filling. Theaim of the present study was to investigate the effects of prospectiveadministration of vardenafil on the erectile function in patients under-going bilateral nerve sparing radical prostatectomy.Methods: Patients with excellent preoperative erectile function whounderwent bilateral nerve sparing prostatectomy (n = 37) were ran-domized to receive vardenafil (10 mg daily at bedtime from the 8thpostoperative day) (n = 19, group 1) or placebo (n = 18, group 2). Allpatients completed the International Index of Erectile Dysfunction(IIEF) scale and received vascular evaluation in the form of ultrasoundassessment of postocclusive flow-mediated dilation of cavernosal arter-ies 3 and 6 months after the operation.Results: The mean age of patients in the group 1 and 2 were 63.06 ±6.94 and 64.36 ± 3.25 respectively. IIEF-EF domain scores and thepercent of increase of the cavernosal arteries diameter (PICAD) weresignificantly higher in the treatment group compared to the placebogroup both on 3 (19.4 ± 3.74 and 52.5 ± 3.08 vs. 10.12 ± 1.54 and 25.9± 5.41, respectively, p < 0.01) and 6 month (21.05 ± 1.87 and 53.8 ±4.28 vs. 11.24 ± 1.48 and 21.5 ± 4.75, respectively, p < 0.01) followups.Conclusion: Present study shows that daily administration of varde-nafil after bilateral nerve sparing prostatectomy improves erectile func-tion possibly by preventing the deleterious effects of altered arterialsupply on the cavernous tissue.Policy of full disclosure: None

MP-03-113

Interest of a guide with triiodothyroninneuroregenerative medium for erectile functionrecovery in a rat model of cavernous nerve injuryBessede, T.1; Alsaid, B.2; Bernabe, J.3; Giuliano, F.3; Quillard, J.4; Beboit, G.1 Droupy, S.1

1CHU de Bicetre, Urology, Le Kremlin Bicêtre, France; 2CHU de Bicêtre,Experimental Surgery Laborator, le Kemlin Bicêtre, France; 3Pelvipharm,GIF-SUR-YVETTE, France; 4CHU de Bicêtre, Anatomo-Pathologie, leKremlin Bicêtre, France

Objective: In a cavernous-nerve crush-injury rat model, we aimed toevaluate the effects of neuroregeneration guidance combined withlocal delivery of thyroid hormones.Methods: Forty five rats have been divided into 5 equal groups :SHAM, guide without lesion, lesion, lesion + guide, lesion + guide +neuroregenerative medium (T3). All surgical procedures were bilateral. Cavernous nerves were crushed with microcascular bullogclamp of 100g/cm2. A silicone guide was placed around the nerves. The guides were filled with triiodothyronine (T3)neuroregenerativemedium. Erectile function was assessed 10 weeks post-operatively.Intra-cavernous pressure (ICP) and mean arterial pressure (MAP) weremonitored during electrical stimulation of cavernous nerves at variousfrequencies. The main outcome was hardness of erection defined asDICP/MAP. Fluorescent immunohistochemical analysis of cavernousnerves was performed to assess morphologically nervous regeneration.Results: Electrophysiological datas showed a better recovery of erec-tile function in the group with guide + neuroregenerative mediumcompare to the empty guide. Immunohistochemical analysis of cav-ernous nerves provided morphological arguments showing that regen-erated axons were straighter in nerves with guide and wider if guideshad been filled with neuroregenerative medium.Conclusion: Guidance of nervous regeneration avoids axonal sprout-ing. The use of a guide allows local delivery of thyroid hormones thatimproves neuroregeneration and erectile function recovery followingnerve injury in a rat model. Combined strategies for tertiary preven-tion of post-operative erectile dysfunction proves to be efficient in rat.Policy of full disclosure: Grant for research from the French Uro-logical Association.

MP-03-114

The effect of hyperbaric oxygen therapy on erectile function recovery in a rat cavernous nerve injury modelMüller, A.1; Tal, R.2; Donohue, J.2; Kobylarz, K.3; Sulser, T.1; Scardino, P.2;Mulhall, J.3

1University Hospital Zurich, Urology, Switzerland; 2Memorial Sloan-Ket-tering Cance, Urology, New York, USA; 3Weill Medical College of Corne,Urology, New York, USA

Objective: Cavernosal oxygenation appears to be important forpreservation of erectile tissue health. Hyperbaric oxygen therapy(HBOT) was shown to improve tissue oxygenation and have neuro-modulatory effects. This study was designed to define the effects ofHBOT on erectile function (EF) and cavernosal tissue in the rat cav-ernous nerve (CN) injury model.Methods: Four groups of Sprague-Dawley rats were studied: rats withbilateral CN-crush, HBOT treated (Crush+/HBOT+); bilateral CN-


J Sex Med 2008;5(suppl 2):69–93

Tuesday, 27 November 200714.30–16.00 Room 3MP-04 Surgery, Peyronie’s disease, and priapismChairs A. Martin-Morales, Spain

P. Scheplev, Russia

MP-04-116

Location and nature of nerves fibres in the inferiorhypogastric plexus and its efferent’s nerves in humanfetusAlsaid, B.1; Karam, I.2; Bessede, T.2; Abd-Alsamad, I.3; Uhl, J. F.4; Delmas, V.4; Benoit, G.5; Droupy, S.5

1Le Kremlin Bicetre, France; 2UPRES 1602, University Paris 11, LeKremlin Bicetre, France; 3CHI Creteil, Anatopathologie, France; 4Institutd’Anatomie, Université René Descartes, Paris, France; 5CHU de Bicetre,Urological Surgery, le Kremlin Bicetre, France

Objective: Precise location, origin and nature of nerve fibres in theinferior hypogastric plexus and its efferent’s nerves are difficult to studyby classical anatomical studies based on cadaveric dissection. Thisstudy was designed to identify nerve fibres location and nature (adren-ergic, cholinergic and sensitive) in the male pelvis and to provide athree-dimensional representation of pelvic nerves and their relationwith anatomical structures in the human male fetus.Methods: : Seven transverse sections were performed every 200 µalong the pelvic portion of two human male fetuses (16 and 17 weeksof gestation). Sections were treated by histological and immunohis-tochimical methods (Hematoxilin-Eosin-Safran, Luxol Fast Blue,immunolabeling of: Protein S100, VACHT, TH, CGRP and Sub-stance P). Three-dimensional pelvic reconstruction was obtained fromthe serial sections using Surf Driver software (winsurf).Results: Bi-dimensional histological and the three-dimensionalanatomical studies allowed to identify the precise location and natureof fibres in the inferior hypogastric plexus and its efferent’s nerves. Theadrenergic fibres (sympathetic) are located in the superior part of theplexus and distributed to the bladder neck, prostate, seminal vesiclesand vas deferents. The cholinergic fibres (parasympathetic) are locatedin the inferior part of the plexus. They innervate the same structuresand end forming the cavernous nerves that extend to the corpora cav-ernosa associated with very few adrenergic fibres. Some adrenergic andcholinergic fibres travel just posterior to the cavernous nerves andinnervate the bulbous spongiosum. The prostate and seminal vesiclereceive innervation from mixed nerves (adrenergic, cholinergic andsensitive fibres).Conclusion: The three-dimensional reconstruction of the pelvicnervous elements, permits to determine their location and their nature,allowing a computer assisted dissection (CAD), and the transfer ofanatomical knowledge to pelvic surgery in order to improve functionalresults concerning sexual function. In the future, the three-dimen-sional cartography of the neuro-transmitters peripheral distributioncould help to select molecules for pharmacological application in the treatment of incontinence, erectile dysfunction and ejaculatory disorders.Policy of full disclosure: None

MP-04-117

Fixation of the neovaginal vault to Coopers’ ligamentin male to female transgender patientsRehder, P.1; Pinggera, G.-M.2; Herwig, R.2; Gozzi, C.3

1Medical University Innsbruck, Neurourology, Dept. Neurology, Austria;2Medical University Vienna, Urology, Austria; 3Ludwig-Maximillians-Universitä, Urology, Munich, Germany

Objective: Reconstructing a neovagina from well vascularised penileskin is a well recognised technique in male to female transgendersurgery. The aim was to successfully fixate the neovaginal vault, at firstrelying on passive fixation by scarring.Methods: Six patients (23–57, average 30 years of age) that qualifiedfor gender reassignment were recruited to undergo surgery(2 stageprocedure) that amounted to bilateral inguinal orchiectomy, completeexcision of the corpora cavernosa, shortening of the urethra, neovagi-nal reconstruction using penile skin and subcutaneous fascia, clitorisreconstruction from glans with sparing of the dorsal neurovascularbundle, scrotal trimming, perineoplasty and breast augmentation. Thepre-operative work-up included psychotherapy for at least two years,urological examination, and hormonal therapy for at least one year andforensic medical evaluation. The first patient underwent no proximalneovaginal fixation. In the latter five patients the proximal neovaginalvault was fixed to Coopers’ ligament with a non-resorbable suture.Results: The follow-up ranged from 4 to 64 (average 38) months afterthe last operation. 5 of 6 patients reported successful intercourse. Onbimanual examination the first patient had the neovagina directedtowards the rectum and anus. This patient complained of anorectaldiscomfort during intercourse. The fixated neovaginae in the latter fivepatients healed in place without any slippage. All six patients were verysatisfied with the cosmetic result.Conclusion: Fixating the neovaginal vault to Coopers’ ligament pre-vents slippage or prolapse thereof. It did not increase the morbidity ofthe procedure. As the neovagina is positioned into a male pelvic outletit seems to descend with time if not properly fixated. To ensure thatthe neovaginal length is maintained it is important for it to properlygrow into position. When using well vascularised penile skin there isno significant atrophy of the neovaginal skin over time.Policy of full disclosure: None


J Sex Med 2008;5(suppl 2):69–93

MP-04-118

Neovaginal prolapse prevention in male transsexualsby sacrospinous ligament fixationStanojevic, D.1; Djordjevic, M.2; Kojovic, V.3; Bizic, M.2; Majstorovic, M.2;Perovic, S.2

1School of Medicine, Belgrade U, Serbia; 2University Children’s Hospital,Urology, Belgrade, Serbia; 3School of Medicine, Belgrade U, Urology, Serbia

Objective: Vaginal prolapse is one of the complications after vagino-plasty in male-to female sex reassignment surgery. We present ourexperiences of vaginal sacrospinous ligament fixation after vaginoplastyin male transsexual patients with aim to prevent its postoperative prolapse.Methods: From August 1997 through February 2007, a total of 68male transsexual patients (mean age 27 years, range 18–58) underwentsacrospinous ligament fixation for neovaginal prolapse during male-to-female sex reassignment surgery. Neovagina was created from penileskin tube flap combined with urethral flap. Deep and wide perinealcavity between the urethra, bladder and rectum was created by dissec-tion of the tendineous centre and recto-urethral muscle. The rightpararectal space is opened by penetrating the right pararectal fascia(rectal pillar) and right ischial spine was palpated. Using the ischialspine as a prominent landmark, sacrospinous ligament is palpated.Long-handled Deschamps ligature is used to pierce the ligament medi-ally to the ischial spine. Vaginopexy to the sacrospinous ligament iscarried out and the neovagina placed deep in the perineal cavity.Results: The median follow-up was 41 (7–102) months. Sacrospinousligament fixation was successfully performed in all patients. The meanvaginal length was 10.9 (9.5–16) cm. A 48 patients (71%) were capablefor normal sexual intercourse. The appearance of neovagina was aes-thetically acceptable in 58 patients. Vaginal prolaps did not occurre,except minor bulge of the anterior vaginal wall in three cases resolvedby simple excision.Conclusion: Vaginal sacrospinous fixation is feasible in male trans-sexuals for neovaginal prolapse prevention. However, extensive expe-rience of male pelvic surgery is required to avoid possiblecomplications.Policy of full disclosure: None

MP-04-119

Albuginea modelling and oversizing implantation insevere deformed and short penis: 5 years follow-upSedigh, O.1; Paradiso, M.1; Liberale, F.1; Graziano, M. E.1; Morabito, F.1;Ferrando, U.1

1San Giovanni Battista Hospital, Urology, Torino, Italy

Objective: Our experience in penile-implantation is complicated bylarge percentage of End Organ Disease; Wilson’s manoeuvre is notsufficient to correct properly the curvature, for local adverse condi-tions (LAC), with large persistence of deviation. We propose a com-bined technique: implantation and straightening corporoplasty.Methods: We first implant prosthesis 2 cm longer than corpora cav-ernosa and then incise albuginea. In presence of hard calcification orbone tissue, we use a combination of implanting and grafting. Our phi-losophy is to implant always inflatable implants. CRX-AMS and Alfa1 Coloplast prosthesis are excellent for this surgery. We leave cav-ernous tissue between penile implant and albugineal incisions, to coverimplant with Buck fascia only, without any kind of grafting. CRX insevere fibrosis makes penis longer with small loss in diameter, in orderto prevent short penis syndrome.Results: We implanted over 80 penile implants (10 CRX-AMS) andhad 44% of LAC (10% in USA). In 60% of cases, we used 12 and 15cm length cylinders. LAC after radical surgery (RS): 21% in bothcountries. Evaluations after 3 and 12 months reports good couple sat-isfactions. No cold glans and penile deformity at 2 years.Conclusion: RS induces ED penile fibrosis and shortening. Patientsshould be implanted not over 12 months after RS in order to obtainless difficult implantation. Patients with severe penile curvature, short-ening and impaired penile rigidity may be offered albuginea model-

ling and oversizing implant, which are proved to be effective and safein long-term assessment. Plaque incision and penile implanting forcomplex fibrotic deformity are associated with significant patient sat-isfaction rate.Policy of full disclosure: None

MP-04-120

Real penile lengthening by corporotomy singleincision, based on geometrical principle, combinedwith simultaneous prosthesis implantationKurbatov, D.1

1State Endocrinological Centre, Reproductive Uroandrology, Moscow, Russia

Objective: The conventional surgical penile lengthening includes thesection of the suspender ligament. But the results of organ’s enhanc-ing are minimal or even absence. In the patients having small penisand suffering ED we apply the surgical method of real penile length-ening combined with simultaneous prosthesis implantation.Methods: 24 men aged 43–62 (mean 53.4 ± 7.2), suffered ED andsmall penises, were treated from Nov. 2005 to July 2007. The etiolo-gies of ED were cardiovascular disease (19 pts), D. Mellitus (3 pts),radical prostatectomy (2 pts). First group included 8 patients with EDand Mb. Peyronie complicated penile curvatures. 16 patients of secondgroup suffered severe ED without any penile deformities. Penilelength in stretched position in both groups ranged from 8,5 to 12 cm(mean 10,5 ± 1,2). The applied surgical technique based on geometri-cal principle and was the similar in both groups. We performed cor-porotomy by single incision, penile implantation and grafting. Thesubcoronal incision, degloving of penile skin, mobilization of neuro-vascular bundle and the single circular transverse incision of tunicaexcept urethral plate were performed. The incision was forked at theends for corpora’s lengthening. Then penile prosthesis were implantedby conventional technique through corporotomy. For tunica albugineagrafting we used: cadaveric dura mater (6), boving pericardium (4),Tahocomb (2), boving biocolla gen (12).Results: The gained real penile lengthening was 2,0–4,2 cm (mean 3,2 ± 0, 8). Complication occurred in 2 patients (8,3%) with D. Melli-tus: periprosthesis infection (prosthesis were explanted) and partialnecrosis of prepuce cutis (treated conservatively). No one patient hadloss of glance sensitiveness.Conclusion: This surgical technique is not dangerous and may gainthe real penile lengthening as to the patients with ED and penile cur-vatures, as to the impotent patients without any penile deformities.Policy of full disclosure: None

MP-04-121

Circumcision is not mandatory in penile surgeryGaraffa, G.1; Christopher, N.1; Ralph, D.1

1Unversity College London, St Peters Hospital, United Kingdom

Objective: The standard practice when straightening a congenital oracquired penile curvature is to perform an additional circumcision. Inthe year 2000 this concept was questioned and the subsequent resultswhen patients were given a choice are presented.Methods: Between 2000 and 2007 a total of 191 consecutive patients(mean age 46 yrs, range: 17–74 yrs) have had their penis straightenedby either a Lue (n = 68) or a Nesbit procedure (n = 132) using a deglov-ing subcoronal circumferential incision. 48 patients had been previ-ously circumcised. 22 patients presented with a tight foreskin of which6 refused an additional circumcision. 116 patients had a normalretractable foreskin of which 78 opted not to be circumcised. 5 patientshad previous penile surgery and a normal foreskin: 2 opted not to becircumcised.Results: The mean follow up of the patients was 5.5 months (range: 1–50 mths). A secondary circumcision was performed in 3 of 6(50%) patients with a tight foreskin, in 1 of 78 (1.2%) patients with anormal retractable foreskin and in 1 of the 2 patients who had had previous penile surgery and had a normal foreskin (50%). Patient sat-isfaction and significant penile shortening was 90% and 9% in those


J Sex Med 2008;5(suppl 2):69–93

that maintained their foreskin and 96% and 14% in those who werecircumcised.Conclusion: Circumcision should not be considered as a routine partof penile surgery unless a significant phimosis is present or revisionsurgery is contemplated.Policy of full disclosure: None

MP-04-122

Sexual function after reconstructive urethroplasty foranterior urethral stricturesScheplev, P.1; Gvasaliya, B.2; Garin, N.21Moscow, Russia; 2RMAPE, Endourology, Moscow, Russia

Objective: To evaluate the effect of reconstructive urethroplasty onsexual function. Few long-term patient-reported data are availableregarding sexual function after reconstructive urethroplasty for ante-rior urethral strictures.Methods: We evaluate sexual function of 108 patients who underwentreconstructive surgery for anterior urethral strictures by mailingdetailed questionnaire or a telephone interview. Questions addressedthe patient satisfaction with erection, ejaculatory latency time andintercourse satisfaction, change in erect penile length and angle, etc.The response rate was 88% (95 of 108 patients). Results were strati-fied by the urethral reconstruction method (buccal mucosal graft,penile flap, etc).Results: Average followup was 31 months (range 6 to 112). T). Themedian (range) age was 43.5 (19–77) years. Only the men aged more then 50 years reported decreased sexual function after surgery (p < 0.05). Men with longer periods (>12 months) of recovery reported better erectile and ejaculatory function then patients withrather short periods (<12 months) after surgery (p < 0.05). Penile skin flap urethroplasty was associated with a slightly higher incidenceof impaired erectile function than urethroplasty using buccal mucosal graft (p > 0.05). Postoperative improvement of ejaculatoryfunction was the most essential in comparison with other componentsof sexual function (p < 0.05). Patients with longer strictures have showna higher incidence of penile shortening and erectile dysfunction (p > 0.05).Conclusion: The evaluation of long-term postoperative sexual func-tion after is very important for a high-grade estimation of results ofreconstructive urethroplasty. Despite obtained data, further studies arenecessary in this direction.Policy of full disclosure: None

MP-04-123

Preliminary results of use of free preputial graft in thetreatment of penile curvaturesRadopoulos, D.1; Vakalopoulos, I.2; Thanos, P.1; Demetriadis, P.1

1“G.Gennimatas” General, Urology, Thessaloniki, Greece; 2Urology, Thes-saloniki, Greece

Objective: To study the outcome and possible complications of treat-ing acquired and congenital penile curvatures by corporoplasty and useof preputial free graft.Methods: 13 patients with penile curvature, aged 20–68 years old(mean 44 y.o) have been treated with full thickness corporotomy andcovering of the gap by free preputial skin graft. Four of them had con-genital curvature, without chordee and hypospadias and rest 9 had Pey-ronie’s disease. The preoperative study included history, clinicalexamination, IIEF-5 score, penile ultrasound scan, counting of penilelength and coloured Doppler after alprostadil intracavernosal injection(ICI). Follow up included 3 visits on the 1st, 3rd and 12th month post-operatively. On the last two visits same investigation as preoperativelywas performed.Results: 75% of the patients had complete straightened penis, about1 cm penile elongation, no dilatation of the graft (ballooning) andincreasing of penile blood supply without venous leakage, as appearedfrom the values of maximum Postsystolic Velocity (PSV: mean 1.2cm/sec increase), Enddiastolic Velocity (EDV) and Resistance Index

(RI: almost no alteration) in ICI-Doppler investigation. Mean IIEF-5score increased 2 units and patients were very satisfied. The rest 25%had incomplete penile straightening and satisfaction was lower, butalso nobody complained for erection worsening, or ballooning of thegraft area.Conclusion: Full thickness incision of penile curvature area, has theadvantage of straighten the penis, without shortening as in classicalNesbit, but it needs grafting of the created gap. Several grafts havebeen used, but preputial graft is in our opinion an easy, cheap and quickharvested tissue, familiar to the urologist. As a result it simplifies theoperation and decreases surgical time. The results are excellent andthere is neither venous leakage and erectile dysfunction, nor balloon-ing of the graft, which thought to be the major disadvantages of thistissue.Policy of full disclosure: None

MP-04-124

Reduction corporoplasty for the surgical treatment ofgeometric erectile dysfunctionPerovic, S.1; Djinovic, R.1; Basic, D.2; Sansalone, S.3

1University Children’s Hospital, Urology, Belgrade, Serbia and Montenegro;2School of Medicine, University, Urology, Nis, Serbia and Montenegro;3University “Tor Vergata”, Urology, Roma, Italy

Objective: The most important characteristics of functional erection,i.e. an erection which is adequate for sexual intercourse is rigidity.Three main factors for penile axial rigidity is intracavernosal pressure(hemodinamics, tissue expandability, cavernosal tissue mechanicalproperties and ratio between the two dimension of the penis—lengthand circumference (penile geometry). We present surgical techniquefor pure geometrical erectile dysfunction in patient unable to physio-logically develop a rigid erection for a pathologic L/C ratio.Methods: In the period from 1995–2002 we treated 21 young managed between 17–22 years (mean 19.4) with life-long erectile dysfunc-tion not responding to oral or intracavernosal treatment. We identi-fied value of length/circumference ratio above 1.34. These patientshave normal hemodinamics and normal tissue mechanical properties,but were not capable to develop rigid erections for geometrical reasonssolely. In the treatment we performed reduction corporoplasty usingpenile disassembly technique.Results: Follow-up was 5–12 years (mean 7.3 y). In all cases exceptone establishing of penile rigidity was achieved. Cavernosometryshowed that axial rigidity could be reached at a physiological intra-cavernosal pressure (60 mmHg) whereas preoperatively a supraphysi-ologic pressure of more then 90 mmHg was needed.Conclusion: In young man with lifelong erectile dysfunction there arecases of pure geometrical ED which could be successfully treated sur-gically using reductional corporoplasty.Policy of full disclosure: None

MP-04-125

Long-term outcome of penile corporoplasty for correction of Peyronie’s disease: Our department experienceTomada, N.1; Lopes, I.2; Vendeira, P.2

1Hospital S. Joao, Urology, Oporto, Portugal; 2Hospital S. João, Oporto, Portugal

Objective: To investigate the 17 years outcome of patients with Pey-ronie’s disease (PD) treated with penile corporoplasty (Yachia tech-nique) in our department.Methods: Sixty five patients underwent surgical treatment for PDbetween 1991 and 2007 and were retrospectively evaluated. Admissionprotocol included a detailed sexual and medical history, auto-photog-raphy and evaluation of penile deformity after intracavernous admin-istration of alprostadil. We used the Levine and Lenting’s algorithmfor surgical treatment. Data was obtained from medical records, clin-ical evaluation and telephone interview. Post-operative follow-up wasat 6 weeks, 12 months and 24 months. Mean age at surgery was 56


J Sex Med 2008;5(suppl 2):69–93

years (28–70 yrs). Mean time follow-up was 17.4 months (2–37months).Results: Surgical purpose was obtained in 63 patients (success rate of96.9%). At six weeks, complete straightening of the penis was achievedin 34 patients (53.9%), and partial straightening which allowed sexualintercourse in 29 patients (46.1%). One patient reported gland hypos-thesy and all of them reported subjective perception of penile short-ening (0.5 cm to 4 cm). Fifteen patients developed recurrent deformityat 2 years follow-up, with compromise of sexual intercourse in 5patients. Patients’ responses to our questionnaire showed that, overall,90% of the patients and partners were satisfied with the surgical result.Conclusion: According to the results of this long-term, retrospectivestudy, and after medical therapy is considered and the PD has stabi-lized, surgical correction using Yachia technique is an excellent optionfor patients with functional impairment, specially if selected byLevine’s and Lenting’s algorithm. All patients should be informed pre-operatively about the risk of penile shortening and residual curvature.The recurrent penile deformity should be related with the etiopatho-genesis of the disease that remains unclear.Policy of full disclosure: None

MP-04-126

Surgical treatment of Peyronie’s disease: A singlecenter experience with 145 patientsAkman, T.1; Sanli, O.1; Onem, K.1; Tefik, T.1; Amasyali, A.2; Kadioglu, A.3

1University of Istanbul, Department of Urology, Turkey; 2University ofIstanbul, Turkey; 3Istanbul Universitesi, Dept. of Urology, Capa, Istanbul,Turkey

Objective: To assess the outcomes of the surgical techniques used inPeyronie’s disease (PD) surgery.Methods: One hundred fifty patients received surgical treatment forPD. Fifteen and 75 patients underwent simple corporoplasties andincision of the plaque, and venous (IV) grafting, respectively, whereas60 patients with erectile dysfunction underwent penile prosthesisimplantation. At follow-up, the erectile function and penile defor-mity were assessed at 3 and 12 mo postoperatively, and every 6 mothereafter.Results: Postoperative results were satisfactory in 14 of 15 patientswith simple corporoplasties, with a mean angle of deformity andfollow-up of 51.0° ± 14.9° and 21.0 ± 9.7 mo, respectively. Amongpatients undergoing IV grafting with sapheneous vein (mean curvatureangle: 61.6° ± 19.5°), 70 were regularly seen with a mean follow-up of41.7 ± 35.1 mo. Penile curvature was completely straightened in 53(75.7%) patients, whereas 12.8% and 11.4% had residual curvature lessthan 20° and more than 20°, respectively. The mean degree of penilecurvature of patients with penile prosthesis was 46.9° ± 20.1°. Straight-ening of the penis was accomplished with implantation of the pros-thesis only, manual modeling, plaque incision and grafting (autologousrectus fascia in the majority), incision of the plaque, and penile plica-tion in 35%, 30%, 31.6%, 1.6%, and 1.6%, respectively. In the pros-thesis group, two patients had recurrent curvatures.Conclusion: IV grafting is a good option with satisfactory mid- andlongterm outcome. Insertion of the prosthesis only and manual mod-eling correct the curvature in the majority of the patients. For theremaining patients, autologous rectus fascia is an appropriate graftmaterial.Policy of full disclosure: None

MP-04-127

Intracavernous injections of corticoids are efficient forpainful La Peyronie diseaseBondil, P.1; Demey, A.1; Ozone, F.1; Knouzy, B.1; Bouraoui, K.1


Objective: The last international guidelines (ICED 2005) counteractthe use of intracavernous injections of corticoids (ICIC) for La Pey-ronie disease (LP). In a previous study (1) about 45 cases of LP in acutephase, we have shown their rapid and clear efficacy on pain with com-

plete (61.4%) or partial improvement (13.6%). Objective: to confirmthis beneficial effect on pain by using a more objective measurementthan the simple physician interrogation.Methods: a) sample: 46 men (mean age: 54.2) all consulting for painfulLP, b) self evaluation of pain by using the Huskisson analogical visualscale (AVS) numbered from 0 to 10, at the beginning then after eachICIC, c) technique: ICI of 100 mg hydrocortisone inside or aroundthe node; d) frequency: one time a week (three times minimum andmore in case of improvement).Results: The 68% decrease of mAVS (mean AVS) initial 4.45 vs. 1.42final shows the efficacy of ICIC with similar results: a) 27 recoveries(58.7%): 4 mAVS initial vs. O final; b) 8 clear (50% AVS decrease)improvements (17.3%): 5.5 mAVS initial vs. 2.9 final; c) 11 poor orabsent efficacies (24%): 4.6 mAVS initial vs. 3.8 final. The mean ICICnumber was 5 (3–11) showing the rapid efficacy. None impairment ormorbidity have been noted. For the most severe cases (10 initial AVS> or = 5), the efficacy is still present (60% improvement) but lower (7 mAVS initial vs. 2.8 final).Conclusion: This prospective study with objective evaluation of painby patient confirms our previous study. In case of acute phase of LP,the bad reputation of ICIC is not justified. They have a beneficial effectimmediately certain (rapid and clear decrease of pain in 76%) andlikely secondary (decrease of fibrous sequels by stopping / reducing theinflammatory phase). 1) Demey et al. Prog Urol. 2006, 16: 52–7.Policy of full disclosure: None

MP-04-128

The use of bovine pericardium for Peyronie’s disease.Preliminary resultsKartsaklis, P.1; Konstantinidis, C.2; Palaiodimos, I.3; Andreadakis, S.3;Gekas, A.3

1General Hospital of Patras, Greece; 2National Institution of Rehabi,Urology, Athens, Greece; 3General Hospital of Patras, Urology, Greece

Objective: Our aim was to evaluate and present the clinical results ofbovine pericardium use for surgical treatment of Peyronie’s disease.Methods: From January 2005 to January 2007, 24 patients underwentsurgical correction of penile curvature using bovine pericardium.Disease was present for at least 12 months and stable for the last 3months. All patients were preoperatively evaluated with a medical andsexual history, physically, with International Index of Erectile Func-tion (IIEF-5), underwent Doppler sonography and the degree of cur-vature and penile length were documented. Twenty-two patientsunderwent plaque incision and 2 plaque excision suffered from plaqueossification. Average follow up was 16,2 months (range 6 to 24).Results: Postoperatively 20 patients (83,3%) had successful penilestraightening, while 4 (16,7%) had a residual curvature less than 10o.Postoperative erectile dysfunction was presented in 2 (8,3%) patients,one treated with PDE-5 inhibitors and the second who suffered frompenile ossification underwent penile prosthesis implantation. Preputialoedema was reported in 8 (33,3%) patients and two was treated surgi-cally because oedema persisted after six months. Postoperatively all thepatients complained for penile shortening which was documented in23 (95,8%) of them (range 1 to 2,3 cm).Conclusion: Bovine pericardium is a safe tissue for tunica albugineagrafting following plaque incision or excision in Peyronie’s disease.Patients suffering from Peyronie’s disease must be informed about sur-gical treatment’s complications and patient’s expectations must bealways considerable.Policy of full disclosure: None

MP-04-129

Advance in local treatment of Peyronie’s disease:Intralesional injection using a new plunger mechanismsyringe with ergonomic leverage handlingZucchi, A.1; Fioretti, F.1; Mearini, E.1; Tuffu, G.1; Bitelli, M.1; Perovic, S.2

1University of Perugia, Urology and Andrology, Italy; 2University of Bel-grade, Department of Urology, Serbia


J Sex Med 2008;5(suppl 2):69–93

Objective: We report our experience about medical treatment in Peyronie’s Disease (PD) using a plunger mechanism syringe withergonomic leverage handling. This syringe is very useful to performinjection of different drugs directly into fibrotic plaque by achieving ahigh hydraulic pressure, obtaining both pharmacological and mechan-ical effect.Methods: From June 2002 to December 2006 we treated 67 men withPD by administering 10 intra-lesion injections (1 injection/week),alternating betamethasone 4 mg (2 ml) and verapamil 5 mg (2 ml), andusing a small, but very strong needle (0.4/8 mm—27 G). We reporthere detailed data on 56/67 pts. The mean age of the patients was 54years; 50 pts. (89%) reported plaque-related symptoms during erec-tion. Palpable plaque was present in all the patients. Recurvatum waspresent in 45 patients (80%).Results: At a mean follow-up of 30 months we observed early resolu-tion of the symptoms in 48/50 pts. (96%). A significant reduction ofplaque size (US measured) was noted in 43% percentage of cases(24/56) [p = 0.001]. Recuvatum improved only in a small percentageof cases 12/45 (26.6%) but no patient presented progression, with anoverall improvement in sexual life (84%).Conclusion: This device represents the best choice for intra-lesiondrug administration in the treatment of PD. This approach offers ahigh concentration of drugs inside the plaque and a mechanical effecton it, minimal side effects or adverse reactions for the patients as wellas minimal involvement of the tissues surrounding the plaque.Policy of full disclosure: None

MP-04-130

New selection criteria for surgical treatment ofPeyronie’s diseaseRossello, M.1; Mus, A.1; Conde, G.1

1Centre for Urology, Andrology, Urology, Palma de Mallorca, Spain

Objective: Offer a patient selection criteria for surgical treatment ofPeyronie’s Disease (PD) in patients over 50 years of age. Demonstratethat the best solution for patients with risk factors for Erectile Dys-function (ED) is the prostheses implant procedure.Methods: We consider: A) 35 papers from the World Peer Literaturepublished between 1990 and 2005 (1206 patients in total) B) A total of15 patients between 50 and 60, 6 from our Centre and 9 from otherCentres in Spain. We have no data from Group A. The 15 patientsfrom Group B who first had a curve correction all complained fromproblems of erection or axial rigidity. 4 of them had a residual curva-ture, 9 of them had a shorter penis. The same 15 patients later had apenile prostheses implant, with an optimum satisfaction level for all ofthem.Results: In patients with PD who had a penile prostheses implant, nocomplications were registered and the satisfaction level was a lot higherthan with any reconstructive surgery or curve correction. Albugineaplication would only be recommended for the patients who would haveno risk factors.Conclusion: A) The size of the penis, its axial rigidity and all possi-ble risk factors have to be taken into account. Furthermore, treatmentmust vary in different groups of age. We suggest to make out thepatients within decades: between 30 and 40, between 40 and 50,between 50 and 60, and from 60 onwards, so to have more valid sta-tistics. B) For patients over 50 years of age, whatever the degree ofcurvature, if they have a penile rigidity inferior to 600 grams, if theyare positive that the length of their penis has shortened, and whennodules can be observed on the high resolution scan, we recommenda penile prosthesis implant.Policy of full disclosure: None

Wednesday, 28 November 200709.00–10.30 Room 3MP-05 General issues in sexual health, riskfactors, epidemiologyChairs: I. Moncada, Spain

E. Waldkirch, Germany

MP-05-131

Plasma levels of asymmetric dimethylarginine(ADMA) in relation to vasculogenic erectiledysfunction in essential hypertensive patientsVlachopoulos, C.1; Ioakeimidis, N.1; Rokkas, K.1; Aznaouridis, K.1; Baou, K.1;Samentzas, A.1; Askitis, T.1

1Athens Medical School, 1st Cardiology Department, Greece

Objective: Hypertension is the most common comorbidity in patientswith ED and endothelial dysfunction appears to be a link betweenthese conditions. Elevation of asymmetric dimethylarginine (ADMA)which is a endogenous competitive inhibitor of the nitric oxide syn-thetase, has been associated with peripheral and coronary endothelialdysfunction in hypertensive patients. Aim of the present study was toassess whether increased levels of ADMA are associated with ED inpatients with hypertension.Methods: We studied 47 treated essential hypertensive men with presumed vasculogenic ED, 24 age-matched hypertensive men withsimilar risk factors without ED and 26 age matched healthy controlswithout ED, known cardiovascular disease or risk factors. ED wasdiagnosed according to history and score of the 5-item Sexual HealthInventory for Men (SHIM-5, cut-off value <21). ADMA levels weremeasured with ELISA.Results: Hypertensive patients with ED exhibited higher levels ofADMA compared to hypertensive patients with normal erectile func-tion (P < 0.01, left plot). In hypertensive patients with similar riskfactors but without ED, ADMA levels were significantly increased (P< 0.05) compared to healthy controls. In hypertensive patients, a neg-ative correlation between ADMA levels and SHIM-5 score wasobserved (right plot). Moreover, in a multivariate linear regressionmodel, ADMA levels were significantly (P = 0.02) associated withseverity of ED, after controlling for age, body-mass index, smokinghabits, mean pressure, fasting glucose, LDL, HDL and hsCRP.Conclusion: Increased plasma concentrations of ADMA are relatedto the presence and severity of ED in hypertensive men. This findingmay provide additional information to the pathophysiology of ED inthese patients.Policy of full disclosure: None

MP-05-132

Differential endothelial dysfunction in penile andcoronary arteries during metabolic syndromePrieto, D.1; Villalba, N.1; Sanchez, A.1; Hernandez, M.1; Garcia-Sacristan, A.1; Benedito, S.1

1Complutense University, Physiology, Pharmacy School, Madrid, Spain

Objective: Erectile dysfunction (ED) is considered an early sign ofsystemic endothelial dysfunction and has been proposed as a potentialmarker for silent coronary artery disease (CAD) in type 2 diabetes mel-litus patients. The purpose of the present study was to evaluate thefunctional responses of penile and coronary arteries from an animalmodel of Metabolic Syndrome, which is a cluster of cardiovascular risk


J Sex Med 2008;5(suppl 2):69–93

factors characterized by visceral adiposity, insulin resistance, highplasma triglicerides and low HDL cholesterol.Methods: Branches of the dorsal penile arteries (PA) and of the leftdescending coronary artery (CA) from 16–19 months-old Zucker Lean rats (ZLR) and Zucker Fatty rats (ZFR) were mounted in paral-lel in microvascular myographs, and vasodilator and vasoconstrictorresponses were recorded.Results: Acetylcholine-elicited relaxations were severely impaired inPA from ZFR compared to ZLR (maximal relaxant responses 36 ± 5%vs 75 ± 3%, p < 0.001, n = 24) and only slightly reduced at the EC50level in CA. Contractions to both noradrenaline (144 ± 3 vs 166 ± 7%of KPSS in ZLR and ZFR, respectively, n = 27, p < 0.01) and 5–HT(114 ± 7% vs 165 ± 7%, p < 0.01, n = 24) were significantly enhancedin PA and CA, respectively, from ZFR. Blockade of NO synthase abol-ished endothelium-dependent relaxations in PA and CA, and potenti-ated noradrenaline- and 5-HT-induced contractions in arteries fromZLR but not from ZFR. The NO-mediated vasodilator responses tothe phosphodiesterase 5 (PDE5) inihibitor sildenafil were attenuatedin PA from ZFR (maximum response 64 ± 4% in ZFR vs 43 ± 7% inZLR, p < 0.05, n = 7).Conclusion: The present results demonstrate a differential impair-ment of the NO-mediated endothelial responses of PA and CA fromanimals with Metabolic Syndrome. The severity of the altered vasodi-latation in the PA might anticipate the functional impairment of themore preserved coronary vascular bed. Supported by grants PR1/106-14441-A and SAF2006-09191.Policy of full disclosure: None

MP-05-133

Erectile dysfunction (ED) as early marker of cerebralischaemic damage. Is it useful performingneurological investigations?Michetti, P. M.1; Zaccagnini, M.1; Vicentini, E.2; Del Piero, V.2; Altieri, M.2;Shahabadi, H.1; Ciccariello, M.1; De Dominicis, C.1

1La Sapienza University, Urology, Rome, Italy; 2La Sapienza University,Neurology, Rome, Italy

Objective: Erectile dysfunction is not only an evidence of diffuse ath-erosclerosis, but it’s also an index of early endothelial damage. ManyAuthors demonstrated the association with cardiovascular events andcoronary artery diseases; the severity of ED was correlated with theangiographic extension of coronary atherosclerotic process. However,to date few studies have given informations about association betweenED and subclinical cerebral ischaemic damage. The primary aim ofthis explorative study was to test the hypothesis that patients with iso-lated ED, without signs of systemic and carotid atherosclerosis, com-pared to healthy population, have a reduced cerebral vasoreactivity(CVR) as a marker of endothelial damage.Methods: 15 patients with ED (ED+) and 15 without ED (ED-) sub-jects, matched for age and vascular risk factors, were submitted toandrological and neurolological screening. Dynamic Ecocolordopplerof cavernous arteries and Nocturnal Penile Tumescence Scan wereperformed. Neurological assessment was performed by carotid DuplexUltrasound and Transcranial Doppler and by assessing Cerebrovascu-lar Reserve on both middle cerebral arteries simultaneously calculat-ing Vasomotor Reserve (VMR), measured after breath holding andhyperventilation and Breath Holding Index.)Results: Carotid Duplex scanning showed a light carotid stenosis onlyin 3 patients (2 in the ED+ and 1 in the ED- group). No differenceswere observed in intima-media thickness between ED+ and ED. Slightslower mean middle cerebral arteries flow velocities were observed inED+ in respect to ED -. ED + patients showed a reduced VMR anda slower VMR rate of change in respect to ED-.Conclusion: The reduced reactivity in patients with isolated ED mayrepresent a marker of early cerebral vasomotor dysfunction due to sub-clinical endothelial damage. In our opinion performing neurologicalinvestigations in ED patients is an unnecessary screening, even if ourdata encourage further studies about the relation between ED andcerebral ischaemic damage.Policy of full disclosure: None

MP-05-134

Brazilian aging male population studyAbdo, C.1; Afif-Abdo, J.2

1University of São Paulo, Sao Paulo, Brazil; 2Hospital Santa Cruz, Urology,Sao Paulo, Brazil

Objective: To present the results of a study concerning general health,sexual health and quality of life of Brazilians above 40 years old focus-ing on male indices.Methods: A self-administered and anonymous questionnaire wasapplied to 10,161 subjects, 40 years old and above, in 19 Braziliancities. Questions on general and sexual health, life habits and the AgingMale’s Symptoms scale (AMS) were answered in this survey. The datawas analyzed with chi-square tests; p ≤ 0.05 was considered statisticallysignificant.Results: The average age of the 5.658 male subjects was 52 years, and74.3% were in steady partnerships. 96.8% mentioned sexual activityin the previous year; 16.2% were obese and 50.3% were overw-eight; 14.9% had already used phosphodiesterase-5 inhibitors toobtain/sustain erection, 69.0% of whom with good results. 17.9%referred urinating two or more times throughout the night. In the pre-vious year, 33.5% had been seen by a urologist and had digital rectalexamination; 64.1% declared that they had been PSA tested, 3.9% ofwhom with “increased results”. The AMS revealed high levels of mod-erate/severe answers to: nervousness, irritability, sleep problems, jointpain and muscular ache, physical exhaustion, depressive mood, exces-sive sweating, decrease in the number of morning erections anddecrease in sexual desire/performance. This and seven other parame-ters that comprise the AMS indicated that 13.3% of the subjects hadsuggestive androgen deficiency in aging male (ADAM) symptoms.Among those with moderate/severe AMS erectile dysfunction (ED)was twice as among the ones with none/mild answers to the AMS.Conclusion: Male aging in Brazil causes losses in the sexual function,genito-urinary symptoms and metabolic syndrome. Moderate/severeAMS scale scores indicate two times more ED than none/mild answersto the AMS scale.Policy of full disclosure: This research was sponsored by BayerSchering Pharma Brazil.

MP-05-135

NCEP-ATP-III defined metabolic syndrome, type 2diabetes mellitus and prevalence of hypogonadism inmale patients with sexual dysfunctionCorona, G.1; Mannucci, E.2; Petrone, L.1; Belercia, G.3; Paggi, F.3; Fisher, A. D.1; Lotti, F.1; Chiarini, V.4; Forti, G.1; Maggi, M.5

1Andrology Unit, University of Florence, Italy; 2Diebetes Section, GeriatricUn, UNIVERSITY OF FLORENCE, Italy; 3Endocrinology Unit, Poly-technic University of Marc, Ancona, Italy; 4Endocrinology Unit, Maggiore-Bellaria Hospital, Bolgna, Italy; 5University of Florence, ClinicalPhysiopathology, Italy

Objective: Type 2 diabetes mellitus (T2DM) and metabolic syndrome(MetS) are characterized by insulin resistance and often associated withmale hypogonadism. To discriminate the specific contribution ofT2DM and MetS to male hypogonadism.Methods: A consecutive series of 1134 (mean age 52.1 ± 13 years) malepatients with sexual dysfunction was studied. Several hormonal andbiochemical parameters were studied along with ANDROTEST, a 12-item validated structured interview, specifically designed for thescreening of hypogonadism (total testosterone TT, <10.4 nmol/l orfree-testosterone FT, <37 pmol/l) in a male population with sexual dysfunction.Results: Irrespective of the criteria used to define hypogonadism,MetS was associated with a significantly higher prevalence of the con-dition, both in subjects with and without T2DM (41 and 29% vs.13.2% and 77.1 and 58% vs. 40.6%; respectively for TT and FT inpatients with MetS and with or without T2DM, when compared withsubjects without MetS and T2DM; both p < 0.0001). Conversely,T2DM was associated with a higher prevalence of hypogonadism in


J Sex Med 2008;5(suppl 2):69–93

subjects with MetS but not in those without MetS. Patients with MetS,with or without T2DM, also showed a higher ANDROTEST scorewhen compared with patients without MetS. Logistic multivariateregression analysis, incorporating the five components of MetS, iden-tified a significant association of elevated waist circumference andhypertriglyceridaemia with hypogonadism both in patients, with orwithout T2DM.Conclusion: Our study demonstrated that MetS and in particular vis-ceral adiposity (as assessed by increased waistline and hypertriglyceri-daemia) is specifically associated with hypogonadism in subjectsconsulting for sexual dysfunction.Policy of full disclosure: None

MP-05-136

Rigiscan monitoring of nocturnal tumescence inpatients with low testosterone level treated withtestosterone undecanoateYassin, A.1; Shamsodini, A.2; Saad, F.3; Alzubaidi, R.2; Al Ansari, A.2;Alkadi, S.2

1Segeberger Kliniken, Clinic of Urology & Andrology, Norderstedt,Germany; 2Hamad Medical Corporation, Urology, Doha; 3Gulf MedicalCollege & Bay, Male Healthcare, Berlin, Germany

Objective: To assess the effect of testosterone therapy in particular,injectable long-acting testosterone undecanoate on penile compositionand nocturnal tumescence and erection.Methods: 11 testosterone deficient subjects (total testosterone <12 nmol/l) with ED went through RigiScan control at baseline, after3 and 6 months during treatment with 1000 mg, injections of Tes-tosterone Undecanoate at day 1, 6 weeks later and then every threemonths. Baseline and monitoring program included history, physicalexamination, co-morbidities and concomitant medication. IIEF ques-tionnaire, DRE, PSA, t Testosterone level, liver function test, CBCand lipidogramm. Exclude patients with PSA >4 and abnormal DRE or high LFT. Patient education including video demonstration.Rigiscan for 3 consecutives nights at home, analysed for: number oferection events, average event rigidity in Tip & Base, base line cir-cumference (cm), & average event tumescence (cm) in both Tip andBase.Results: Remarkable improvement of number of erections or noctur-nal penile tumescence events from 2,7 ± 0,72, to 4.76 ± 0,63, as wellas number of average event rigidity from 56,6 ± 1.8 at tip and 48,09 ±90 at base up to 74,8 ± 88 at tip and 68,12 ± 54 respectively. No alter-ations found in follow up protocol with regard to liver function, PSA,DRE and CBC. Improvement in all lipid parameter.Conclusion: Testosterone therapy with t-undecanoate in hypogonadalpatients with ED is significantly improving penile rigidity and theevents of NPT within 3–6 months. These data are remarkably quan-tifying the erectile quality in this cohort.Policy of full disclosure: None

MP-05-137

The early period result of vasectomy: Effects on thequality of life and erectile functionPahin, A. F.1; Yildiz, G.1; Tuncay, B.1; Zorlu, F.11SB Tepecik Teaching Hospital, Urology, Izmir, Turkey

Objective: We aimed to research the early term effects of vasectomiesapplied for family planning on the quality of life and erectile function.Methods: This study was planned as a randomized prospective on05.16.2005 and is ongoing. Its early term results are given below. ShortForm-36 (SF-36) and International Erectile Function Index Form(IIEF) is completed for each case before the vasectomy. The no-scalpelvasectomy method was used. Study participants were asked to com-plete the short Form-36 (SF-36) and International Erectile FunctionIndex Form (IIEF) 3, 6, and 12 months after the vasectomy. We com-pared the results of both foms before the vasectomy and 3, 6 and 12months after the vasectomy. For the statistical analysis we have usedthe Student’s t test with a 95% margin of reliability.

Results: A total of 89 cases between 05.16.2005 and 01.15.2007 havebeen studied. Of vasectomy cases in the 3rd month 89 cases, in the 6thmonth 72 cases, and in the 12th month 58 cases completed the IIEFand SF-36 forms. While there are statistically significant resultsbetween pre-vasectomy and the IIEF forms which were completed inthe 3rd and 6th months (in order p = 0,043 and p = 0,025), by the 12thmonth there was no difference (p = 0,086). When we evaluated SF-36at the 3rd month we determined positive development in role strength(p = 0,007), general health (p = 0,001), social function (p = 0,012), andmental health (p = 0,002). We observed no significant difference inPhysical Function (p = 0,053), Pain (p = 0,168), Vitality (p = 0.052)and Emotion (p = 0,096).There was a significant difference in Physi-cal Function (p = 0,033) General Health (p = 0,001), Vitality (p =0,023), Social function (p = 0.017) and Mental health (p = 0.005) atthe 6th month. There was no difference in Physical Function (p =0,063), Pain (p = 0,113) and in Emotional role strength (p = 0,167).Finally we determine a positively significant difference in PhysicalFunction (p = 0,049), General health (p = 0,007), Vitality (p = 0,036),Social function (p = 0,013) and Mental health (p = 0,005) at the 12thmonth.Conclusion: In the early term observations for vasectomy, we can saythat vasectomy had no negative effect on quality of life and erectilefunction, morover, positive improvement has been observed particu-larly on mental and general health.Policy of full disclosure: None

MP-05-138

A study on blood and seminal serotonin level inmarried couple with infertilityReda, M.1

1Cairo, Egypt

Objective: Our aim is to correlate blood serotonin level to depressionin infertile couple, determine whether seminal serotonin level mayserve as marker for depression, and evaluate seminal serotonin effecton spermatic profile.Methods: Thirty two infertile couples and 12 control group were maleand females age and sex matching to subject, were recruited duringcounseling interview for infertility problem in assisted reproductiontechnique (ART) clinic at Gynecology Obstetric Hospital of Ain-Shams University.Results: Results showed that female depression was presented in 93%of cases while 100% in male, female depression had higher severitythen males. Blood and seminal serotonin was measured using Com-petitive Enzyme Immunoassay technique. Blood serotonin indepressed couples was significantly higher than that of the control (Pvalue < 0.000). Severity of depression was positively correlated withfemale serum serotonin level, while males gave no relation. Significantpositive correlation was found between serum serotonin levels andseminal serotonin level. High seminal serotonin level negatively affectsperm efficiency.Conclusion: The study showed that depression is evident in infertilecouples, with higher severity in females. Serum serotonin elevated indepressed couples with positive correlation with severity in females. Inmale partner elevated seminal serotonin was correlated to elevatedserum serotonin level which affected sperm efficiency profile as regardspermatic count, motility and percent of abnormal forms.Policy of full disclosure: no funding agencies

MP-05-139

Dapoxetine has no effects on hemodynamics orelectrocardiographic assessmentsModi, N. B.1; Nath, R.1; Wang, B.1; Rivas, D.2; Gupta, S. K.1

1ALZA Corporation, Clinical Pharmacology, Mountain View, CA, USA;2New Hope, PA, USA

Objective: To evaluate the effects of dapoxetine, an investigationalcompound for the on-demand treatment of premature ejaculation, onhemodynamics in hypertensive men currently stable on treatment and


J Sex Med 2008;5(suppl 2):69–93

on QT prolongation and electrocardiograms (ECGs) in healthy men.Methods: Three studies were conducted. Study 1 was a double-blind,placebo-controlled, crossover study that randomized hypertensive mencurrently stable on treatment (N = 15, ages 18–65 years) to receivesingle doses of placebo and dapoxetine 100 mg. Blood pressure wasmeasured for 8 hours before and 24 hours after treatment; treadmilltesting (Bruce protocol) was conducted 1.5 hours after treatment.Studies 2 and 3 were randomized, placebo- and positive-controlledcrossover studies in healthy men (ages 18–45 years) who received asingle dose of dapoxetine 60 mg, dapoxetine 120 mg, moxifloxacin 400mg (positive control), or placebo (Study 2; N = 48); and 2 doses ofdapoxetine 120 mg or placebo given 3 hours apart, or moxifloxacin 400mg (Study 3; N = 48). Twelve-lead ECGs were recorded continuouslyusing Holter monitoring from approximately 30 minutes before toapproximately 24 hours after dosing.Results: In Study 1, mean changes in hemodynamics from pre-exer-cise to completion of the treadmill test were similar for dapoxetine andplacebo. Mean blood pressure measurements during the first 24 hourswere slightly greater (generally <5 mmHg) with dapoxetine than withplacebo, but not clinically significant. In Studies 2 and 3, dapoxetinedid not have clinically significant ECG effects in comparison withplacebo at any dose studied and did not prolong the QTc interval,while moxifloxacin increased the QTc interval. No clinically signifi-cant effects on hemodynamics were observed in Studies 2 or 3. In all3 studies, adverse events were generally mild in severity, with nauseabeing the most common.Conclusion: In these studies, no clinically significant effects of dapox-etine were observed on hemodynamics or ECGs, including the QTcinterval.Policy of full disclosure: This study was funded by Johnson &Johnson Pharmaceutical Research and Development and ALZA Cor-poration. D.R. is an employee of J&J PRD. N.B.M., R.N., B.W., andS.K.G. are employees of ALZA Corporation.

MP-05-140

Chronic illness and sexuality: Patients’ perceptionLemaire, A.1; Alexandre, B.1

1ADIRS, Lille, France

Objective: Sexual problems in persons with chronic disease often leadto anxiety, marital discord, and withdrawal. It is the responsibility ofall health care professionals to inquire about sexuality. We try todemonstrate this allegation via 2 surveys performed by French associ-ation ADIRS among 2 groups of patients with chronic disease: COPD(group1), diabetes (group 2).Methods: In group 1, 7000 questionnaires have been sent to patientswho were members of specific associations; sexual functioning wasassessed. In group 2, 1000 Questionnaires have been sent to patients,member of French diabetic association (AFD).Results: In group 1, 468 men and 244 women completed the ques-tionnaire.214 men (45.3%) and 27 women (11.07%) describe sexualproblems. Among men, 144 (77%) describe erectile dysfunction and70 (37.4%) ejaculatory disorders; 117 (62.5%) estimated it alteredquality of life. 116 confirmed the sexual problem must be evoked bymedical team while only 70 men (37.4%) were seeking for treatment.Only 23 (12.3%) said that health care professionals correctly managedthe sexual problems. In group 2, 303 patients have replied. Amongmen, 177 (58.4%) describe erectile dysfunction and 68 (22.4%) ejac-ulatory disorders. 134 (44.2%) estimated it altered quality of life. 201confirmed the sexual problem must be evoked by medical team whileonly 140 men (46.2%) were seeking for treatment. Only 13 (4%) saidthat health care professionals correctly managed the sexual problems.When the question, “What are you looking for?” was asked in group1, 27.5.% wanted information about treatment, 34.6% were lookingafter specific treatment and 37% specific treatment plus psychother-apy. Similar results were obtained in group 2.Conclusion: In these studies, 40 to 60% of patients with chronicillness described a deterioration of quality of life due to sexual prob-lems. Even if they don’t want a treatment, 30% of the patients in eachgroup want simple information about their own problem. Health pro-

fessionals need to give education, support, and counselling on sexual-ity for patients with chronic diseasePolicy of full disclosure: None

MP-05-141

Couple perceptions and attitudes towards erectiledysfunction: Findings of the FEMALES studyEardley, I.1; Fisher, W.2; McCabe, M.3; Sand, M.41St James’ University Hospital, Pyra Department of Urology, Leeds, UnitedKingdom; 2University of Western Ontario, Department of Psychology,Canada; 3Deakin University, Department of Psychology, Burwood, Aus-tralia; 4Bayer Schering Pharma, Scientific Affairs, Wuppertal, Germany

Objective: Both patients and their partners are affected by erectiledysfunction (ED), and this condition should therefore be regarded asa shared sexual concern. The Female Experience of Men’s Attitudes toLife Events and Sexuality (FEMALES) study assessed the level of con-cordance or divergence among couple members’ perceptions regard-ing the specific functional impairments characterising the malepartner’s ED, and concordance or discordance of their attitudes, beliefsand experiences.Methods: Questionnaires were sent to partners of men with ED whoparticipated in the Men’s Attitudes to Life Events and Sexuality(MALES) 2004 study, and who consented to their partner’s involve-ment. A modified version of the questionnaire used in the MALESstudy was developed. This comprised 65 items relating to women’sperceptions, beliefs and attitudes regarding aspects of ED. FEMALESquestionnaire responses were analysed in relation to responses toequivalent questions provided by male study participants.Results: Women’s perceptions of the specific functional impairmentscharacterising their partner’s ED and the frequency of the partner’serection difficulty were highly associated with the assessments men hadprovided themselves. Significant associations were observed betweencouple members’ responses relating to their beliefs about the causes ofED, effects of ED on their relationship, communication about ED,finding a solution to ED and attitudes towards medication. A numberof sex-specific findings were highlighted, where couple members helddivergent views on the effect of ED on the couples’ everyday and sexuallife.Conclusion: The findings of this study demonstrate a high degree ofconcordance in the perceptions of the male partner’s ED withincouples, and their attitudes and beliefs about ED. However, a numberof differences between males’ and females’ perceptions and attitudeswere evident. Instances of discordance may be significant for thecouple, and may contribute to treatment avoidance or conflict.Policy of full disclosure: This study was sponsored by Bayer Scher-ing Pharma AG. Mr Eardley and Professor McCabe have acted as paidconsultants and speakers for Bayer Schering Pharma, Pfizer and Lilly-ICOS. Dr Fisher has acted as a paid speaker and consultant for BayerSchering Pharma and Pfizer. Michael Sand was an employee of BayerSchering Pharma at the time of the study.

MP-05-142

Validation and psychometric properties of theEnglish-language version of the female assessment ofmale erectile dysfunction detection scale (FAME)Rubio-Aurioles, E.1; Dean, J.2; Longworth, J.2; Eardley, I.3; Brock, G.4; Lee, J.5

1AMSSAC, Tlalpan, Mexico; 2The Salisbury Clinic, The Clinic, Plymouth,United Kingdom; 3St James’s University Hospital, Pyra Department ofUrology, Leeds, United Kingdom; 4St Joseph’s Health Care, Lawson HealthResearch Institu, London, Canada; 5Prostate Cancer Institute, UrologyResearch, Calgary, Canada

Objective: Erectile dysfunction (ED) impacts on both the man withthe condition and his female partner. The Female Assessment of MaleErectile dysfunction detection scale (FAME) was developed after qual-itative research, and its validity and reliability in a Spanish-speakingpopulation is already established. The objective of this study was to


J Sex Med 2008;5(suppl 2):69–93

document the validity and reliability of the English-language transla-tion of FAME among English-speaking participants from the UK andCanada.Methods: This multicentre study recruited couples comprising menwithout ED or men with untreated ED, and their female partners. Theconcurrent validity of FAME was assessed by measuring the Spear-man’s rho correlation coefficient between FAME and clinical diagno-sis, Sexual Health Inventory for Men (SHIM) scores, and erectilefunction domain of the International Index of Erectile Function (IIEF-EF) scores. Reliability was tested with Cronbach’s alpha; sensitivity andspecificity were checked against clinical diagnosis. The optimal cutpoint (i.e. the point at which an equivalent or lower score is consid-ered to indicate the presence of ED) was calculated by assessing sen-sitivity and specificity at several different cut points.Results: Three centres in the UK and two in Canada recruited coupleswith untreated ED (n = 51) and a comparison group comprisingcouples without ED (n = 57). FAME correlated significantly (p < 0.001)with clinical diagnosis (0.791), SHIM score (0.788), and IIEF-EFdomain score (0.777). Cronbach’s alpha was 0.941, indicating goodinternal consistency. At a cut point of 24 on FAME, sensitivity was86.0% and specificity was 96.1%, compared with corresponding valuesfor SHIM in this population of 80.3% and 95.7%, respectively.Conclusion: Accurate detection of ED in males by the female partneris possible. In this study, FAME (completed by the woman) displayedhigher sensitivity and specificity than SHIM (completed by the man).FAME demonstrated validity and reliability, as well as sensitivity andspecificity comparable with SHIM, in this multinational English-speaking population.Policy of full disclosure: Dr Rubio-Aurioles has acted as a paid con-sultant and speaker for Bayer Schering Pharma and Lilly-ICOS. DrDean has acted as a paid consultant, speaker or clinical trial investiga-tor for the following companies: Bayer, Boehringer-Ingelheim, GSK,Ipsen, Johnson & Johnson, Eli Lilly, Lilly-ICOS, MEDA, Pfizer,Plethora, Procter & Gamble, Pro-Strakan and Schering. Dr Long-worth has received payment as an investigator from Pfizer and Procter& Gamble and from Johnson & Johnson for sponsored clinical trials,and has accepted hospitality from Pfizer and Bayer. Mr Eardley hasacted as a paid consultant and speaker for Bayer Schering Pharma,Pfizer and Lilly-ICOS. Dr Brock has performed research and servedas a consultant and speaker for, and owns stock in, Bayer, Pfizer andLilly. Dr Lee is an advisor, investigator and speaker for Bayer Health-care. Michael Sand was an employee of Bayer Schering Pharma.

MP-05-143

Sexual dysfunctions and mental health inhaemodialysed patients—a SED multicenter studyLew-Starowicz, M.1; Lew-Starowicz, Z.2; Gellert, R.3

1Inst. of Psychiatry& Neurology, Department of Psychiatry, Warszawa,Poland; 2Postgraduate Medical Universit, Department of Clinical and For,Warszawa, Poland; 3Bielanski Hospital, Department of Internal Medicin,Warszawa, Poland

Objective: Chronic renal failure causes pathophysiological changesthat affect sexual function. Mood and sexual disorders are poorlyunderstood in dialysed patients. The aim of the study was to measurethe prevalence of various sexual dysfunctions, depression and comor-bidities in haemodialysed patients, as well as the links between them.Methods: In a multicenter (6 dialyse units), observational study, 112patients (42 women and 69 men) aged 20–60 were interviewed andassessed using The Arizona Sexual Experience Scale, Mell-Krat Scale,International Index of Erectile Function (IIEF-5), Beck DepressionInventory and Self-Evaluation Questionnaire. Patients’ medicalrecords were also investigated. The findings were compared with thedata available for the general population of Poles.Results: The most frequent sexual dysfunctions in haemodialysedpatients were loss or diminished sexual needs (84,7% of males and48,8% of females), erectile dysfunction (44,5%), inhibited or lack ofejaculation (51,5%), female arousal dysfunction and anorgasmia(67,8% and 80,7%, respectively). Cardiovascular and metaboliccomorbidities were found significantly higher compared to the general

population. The rate of undetected depression was extremely high(80,5%, 10-fold higher than found in medical records or self-reported). The quality of sexual life was poorer in patients with depres-sion and related to its severity (p < 0,05), patients with erectiledysfunction and bothered by decreased ability to maintain sexual activ-ity showed significantly higher levels of anxiety and depressive symp-toms (p < 0,001). Only 25% of patients were previously asked by aphysician about their sexual health.Conclusion: We found a high level of sexual disability in haemodial-ysed patients, that is connected with their comorbidities, the preva-lence and severity of depression and anxiety. The issues of sexual andmental health are strongly under-evaluated by medical professionals inthis group. The implementation of diagnostic and therapeutical algo-rhitms seems to be mandatory.Policy of full disclosure: None

MP-05-144

Personality characteristics in a forensic sample ofchild sexual abusersPechorro, P.1; Vieira, R.2; Poiares, C.3

1Faculty of Medicine of Lisbon, Portugal; 2Faculty of Medicine of Lisbon, Sexology, Lisboa, Portugal; 3Universidade Lusófona, Criminology, Lisboa,Portugal

Objective: The aim of this study was to evaluate the personality profiles and the emotional adjustment of a sample of arrested childsexual offenders, using the Millon Clinical Multiaxial Inventory-II(Millon,1987) and a general socio-demographic and sex behaviourquestionnaire.Methods: From a series of 55 incarcerated persons, it was analyzed agroup of 41 adult Portuguese males, b/w the age of 18 and 73, with amean age of 42.8% (DP = 14.1). The evaluation was carried on usinga psychometric instrument: Millon Clinical Multiaxial Inventory-II(MCMI-II,Portuguese full version, 26 scales, 175 items),and a demo-graphic, social and sexual behaviours questionnaire.Results: We obtained at least a significant elevation in one MCMI-IIscale in all the subjects. Analyzing in detail our results, four scalesbelonging to the-clinical pattern of personality- showed the highestscores: Dependent (63.4% of subjects); Compulsive(56.0%); Avoidant(48.8%); Schizoid (43.9%). In the category of -severe pathology of per-sonality- our data reported a relative elevation in the scale Schizotypal(24.3%). In the category ofclinical syndromes- a relative elevation inthe scale Anxiety Disorder (53.6%) was obtained. In the class of -severesyndrome-(Delusional Disoreder) we only reported a much more rel-ative high score in 12.2% of the subjects of our sample.Conclusion: Our results demonstrate a heterogeneous profile of personality obtained in the MCMI-II. Although there is no single child sex molester personality type, our results shows some character-istics of the child sexual abusers that are partially in accordance withothers studies. However an extension of this series is warranting tobetter defined the place of this psychometris instrument for forensicpurposes.Policy of full disclosure: None

MP-05-145

Psychometric validation of the sexual distressevaluation questionnaire for men (SDEQ-M)Ugolina, V.1; Macri, E.2; Capone, M.3; Ceruti, C.4; Franco, G.5; Gentile,V.6; Giammusso, B.7; Ludovico, G.8; Pescatori, E.9; Pirozzi Farina, F.10;Piubello, G.11; Scalvini, T.12; Soli, M.13; Turchi, P.14; Vaggi, L.15; Vetri, M.16

1Istituto di Psicologia, Bologna, Italy; 2Cegedim Strategic Data, Abacam,Milano, Italy; 3ASL 2 Trieste, UO di Urologia, Italy; 4AO S.Luigi—Orbas-sano, Divisione di Urologia, torino, Italy; 5Università La Sapienza—Roma,Dept Urologia, Italy; 6Università La Sapienza—Roma, Dip. Urologia I,Italy; 7Università di Catania, Urologia, Italy; 8Univ di Bari, Urologia, Italy;9Bazzano (Bologna), Italy; 10Università di Sassari, Urologia, Italy; 11Univer-sità di Verona, Medicina Interna, Italy; 12Osedale di Brescia, Med int, Italy;13Università Bologna, Andrologia, Italy; 14Andrologia Prato, Andrologia,Italy; 15L’Aquila, andrologia, Italy; 16Univ di Catania, Endocrinologia, Italy


J Sex Med 2008;5(suppl 2):69–93

Objective: Male Sexual Distress (MSD) is a recently described con-dition, not falling in the established clinical categories of Sexual Med-icine (J Sex Med, 2007; 4: 762–770). The purpose of this study hasbeen the psychometric validation of a self-administered ad-hoc ques-tionnaire, aimed to identify and grade MSD.Methods: An initial 30 items pool was the result of a qualitative study,based on the following indicators of MSD, obtained by the publisheddefinition of MSD (see reference above): condition of inadequacy,feeling of inadequacy, non-transitory condition, “sexual health”(WHO working definition) impairment, multifaceted origin of MSD, possible evolution of MSD into Erectile Dysfunction (ED). Theinitial 30 items questionnaire has been administered by 13 Androlo-gists, knowledgeable about the MSD condition, to a total of 258 menacross Italy with the following characteristics: 130 men with MSD, 68

men with ED, 18 men presenting unconventional requests for pro-erectile medications, 42 men without andrologic conditions (controlgroup).Results: Data obtained underwent item analysis, cluster analysis, dis-criminant analysis. This procedure allowed us to select 16 items of theoriginal pool, as functional in discriminating among the different eval-uated conditions, with particular respect to MSD.Conclusion: The process of psychometric validation has allowed usto identify 16 items that define the Sexual Distress Evaluation Ques-tionnaire for Men (SDEQ-M). This tool might allow Sexual Medicineresearchers to explore both the prevalence of Male Sexual Distress andthe outcome of possible therapeutic approaches.Policy of full disclosure: All authors have financial interest withPfizer Italy

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PP-01 Basic Science

PP-01-146

Nitric oxide inhibition induces penile vascularhyperreactivity via endothelin up-regulationAdams, M.1; Banting, J.2; Manabe, K.2; Heaton, J.2; Shamloul, R.3

1Queen’s University, Pharmacology & Toxicology, Kingston, Canada;2Queen’s University, Pharmacology, Kingston, Canada; 3Queen’s University,Dept. of Pharmacology, Kingston, Canada

Objective: To determine whether the inhibition of endothelial-derived nitric oxide (NO) results in enhanced locally generatedendothelin (ET)-mediated vasoconstriction in the penile vasculature.Methods: Using an isolated perfused penile vascular preparation, weassessed changes in perfusion pressure (PP), at a constant flow rate, in response to the selective α1-adrenocepter agonist methoxamine(MXA) at sub-pressor concentrations, MXAsubpress (0.5–1 µg/ml)and at submaximal concentration, MXAsubmax (6–9 µg/ml). A nitricoxide synthase inhibitor, L-NAME (100 µg/ml) was infused alone or in combination with MXA. Then, an ETA/ETB antagonist,PD145065 (30 µg/ml) was given when the PP was elevated by MXA-subpress and L-NAME. In a separate group of rats, cumulative con-centration-response curves to ET-1 and MXA with ETsubpress wereobtained.Results: MXA subpress, ET subpress and L-NAME alone did notincrease basal PP. L-NAME markedly potentiated the vasoconstrictorresponses to both levels of MXA, which was almost completelyrestored by PD145065. ETsubpress also potentiated (4-fold) the vaso-constrictor responses to MXA.Conclusion: Our findings demonstrate that endothelin plays a keyrole in mediating the α1-adrenoceptor vasoconstriction caused by lowNO levels. In the pudendal vasculature, this phenomenon leads toincreased ET activity which subsequently may play a critical role inerectile dysfunction.Policy of full disclosure: Rany Shamloul is supported by a Merck-Frosst postdoctoral fellowship

PP-01-147

The rat corpus spongiosum pressure (CSP) telemetrymodel and its applicationBaxter, D.1; Reynolds, D.2; Edmunds, N.2

1United Kingdom; 2Pfizer Global R&D, Genitourinary TA, Sandwich, Kent,United Kingdom

Objective: Historically spontaneous erections in conscious rats havebeen quantified using behavioural observation, however, recently tele-metric monitoring of corpus cavernosal, or corpus spongiosus pressure(CSP), has been successfully utilised. This study was designed tocompare these two methods of quantification and to investigate anyfurther utility of CSP-implanted animals.Methods: All experiments were conducted in accordance with UKlegislation and subject to local ethical review. Telemetric pressuretransducers were implanted into the corpus spongiosum of male ratsunder urethane anaesthesia. Following recovery, CSP recordings andbehavioural observations were taken concomitantly for 30 minutesafter addition of vehicle or apomorphine. During this time it was notedthat micturition events could also be clearly identified from CSP.Therefore, in a separate study, CSP was concurrently monitored in theanimals placed in automated metabolic cages capable of accuratelydetermining micturition events.Results: When quantified using CSP, apomorphine (10, 30 & 100 g/kg s.c.) caused a dose-dependent increase in the number of erections

(0.7 ± 0.5, 1.8 ± 0.6, 2.8 ± 0.5 and 5.7 ± 0.6 erections for vehicle andapomorphine treated groups respectively, P < 0.01 for 30 and 100 g/kgvs vehicle). Interestingly, the number of erections was lower when theywere quantified through visual observation, especially at higher dosesof apomorphine (0.3 ± 0.3, 1.7 ± 0.6, 1.2 ± 1.0 and 1.8 ± 0.5 erectionsfor vehicle and apomorphine treated groups respectively, P < 0.05 for10 and 100 g/kg vs vehicle). During the micturition experiment therewas an excellent correlation between actual volume voided and dura-tion of each void, measured through CSP telemetry.Conclusion: These data demonstrate that the CSP telemetry modelidentifies erections that would be missed by observation alone and thusoffers clear advantages over behavioural observation as a measure ofspontaneous erections. In addition to this we demonstrate that CSPtelemetered animals allow simultaneous detection and quantificationof erectile and micturition responses.Policy of full disclosure: Pfizer Golbal Research and Development

PP-01-148

The effect of testosterone therapy on bladderfunctions and histology in surgically menopauseinduced ratsCayan, S.1; Tek, M.2; Balli, E.3; Oguz, I.3; Karazindiyanoglu, S.21University of Mersin, Department of Urology, Turkey; 2University ofMersin School of, Department of Urology, Turkey; 3University of MersinSchool of, Department of Histology and Em, Turkey

Objective: Estrogen deficiency in postmenopausal women can causeurogenital dysfunction. However, the effect of testosterone on smoothmuscle of urogenital system in women is not well known. The aim ofthe study was to investigate the effect of testosterone therapy onbladder functions and histological changes in surgically menopauseinduced rat model.Methods: The study included 34 female Sprague- Dawley rats, andthe rats were divided into four groups. After bilateral ooferectomy, 6rats received IM saline injection, as a control group, and 9 rats receivedtestosterone undecanoate 100 mg/kg IM, and 9 rats received testos-terone undecanoate 100 mg/kg IM+ 0,50 mg nasal spray of 17-betaestradiol. Ten rats were taken as sham group. Urodynamic studies wereperformed in all groups before and after the study. The rats were sac-rificed after 60 days, and cystometric and histologic findings of thebladders were compared between the groups.Results: As shown in the table, increase in maximal bladder capacityand smooth muscle/collagen ratio were significantly higher in thetestosterone treatment group than in the control group (p = 0.01 andp = 0.008, respectively). Increases in maximal bladder capacity, bladdercompliance, and smooth muscle/collagen ratio were significantlyhigher in the testosterone+estradiol treatment group than in thecontrol group (p = 0.002, p = 0.005 and p = 0.04, respectively).Conclusion: This study shows that bladder functions may deterioratein postmenopausal period. In addition to estrogen replacementtherapy, testosterone has a significant role to increase bladder smoothmuscle, leading to improvement in bladder functions in post-menopausal women with urogenital system dysfunction.Policy of full disclosure: None

UNMODERATED POSTER PRESENTATIONS ABSTRACTS

Unmoderated Poster Presentations Abstracts 95

J Sex Med 2008;5(suppl 2):94–145

PP-01-149

The effect of the administration of sildenafil citrateon a daily basis on the histology of the mouse testis,epididymis, vas deference and penisDimitriadis, F.1

1G Gennimatas Gen Hospital, Urology, Thessaloniki, Greece

Objective: Sildenafil citrate (Viagra®) is widely used for the treatmentof erectile dysfunction. Extensive pharmacological and toxicologicalstudies in animals and in vitro have provided enough data to demon-strate the safety of this compound which is also confirmed by furtherpharmacokinetic exposure data in several clinical trials. However, theinternational literature furnishes limited data on the histology of themale external genitalia after continuous use of sildenafil. In the presentstudy we investigated the histopathological effects of sildenafil onmouse testes, epididymis, vas deference (VD) and penis using lightmicroscopical techniques.Methods: Twenty-five male mice were divided into two groups. Tenmice were used as a control group, whereas eleven mice were treateddaily with orally doses of sildenafil, within the human therapeuticrange, for the period of one month. At the end of the experimenthistopathological assessment of testes, epididymis, VD and penis wasconducted in all animals. The microscopic observation was performedon tissue samples stained with hematoxylene-eosin, while othersamples were stained with Periodic acid Schiff for better observationof the basement membranes and with Masson Trichrome stain for theevaluation of the connective and muscle tissue.Results: Only minimal alterations were observed on the testesbetween the control and treated groups, which will be discussed indetail. Nevertheless, normal spermatogenesis was present in all tissuesamples. Likewise, no alterations were noted on the epididymis, VDor penis between the control and treated animals.Conclusion: Other microscopical techniques such as electronmicroscopy could provide more details regarding the minimal testic-ular alterations observed in this study. However, under lightmicroscopy sildenafil in therapeutic exposure produces no adverseeffect to spermatogenesis or to histological structure of the mousetestis, epididymis, VD or penis highlighting a profile of very low riskof human toxicity.Policy of full disclosure: None

PP-01-150

Effects of diet control and phosphodiesterase type 5inhibitor on endothelial function in hypercholesterol-diet ratMin, K.1; Kang, D.1; Park, J.1; Kim, H.2; Choi, S.1

1Pusan Paik Hospital, Urology, Busan, Republic of Korea; 2Dankook Uni-versity hospital, Urology, Cheonan, Republic of Korea

Objective: To evaluate the effects of diet control and continuousadministration of phosphodiesterase type 5 inhibitor (PDE5I) onendothelial function destructed in 1% hypercholesterol-diet rat.Methods: Seventy Sprague-Dawley rats divided into 7 groups, 6 week-normal diet group, 10 week-normal diet group, 6 week-hypercholesterol diet group, 10 week-hypercholesterol diet group, 10week-hypercholesterol diet and PDE5I administrated group, 6 week-hypercholesterol diet followed by 4 week normal diet group and 6week-hypercholesterol diet followed by 4 week normal diet andPDE5I-administrated group. For developing the definite endothelialdamage, water including 1 mg/ml L-NAME was supplied to rats forfirst 2 weeks. PDE5I (Vardenafil) was administered transperitoneally1 mg/Kg/day since 2 weeks after cholesterole diet. The parameterswere serum cholesterol, endothelin-1, HIF-1α, TGF-β1 and eNOS.Results: Serum cholesterol increased by cholesterol diet, but did notrestore by diet control or PDE5I administration. mRNA of endothe-lin-1 and HIF-1α increased in cholesterol diet group, but improved indiet control and PDE5I administration group. TGF-β1 increased in

cholesterol diet group, not decreased in diet control group, andrestored by continuous PDE5I administration. eNOS showed downexpression in cholesterol diet group, is not recovered by diet control,but restored significantly by PDE5I administration.Conclusion: Endothelial dysfunction of corpus cavernosum inducedby hypercholesterolemia is not improved enough by control diet only.However continuous administration of PDE5I with diet control mightimprove or prevent endothelial dysfunction induced by hypercholes-terolemia.Policy of full disclosure: None

PP-01-151

Assessment of the use of sildenafil citrate for theprotection of erectile tissue and function followingcastration in the rat modelMüller, A.1; Deveci, S.2; Kobylarz, K.2; Tal, R.3; Sulser, T.1; Mulhall, J.2

1University Hospital Zurich, Urology, Switzerland; 2Weill Medical Collegeof Corne, Urology, New York, USA; 3Memorial Sloan-Kettering Cance,Urology, New York, USA

Objective: Castration by surgical or chemical means is a well-established therapy for metastatic prostate cancer. In animal models,testosterone deprivation to castration level has been shown to inducesmooth muscle structural changes leading to venous leak. In animaland human models, sildenafil citrate (V) improved preservation of cav-ernosal smooth muscle content after cavernous nerve injury. Thisstudy was conducted to define if V use was able to reduce the functional and structural changes that occur in the rat penis after castration.Methods: 50 Sprague-Dawley rats were studied, 40 underwent a bilat-eral orchiectomy (O). The animals were divided into 5 groups, 10animals per group had erectile hemodynamics assessed at two timepoints (7, 28 days). Sham animals (S) had no orchiectomy. Controlanimals had orchiectomy only (O7 and O28), and the treatmentanimals were injected with V 20 mg/kg sc daily after castration for 7or 28 days (V7, V28). Functional analysis was assessed by measuringmean maximum ICP/MAP ratios after cavernous nerve stimulation.TUNEL assay was used to define apoptotic indices (AI) and Masson’strichrome (MT) staining was used to measure smooth muscle-colla-gen ratios.Results: Results: Both treatment groups (V7, V28) showed a statisti-cally significant improvement in ICP/MAP ratio compared to theircorresponding control group (O7, O28) (table). No significant differ-ences existed in ICP/MAP values at 28 days compared to 7 days forboth groups. However, even with V treatment, ICP/MAP values forV7 and V28 remained statistically significant below the S28 group (p< 0.001). The AI for the S28 group was 10%. AI were 28% for O7and O28, 22% for V7 and 32% for V28 (O7 vs V7, p = 0.06; O28 vsV28, p = 0.8). Smooth muscle-collagen ratio for V28 was 29% and sig-nificantly higher compared to 7% for O7 and V7 (p < 0.05).Conclusion: Daily V treatment for 7 days as well as 28 days improvederectile function (EF) in rats after castration. ICP/MAP ratio increasedsignificantly in both treatment groups compared to control groupswith the greatest protection of erectile function after 28 days of Vadministration. The improved EF recovery with V after surgical cas-tration appears to be mediated by smooth muscle preservation.Policy of full disclosure: None

96 Unmoderated Poster Presentations Abstracts

J Sex Med 2008;5(suppl 2):94–145

PP-01-152

The impact of shock wave therapy at varied energyand dose levels on functional and structural changesin erectile tissueMüller, A.1; Akin-Olugbade, Y.2; Deveci, S.2; Donohue, J.3; Tal, R.3; Sulser, T.1; Mulhall, J.2

1University Hospital Zurich, Urology, Switzerland; 2Weill Medical Collegeof Corne, Urology, New York, USA; 3Memorial Sloan-Kettering Cance,Urology, New York, USA

Objective: Minimal literature exists on sequelae of penile shock wavetherapy (SWT) on erectile function. This study was undertaken todefine impact of SWT impact on functional and structural changes inerectile tissue.Methods: In 45 rats 2000 shock waves (sw) at 2 BAR (highdose/energy HD) were applied to the penis weekly including one, two,and three sessions (HD-1, HD-2, HD-3). Each group was followedfor 1, 7, or 28 days before measuring intracavernosal pressure (ICP)and mean arterial pressure (MAP). Fifteen control animals (C1, C7,C28) underwent anesthesia alone. Another 15 animals were exposedto three SWT-sessions applying 1000 sw at 1 BAR (low dose/energyLD) and analyzed identically (LD-3-1, -7, -28). Terminal deoxynu-cleotidyl transferase biotin-dUTP nick-end-labeling assay was used toassess apoptotic indices (AI) and Masson’s trichrome (MT) staining toevaluate smooth muscle-to-collagen ratios.Results: Mean ICP/MAP ratios for C groups displayed a mean of64%. All SWT groups demonstrated significantly reduced ICP/MAPratios (p < 0.05). The LD-3 groups showed a trend toward improvedICP/MAP ratios but remained lower than C groups. No statistical dif-ferences were seen for MT staining in SWT groups compared to C.AIs for the LD-3 group were significantly lower compared to the HD-3 group (p < 0.001), but all AIs were significantly increased comparedto C groups (p < 0.01).Conclusion: Overall, at both energy/dose levels, SWT resulted in atime- and treatment-dependent reduction of ICP/MAP ratios, whichmight be mediated partly through apoptosis and collagenization ofcorporal smooth muscle.Policy of full disclosure: None

PP-01-153

Uroflowmetry as reliable test in detection ofneurogenic erectile dysfunction in diabetic patientsNale, D.11Clinic of Urology, Urology, Belgrade, Serbia

Objective: Aim was to estimate which of uroflowmetric parameterssignificantly correlate with neurogenic detrusor insufficiency and neu-rogenic erectile dysfunction in diabetics.Methods: 94 pts with diabetes mellitus (DM) were included in study(cross sectional study). Mean age of the pts were 53 ± 13 yrs, SD(range: 23–77). The average duration of DM was 9,88 ± 6,95 yrs, SD(range:0,2–31). The patients were divided due to severity of diabeticcystopathy (DC) and lower urinary tract symptoms. 43 pts sufferedfrom incipient DC and had subclinical presentation of autonomic neuropathy, while 51 pts were with prominent DC(RU over 20% of bladder capacity, severely damaged sensibility, hypo or acontractiledetrusor) and clinical presentation of autonomic neuropathy. Alluroflowmetric parameters were determined during spontaneousuroflowmetry and pressure-flow-EMG study. As for ED the thoroughinterview with the pts was carried out, as well as laboratory analysis,penodynamic test, Duplex Doppler ultrasonography, EMG of lowerextremities, Ewing-Clark test.Results: Out of 43 pts in the first group 23 (53,47%) had neurogenicand/or neurogenic-vasculogenic ED, while in the second group out of51 pts, 49 (96,08%) had neurogenic and neurogenic/vasculogenic ED(p = 0.002). In the second group periferic neuropathy was more oftenrecorded (p = 0.008), also earlier onset of DM(0.001), as well as longerduration of DM (p = 0.009). Voiding time and time to Qmax was sig-nificantly longer in the group of pts with more prominent DC (p =

0.03). Voidng volume and PVR was significantly bigger in secondgroup.Conclusion: Uroflowmetry is simple, non-invasive method of urineflow testing i.e. establishing the existence of detrusor insufficiency orsubvesical obstruction, but as well, secondary way, of autonomousdibetical penile neuropathy.Policy of full disclosure: Uroflowmetry is non-invasive screeningmethod for establishing autonomous neuropathy.

PP-01-154

Antenatal corticotherapy influences adult male sexual behaviorOliveira, M.1; Leao, P.1; Sousa, N.1

1University of Minho, ICVS School of Health Sciences, Braga, Portugal

Objective: In clinical practice, the use of antenatal short-term syn-thetic corticotherapies in order to accelerate lung maturation is oftenencouraged. Recently, however, several clinical and animal studies haverevealed behavioral impairments later in life induced by these treat-ments, in which a persistent HPA axis disruption seems to play a critical role. Also, alternative treatments with natural ligands of corticosteroid receptors have been proposed to be less injurious. Sinceno previous studies have focused on the potential implications of theseshort-term prenatal corticoid treatments on adult male rat sexualbehavior, we thought of interest to evaluate them and to compare theimpact of the use of different ligands of corticosteroid receptors.Methods: Pregnant Wistar rats were injected with dexamethasone(DEX-1 mg/kg), corticosterone (CORT-25 mg/kg) or saline on preg-nancy days 18 and 19. Male offspring (n = 8), when aged 3 months,were tested for male sexual behavior by exposure to sexually receptiveovariectomized females. Mounting, intromissions and ejaculationswere assessed. Testis wet weight and testosterone levels were alsodetermined. Data was analyzed using multivariate ANOVA; statisticalsignificance was considered when p < .05.Results: A significant reduction on number of mounts and intromis-sions was found on DEX-exposed, but not on CORT-exposed animals,which displayed an intermediate sexual behavior phenotype. Further-more, an increased latency time to mounting activity and intromissionwas found in the male progeny of DEX-treated dams. Both controlsand CORT subjects displayed a significantly higher intromission ratio(an indicator of efficiency of penile erection) when compared to DEX-exposed animals. Serum testosterone levels of DEX progeny were alsosignificantly reduced. Testis wet weight was not affected.Conclusion: Our data suggests that antenatal dexamethasone impairsmale sexual behavior in adulthood, whilst equipotent corticosteronetreatments trigger a less detrimental effect. These behavioral impair-ments are correlated with hormonal disruption, but further studies arerequired to clarify the mechanism underlying these effects.Policy of full disclosure: The authors have no financial interest orother affiliations with a funding organization or with a commercial sup-porter of the session and/or provider of commercial services to declare.

PP-01-155

Transmission electron microscopy comparative studybetween normal human corpus cavernosum and aninduced male hypogonadism modelOliveira, R.1; Tomada, N.21; Tomada, I.2; Neves, D.2; Vendeira, P.1

1Hospital de Sao Joao, Servico de Urologia, Porto, Portugal; 2Laboratory ofCell Molecular B, Faculdade de Medicina of Unive, Porto, Portugal

Objective: Androgens have an important effect on cellular structureand organization of corpus cavernosum in animal models. Their rolein human penile tissue is still controversial, although clinical and pre-clinical evidence suggest that they are critical for erectile function. Ourobjective was to compare the ultrastructural anatomy of the normaland medical androgen deprived human corpus cavernosum. To ourknowledge, this study has not yet been performed in human tissue and,in this way, we hope it leads to a better understanding of the corporalmorphological changes induced exclusively by the lack of androgens.


J Sex Med 2008;5(suppl 2):94–145

Methods: The human androgen deprived penile fragments used inthis study were removed from young healthy individuals submitted to male to female sex reassignment surgery (3 cases). These patientshad undergone a standard androgen deprivation chemical regimen(espironolactone—100 mg twice daily; cyproterone acetate—50 mgonce daily for 2 years, followed by estradiol—2 mg twice daily for 1year). The normal penile fragments were taken from patients submit-ted to penile deviation surgery (11 cases). The study design was author-ized by the local university ethics comittee. The tissue was fixed inglutaraldehyde, Epon embedded and comparative study was performedby transmission electron microscopy (Jeol 100B).Results: In transsexual corpus cavernosum we observed a clearincrease in fibromuscular stroma, especially collagen fibers. We veri-fied thinning of the basal lamina in both endothelial and smoothmuscle cells, that also presented paucity of contractile filaments andcell surface vesicles, when compared with normal tissue. In the andro-gen deprived specimens endothelial cells surrounding sinusoidal spaceswere thinner. We did not observe adypocites.Conclusion: Characterization of the ultrastructural changes in anandrogen deprivation setting would be relevant in the elucidation ofandrogen insufficiency contribution to erectile dysfunction onset.Since these results corroborate previous evidence on orchidectomizedanimal models, it is our conviction that they represent new insights inunderstanding the role of androgens in the mechanisms of erectilefunction in human.Policy of full disclosure: None

PP-01-156

Can penile blood be a marker to predict erectile capacity?Serefoglu, E. C.1; Erdamar, H.2; Ozdemir, A. T.1; Atmaca, A. F.1; Berktas, M.3; Balbay, M. D.1

1Ankara Ataturk Hospital, Urology, Turkey; 2Beytepe Military Hospital,Medical Biochemistry, Ankara, Turkey; 3Plato Statistic & Medical, Statis-tics, Ankara, Turkey

Objective: The aim of this study was to look into a biochemicalmarker in penile blood sample which can predict the tumescence gradeand/or penile Doppler ultrasound parameters.Methods: A total of 46 patients with erectile dysfunction, evaluatedwith a penile Doppler ultrasound 10 minutes after intracavernosalinjection of 60 mg papaverine, were included. Tumescence grade,peak-systolic velocity (PSV), end-diastolic velocity (EDV) and resis-tive index (RI) were recorded. Approximately 10 cc of cavernosal bloodsamples were drawn. The levels of calcium (Ca), myeloperoxidase(MPO), malondialdehyde (MDA), nitrite, nitrate, vasoactive intestinalpeptide (VIP) and cyclic guanosin monophosphate (cGMP) and theactivity of superoxide dismutase (SOD) were measured. Statisticalanalysis were done with Spearman Correlation Test, Jonckheere-Terp-stra Test and Mann-Whitney U Test when needed. Statistical signifi-cance level was set at 0.05.Results: We could not find any significant correlation between penileDoppler ultrasound parameters and any of penile blood Ca, MPO,SOD, MDA, nitrite, nitrate, VIP levels. However, there was a signif-icant negative correlation between cGMP and PSV (Rho = −0.533, P= 0.001), as well as with RI (Rho = −0.468, P = 0.005). On the otherhand a positive correlation between cGMP and EDV was detected(Rho = 0.322, P = 0.059). Mean cGMP level in tumescance grade 2group was 3.347 ± 0.694 pmol/ml (2.295–4.685), in grade 3 group was3.193 ± 0.669 pmol/ml (2.165–4.094) and in grade 4 group was 2.742± 0.690 pmol/ml (1.290–4.011) which was significant between groups(P = 0.027). In subanalyses, there was no significant difference betweengrade 2 and 3 or grade 3 and 4 in terms of cGMP levels (P = 0.883, P= 0.118 respectively). However there was a significant differencebetween grade 2 and 4 tumescence groups (P = 0.039).Conclusion: Penile blood cGMP level can be a marker which predictsthe tumescence grade and penile Doppler ultrasound parameters.Further studies are required to support this statement.Policy of full disclosure: This study was partially supported byNovartis Pharmaceuticals, Oncology Group, Turkey.

PP-01-157

The effect of testosterone replacement therapy onbladder functions and histology in late onsethypogonadism induced rat modelTek, M.1; Balli, E.2; Cimen, B.3; Efesoy, O.4; Cayan, S.4

1University of Mersin School, Turkey; 2University of Mersin School of,Department of Histology and Em, Turkey; 3University of Mersin School of, Department of Biochemistry, Turkey; 4University of Mersin School of,Department of Urology, Turkey

Objective: Studies suggest that testosterone replacement therapy mayimprove sexual functions in men with symptomatic late-onset hypog-onadism. However, the effect of testosterone on bladder smoothmuscle has not been studied. The aim of the study was to investigatethe effect of testosterone replacement therapy on bladder functionsand histological changes in late onset hypogonadism induced ratmodel.Methods: The study included 25 male Sprague-Dawley rats, and therats were divided into tree groups. In the first group (n = 9) sham oper-ation was performed. After bilateral orchiectomy, 8 rats received IMsaline injection, as a control group, and 8 rats received testosteroneundecanoate 100 mg/kg IM as a treatment group. Urodynamic studieswere performed in all groups before and after the study. The rats weresacrificed after 60 days, and in all rats, serum testosterone level,prostate measurement, cystometric and histologic findings of the blad-ders were compared between the groups.Results: As shown in the table, increase in maximal bladder capacityand smooth muscle/collagen ratio were significantly higher in thetestosterone treatment group than in the control group (p = 0.002 andp = 0.01, respectively). The bladder compliance decreased in thecontrol group, and increased in the treatment group, although the dif-ference was not statistically significant (p = 0,191).Conclusion: This study shows that bladder functions may deterioratein late onset hypogonadism. Testosterone replacement therapy in lateonset hypogonadal men with urogenital dysfunction may have a sig-nificant role to improve bladder function by increasing bladder smoothmuscle.Policy of full disclosure: None

PP-01-158

Preliminary study of angiogenic factors expression in corpus cavernosum in rat after chronic intake ofhigh-fat dietTomada, I.1; Tomada, N.2; Oliveira, R.2; Vendeira, P.2; Neves, D.2

1Universidade do Porto, Faculty, of Nutrition & Food Science, Portugal;2Laboratory of Molecular Cell B, Portugal

Introduction: Epidemiologic studies show a correlation between riskfactors for erectile dysfunction (ED) and cardiovascular disease, someof them potentially modifiable. Recent evidences also indicate a highprevalence of ED in obese men that could be associated with high-fat(HF) intake, and there is evidence that this type of diets may alsoinduce endothelial dysfunction. VEGF (Vascular Endothelial GrowthFactor) is the main vascular growth factor essential to endothelial cellsurvival and proliferation. It is well established that VEGF and othervascular growth factors are frequently diminished in corpus caver-nosum of DE patients, and that its levels are particularly modified inobesity.


J Sex Med 2008;5(suppl 2):94–145

Objectives: Characterization by immunohistochemistry (IH) ofVEGF and HGF (Hepatocyte Growth Factor) expression in corpuscavernosum in a model of HF diet fed rats.Methods: Male Wistar rats (2-months, n = 30) were randomly dividedin two groups: HF diet (45% from fat) treated until complete 4 or 6mo and age-matched control group (standard diet with 4% from fat).Body weight, food ingestion, glycaemia and blood pressure were mon-itorized. Rats were sacrificed by decapitation and trunk blood andpenis fragments were removed for haematoxylin and eosin staining(HE) and immunohistochemical analysis. Goat polyclonal anti-VEGF(R&D) and goat polyclonal anti-HGF (Santa Cruz) were used to IHessays.Results: No significative differences were observed in metabolicparameters studied. HE staining evidenced well preserved endothe-lium in cavernosal vessels delimited by smooth muscle fibers, and plen-tiful connective tissue between cavernosal vessels was observed in bothgroups. No marked differences were found in VEGF and HGF expres-sion in rat corpus cavernosum between groups studied.Conclusion: HF fed rat experimental model presents a great impor-tance in studies of dyslipidemia-related DE. Although we didn’tobserve significative differences in major angiogenic factor expression,further molecular studies will be performed in order to clarify thesefindings. Sponsored project by Faculty of Nutrition and Food Sciencesof Universidade do Porto.Policy of full disclosure: None

PP-01-159

Preparation of penile corpora cavernosous matrix in rabbitsZhu, H.1; Li, H.2; Cui, Y.1; Gui, Y.2; Cai, Z.2

1Peking Univ. Shenzhen Hospital, Plastic Surgery, People’s Republic ofChina; 2Peking University Shenzhen Hos, Lab for Male Repreductive Medi,People’s Republic of China

Objective: Substitutes of penile corpora cavernosa have been used forhuman penile reconstruction in the past 60 years; however, the recon-structed penis often has defect in erective function. With the devel-opment of tissue engineering, functional penile reconstruction usingtissue engineering penile corpora cavernosa (TEPCC) had become apossible solution for the problem. We search for a method using acel-lular corporal tissue matrix (ACTM) for the scaffold of TEPCC.Methods: Penile corpora cavernosa of male adult New Zealand rabbitswere integrally separated and urethra was left intact. The separatedpenile corpora cavernosa were treated with cell lysis buffer (1% TritonX-100 + 0.1% ammonium hydroxide) and incubated at 4°C for 5, 10,15, 20, 25, and 30 days to prepare acellular corporal collagen matri-ces. Then the digested corpora cavernosa were made into slices (6 mm)and stained by HE staining. The efficiency of acelluar treatment wasobserved under microscope. The acellular corporal tissue matrix pre-pared were lyophilized and stored at −80 °C for the future use.Results: The separated penile corpora cavernosa was about 3 cm inlength and 0.7 cm in width at the proximal end and 0.4 cm at the distalend. Smooth muscle cells and endothelium cells were evenly distrib-uted in intracellular matrices. The results of HE staining showed thatthe cells began to strip from the corpora cavernosa on day 5. Thenumbers of cells were significantly decreased on day 15. On day 25,there was no cell observed on the slides of the acellular corporal tissuematrix under microscope. Furthermore, the structure of the acellularcorporal tissue matrix was intact; elastic fibers were arranged regularlywith undestroyed frame.Conclusion: We have successfully set up a method to construct acel-lular penile corporal cavernosa in rabbits, which may be used for thescaffold of tissue engineered penile corpora cavernosa.Policy of full disclosure: This work supported by a grant fromGuangdong Health Science and Technology Research Foundation(A2005646).

PP-02 Risk factors

PP-02-160

Sexual and reproductive functions in epileptic malesAbdallah, M.1

1Cairo, Egypt

Objective: Objectives : To study the sexual and reproductive functionschanges in epileptic males.Methods: Design and Methods: 30-randomly selected- adult, marriedepileptic males and 15 age matched volunteers -married for the sameperiod- as control. The age of puberty, number of children, libido,grade of erection (E5, E4 ... E0), frequency of weekly sex acts, andejaculatory state were recorded. Serum prolactin (PRL), free testos-terone (FT) and follicle stimulating hormone (FSH) were measured.Results: Results :—Patient’s and control ages are matched (32 ± 3.5vs 30.8 ± 1.6 years for control, P > 0.05).—Age of puberty is the samefor both groups (15.2 ± 0.4 vs 15.3 ± 0.5 years for control, P > 0.05).—Period of marriage is the same both groups (3.4 ± 2.2 vs 2.6 ± 1.1 yearsfor control, p > 0.05).—One third (33.3%) of epileptics vs non of thecontrol reported low libido, (P < 0.01).—One third (33.3%) of epilep-tics vs non of the control have E3. The other two thirds (66.7%) vs40% of the control showed E4. Non of epileptics reported E5 vs mostof the control (60%), (p < 0.0001).—Epileptics practice sex nearly2/week (1.9 ± 1.1), while controls do it 3/week (2.7 ± 1.5, p > 0.05).—One fifth (20%) of epileptics vs non of the control have prematureejaculation (PE), (p < 0.05).—PRL is significantly higher in the epilep-tics (272.9 ± 90.2 vs 157.0 ± 58.9 mIu for the control, P < 0.0001).—FT level is the same in both groups (27.1 ± 14.6 vs 28.8 ± 7.1 pg/mlin the control, p > 0.05).—The fertility potential -governed by thenumber of children fathered in the same period of marriage and FSHlevel changes -showed no change. The epileptics have 2.4 ± 1.1 chil-dren vs 2.1 ± 1.2 for the control, (P > 0.05) and the serum FSH level18.9 ± 2.7 vs 18.6 ± 2.3 mIu/ml for the control, (P > 0.05).Conclusion: Conclusions: Epileptics have no problem with pubertybut their libido, rigidity of erection and frequency of sex acts are lessthan normal. They are more prone to PE. These problems are -ingreat part- due to hyper PRL and psychic stress. The role ofantiepileptics need evaluation. They have normal fertility potentialPolicy of full disclosure: None

PP-02-161

Erectile function in patients who underwent prostatesaturation biopsy: Comparision of prostate cancerpatients and normalsAkbal, C.1; Türker, P.2; Tavukcu, H. H.2; Simsek, F.2; Türkeri, L.2

1Marmara University Hospital, Dept. of Urology, Istanbul, Turkey;2Marmara University School of M, Urology, Istanbul, Turkey

Objective: In this prospective study, we evaluated the erectile func-tion following transrectal, ultrasound-guided saturation biopsies of theprostate.Methods: One-hundred-six patients were included in the study.Patients with a persistently elevated prostate specific antigen (PSA)level underwent a saturation biopsy. A median of 22 (min: 20—max:30) core prostate saturation biopsies were taken. Group I included 74patients who were reported cancer free and Group II included 32patients who were reported as having prostate cancer and on a waitinglist for radical treatment. Patients were evaluated for erectile functionbefore and one month after the procedure with an International Indexof Erectile Function-5 (IIEF-5). The severity of the erectile dysfunc-tion (ED) was classified into four categories; severe (5–7), moderate(8–16), mild (17–21), and no ED (22–25). Concomitant systemic dis-eases and medications that would interfere with erectile function wererecorded.Results: According to the IIEF-5, for Group I patients who were pre-viously potent, the ED rates were 11.6 percent at the first month, andno ED was reported at the sixth month of evaluation. For Group IIpatients who were previously potent, the ED rates were 60 percent at


J Sex Med 2008;5(suppl 2):94–145

the first month. The assessment of IIEF-5 scores displayed a statisti-cally significant difference between the baseline and the first month intwo groups.Conclusion: Although the saturation biopsy of the prostate is a safeprocedure on the basis of erectile function, the risk of erectile dys-function after the biopsy should be discussed with previously potentpatients. The impact of biopsy on sexual function might be moreprominent in patients who have prostate cancer because of the anxietyfactor.Policy of full disclosure: None

PP-02-162

The effect of consanguineous marriage on male sexual functionAkbal, C.1; Tavukçu, H. H.1; Tinay, I.1; Mangir, N.1; Simsek, F.11Marmara University Hospital, Dept. of Urology, Istanbul, Turkey

Objective: To evaluate the impact of consanguineous marriage onsexual function in patients with infertility.Methods: Between October 2006 and July 2007, 100 patients, whoadmitted to our Andrology clinic with male infertility, were questionedabout the presence of consanguineous marriage. The degree of con-sanguinity is sub classified as close (first degree) or distant (second orthird degree). Patients with or without consanguinity were comparedin terms of sexual function with the International Index of ErectileFunction- 5 (IIEF-5) questionnaire, presence of oligo-astheno-teratospermia (OAT) or azoospermia. Paired t-test was used tocompare patient characteristics and IIEF-5 scores among the groups.Results: Of those 100 patients, the degree of consanguinity is close infive (5%) patients (group 1) and distant in nine (9%) patients (group2); 86 (86%) patients reported no consanguinity (group 3). The pres-ence of azoospermia is noticed in four (23%) of the patients with con-sanguinity and one patient in this group was also diagnosed withKlinefelter syndrome. Seven patients (50%) had OAT in sperm analy-sis and the remaining three patients were diagnosed with unexplainedmale infertility (21%). The mean age of patients with close consan-guinity was 31.8 (24–40) years and they reported a mean IIEF-5 scoreof 19.2 (13–25). The mean age of patients with distant consanguinitywas 38.3 (28–53) years and they reported a mean IIEF-5 score of 21.5(15–25). The mean age patients who reported no consanguinity was34.4 (24–53) years and they reported a mean IIEF-5 score of 23.5(16–30). There were statistically significant differences in IIEF-5scores between groups 1 to 3 (p = 0.0081). There were no differencesin IIEF-5 scores between groups 1 to 2 (p = 0.3607) and betweengroups 2 to 3 (p = 0.1931).Conclusion: The degree of consanguinity is an important risk factorin having sexual dysfunction in patients with infertility. Patients withclose consanguinity should be evaluated for erectile dysfuntion andtreated during infertility work-up.Policy of full disclosure: None

PP-02-163

Circadian autonomic changes in patients with andwithout erectile dysfunctionDogru, T.1; Basar, M.2; Yuvanc, E.2; Celik, T.3; Iyisoy, A.3

1University of Kirikkale, Cardiology, Ankara, Turkey; 2University ofKirikkale, Urology, Ankara, Turkey; 3Gulhane Military Medical Acade,Cardiology, Ankara, Turkey

Objective: The aim of the present study was to evaluate the differ-ence between the circadian autonomic changes in patients with andwithout erectile dysfunctionMethods: A total of 77 male patients were enrolled into the study.After a detailed physical examination, laboratory analysis includingSMA-24 and sex steroid levels was performed and IIEF scale was filledby all participants. Based on IIEF values, the patients were categorizedinto 2 groups as having erectile dysfunction (IIEF <26) (Group-1) orhaving normal erectile capacity (IIEF >26) (Group-2). Moreover, 24-hour Holter monitoring was performed for recording parasympathetic

and sympathetic activities and nocturnal and morning values were calculated.Results: Thirty-four patients (44.2%) had erectile dysfunction, while43 (55.8%) had normal erectile function. There was no statistically sig-nificant difference between the two groups in terms of age, biochem-ical parameters and serum sex steroid levels. Mean IIEF scores were20.18 ± 6.35 (1–25) in Group-1, and 28.79 ± 1.30 (26–30) in Group-2. The difference between the mean IIEF scores of two groups wasstatistically significant (p = 0.001). All nocturnal sympathetic activitieswere higher and nocturnal parasympathetic activities were lower inGroup = 1 as compared with Group-2. However, the comparisonsreached a statistically significant level only for sympathetic values(pLFn = 0.000, pLF/HF = 0.000, pGSI = 0.002). While no differenceswere observed between the two groups for serum steroid hormonelevels, all sympathetic values showed positive correlation withincreased serum estradiol levels.Conclusion: Nocturnal cardiac activity has a significant impact onpenile hemodynamics, which may be ascribed to serum steroidhormone levels.Policy of full disclosure: None

PP-02-164

Intermediate hyperglycemia in metabolic syndromepredict the risk of precocious onset of erectiledysfunction in type 2 diabetesCoca, V.1; Porav, D.2; Coca, M. C.3; Hancu, N.4

1Diabetes Clinical Centre, Sexual Medicine, Cluj-Napoca, Romania;2Municipal Hospital, Urology, Cluj-Napoca, Romania; 3Diabetes ClinicalCentre, Laboratory, Cluj-Napoca, Romania; 4Diabetes Clinical Centre,Head, Cluj-Napoca, Romania

Objective: Erectile dysfunction (ED) was proven to be seriously cor-related to metabolic syndrome (MS) and cardiovascular risk (CVR).We studied if MS impaired fasting glucose (IFG), impaired glucosetolerance (IGT) or both can predicts an eventually early onset of EDand its prevalence soon after clinically expression of type 2 diabetes(T2DM).Methods: A 264 cohort abdominally obese men, without ED, wereevaluated between 2000–2002 concerning their glucose serum levelstatus, added to other minimum 2 markers defining MS (V1) andbetween 2004–2006 only those of them newly registered with diabeticglycemia (187 men; V2). Only for these baseline data has been recon-sidered and they were retrospectively divided in three groups: A = 63cases (IFG); B = 65 cases (IGT); C = 59 cases (IFG+IGT) and corre-lated with ED as one as an initial symptom in their become T2DM.Results: 1. Gr. A (IFG): V1 (MS) = 63 cases vs. V2 (T2DM+ED) =11 cases (17.43%); RR for ED (95% CI) = 1.16 (0.86–1.29); p < 0.01.2. Gr. B (IGT): V1 (MS) = 65 cases vs. V2 (T2DM+ED) = 9 cases(13.85%); RR for ED (95% CI) = 1.11 (0.78–1.31); p < 0.9. 3. Gr. C(IFG+IGT): V1 (MS) = 59 cases vs. V2 (T2DM+ED) = 16 cases(27.9%); RR for ED (95% CI) = 1.12 (0.92–1.22); p < 0.05.Conclusion: MS intermediate hyperglycemia including both IFG andIGT, more than only one of them alone, could have a significant pre-diction for the precocious onset of erectile dysfunction in the follow-ing T2DM.Policy of full disclosure: None

PP-02-165

Risk factors associated with erectile dysfunctionamong hemodialysis patientsDemir, O.1; Cihan, A.1; Secil, M.2; Celik, A.3; Demir, T.4; Comlekci, A.4;Esen, A.11Dokuz Eylul University, Urology, Izmir, Turkey; 2Dokuz Eylul University,Radiology, Izmir, Turkey; 3Dokuz Eylul University, Nephrology, Izmir,Turkey; 4Dokuz Eylul University, Endocrinology and Metabolism, Izmir,Turkey

Objective: Erectile dysfunction (ED) is commonly encountered complaint among end stage renal disease (ESRD) patients. Uremia,


J Sex Med 2008;5(suppl 2):94–145

neuroendocrinologic disturbances, atherosclerosis and psychogenicdisturbances are known etiologic factors that lead erectile dysfunctionin ESRD patients. The main purpose of the current study is to evalu-ate clinical properties and laboratory findings that associated with EDin ESRD patients who still on hemodialysis treatment.Methods: Forty-two male patients’ who’s still on hemodialysis treat-ment were recruited to study. Erectile functions were evaluated withInternational Index of Erectile Function (IIEF) questionnaire. Twenty-six point of erectile function domain was taken as a cut of point forED. BUN, serum creatinin, complete blood count, plasma glucoselevels on starvation and serum lipid profile of all subjects were takenbefore and after hemodialysis. Penile Doppler ultrasonography (PDU)was also performed to subjects with ED after intracavernous injectionof papaverine HCL at the dose of 50 mg per patient.Results: ED was determined in 28 patients. Clinical and laboratoryfindings of subjects were shown in Table-1. ED patients were olderand had lower serum HDL cholesterol levels compared with non-EDpatients. Only these two parameters were reached statistically signifi-cance level in both groups. The correlation between age and IIEF-EFdomain scores were statistically significant (p < 0.001; r = −0.737). Alsothere was a negative correlation between age and peak systolic veloc-ities in PDU at 5th min (p = 0.012, r − 0.428), 10th min (p = 0.008, r − 0.448) and 20th min (p = 0.009, r − 0.447).Conclusion: In ESRD patients, age is a major risk factor for ED devel-opment. Further clinical studies in large groups are needed to evalu-ate metabolic properties that could lead ED in hemodialysis patients.Policy of full disclosure: None

20%—diabetes, 18%—coronary heart disease, 7%—depression and6%—neurological diseases. 18% men did not report any concomitantdiseases. BPH and HTN most often occurred in older patients, whiledepression and neurological diseases in younger ones. A characteristicfeature of a younger group of patients with ED was taking anabolicsteroids. As many as 40% patients smoked tobacco.Conclusion: Despite proofs that a coronary heart disease and diabetesare the main risk factors of occurrence of ED of vascular origin, theresults obtained in the study are lower from those published [Ref]. Itcan mean that the problem of ED is still embarrassing both for aGeneral Practitioner and a patient. It is also probable that a high per-centage (52%) of coexistence of BPH with ED results from a naturalprocess of getting old. The appearance of LUTS makes men consultan urologist, which is conducive to informing the doctor about prob-lems in sexual life.Policy of full disclosure: None

PP-02-167

The impact of migraine on female sexual functionDeveci, S.1; Horasanli, B.2; Celikkol, C.3; Benli, S.3; Peskircioglu, L.4

1100 Yil Univ. Typ Fak. Hast., Urology, Van, Turkey; 2Baskent Univ. TipFak.Has., Neurology, Konya, Turkey; 3Baskent Univ. Tip Fak Hast., Neu-rology, Ankara, Turkey; 4Baskent Univ. Tip Fak Hast., Urology, Ankara,Turkey

Objective: Migraine is a neurological disorder that causes attacks ofheadache. Migraine without aura is the most prevalent type. This studywas designed to determine the impact of migraine disease on thefemale sexual function.Methods: The women between 19–38 years of age and presenting forthe evaluation and treatment of migraine without aura completed theFemale Sexual Function Index (FSFI) questionnaire. The psychlogicalstatus of the patients were evaluated with Beck’s depression and anxietyscales. Serum prolactin, dehydroepiandrosterone sulfate, free testos-terone, androstenedione, 17alpha-hydroxyprogesterone, estradiol, freethyroxin and thyrotropin were measured. Patients with abnormalserum hormanal levels and with known risk factors of FSD such ashypertension, diabetes mellites, coronary artery disease and smokingwere excluded from the study.Results: Fifty-five patients were enrolled with a mean age of 29 ± 3.2years. None of the patients had depression or anxiety according to theBeck’s depression and anxiety scales. The mean FSFI score of thewomen with Migraine was found as 22.3 ± 4.7. The mean FSFI domainscores are shown in Table 1.Conclusion: These data indicate that migraine have a negative impacton female sexual function. The pathophysiology of sexual dysfunctionin women with migraine is not known and should be determined withfurther studies and extended group of patients.Policy of full disclosure: None

PP-02-168

Evaluation of incontinence, quality of life, and sexualfunction women who operated suburethral slingSari, D.1; Bulut, V.2; Cakmak, O.3; Mertoglu, O.2; Sycramaz, H.4; Bolukbasi, A.3; Esen, A.51Ege University Hospital, Nursing, Izmir, Turkey; 2Tepecik Training Hos-pital, Urology, Izmir, Turkey; 3Atatürk Training Hospital, Urology, Izmir,Turkey; 4Dokuzeylül University Hospital, Urology, Izmir, Turkey; 5DokuzEylül University, Hospital, Turkey

Objective: Although urinary incontinence is not a life threatening dis-order, it has been shown to have detrimental effects on quality of lifein terms of psychological, social and sexual problems. The aim of thisstudy was to evaluate the effects of suburethral sling operation onsexual function, incontinence and quality of life.Methods: Twenty nine women evaluated suburetral sling operationfor stress and mixed incontinence from October 2005 to March 2007.All women and their partners were sexually active. We evaluated allthe women enrolled in the study by taking incontinence and sexual

PP-02-166

Evaluation of the population of men with erectiledysfunction in Poland. Risk factors of erectiledysfunctionDepko, A.1; Leonowicz, T.1; Raj, Z.2; Wieczerzak, Z.2; Jurgielewicz, A.3

1Sexological Outpatient Clinic, Sexology, Warszawa, Poland; 2SexologicalOutpatient Clinic, Gynaecology, Lublin, Poland; 3Pfizer Polska Sp. z o.o.,Medical affairs, Warszawa, Poland

Objective: Evaluation of risk factors of erectile dysfunction (ED) anda frequency of its occurrence in the population of men with ED inPoland.Methods: 8880 men at the age of 20–70 participated in the study conducted by urologists and sexologists in years 2005–2007. All men answered questions contained in an especially prepared ques-tionnaire concerning their state of health, concomitant diseases, treat-ment of an underlying disease, ED risk factors and applied methods ofED treatment.Results: 52% of all studied men suffered from Benign ProstaticHyperplasia (BPH). 31% were diagnosed hypertension (HTN),


J Sex Med 2008;5(suppl 2):94–145

history, administering the Female Sexual Function Index (FSFI) andIncontinence Quality of Life Instrument (I-QOL). Number-percentdistribution, variance analyzes, Student t test and McNemar test wereused for the data analysis.Results: Mean age and FSFI scores of women were 50.4 ± 8.8 yearsand 19.3 ± 10.7, respectively. According to total FSFI score (<25) therewere 65.5% subjects had sexual dysfunction. After suburetral sling pro-cedure improves the quality of life in female patient. Before and afteroperation reported leakage at some point during intercourse 69% and21% respectively. 52% women reported an improvement of theirsexual life after suburetral sling, 7% worsening.Conclusion: This study shows that after suburetral sling operationreduce complain incontinence and improves the quality of life, butprevalence of female sexual dysfunction is significantly high.Policy of full disclosure: None

PP-02-169

Associated risk factors for erectile dysfunction in malediabetic patientsFica, S.1; Calomfirescu, N.2; Georgescu, O.1; Ursache, M.1; Reghina, A.1;Florea, S.1; Grigorescu, M.1

1Elias Emergency Hospital, Endocrinology, Bucharest, Romania; 2GerotaHospital, Urology, Bucharest, Romania

Objective: The aim of this study was to evaluate the corelationbetween testosterone value, cardiovascular risk factors and erectile dys-function in patients with diabetes mellitus (DM) and metabolic syn-drome (MS).Methods: 30 male patients, 24 with DM (4 T1DM /20 T2DM) and6 with MS, age between 19–77 years (mean 48,5 years) were evaluatedby anthropometric measures, metabolic (HbA1c, lipid profile) and sex-hormonal status (total and free testosterone, SHBG). All patientsunderwent a comprehensive history and completed International Indexof Erectile Function (IIEF) questionnaire.Results: The total testosterone value at diabetic patients was forT1DM 419,75 ng/dl, for T2DM 337,9 ng/dl and for thouse with MSwas 329 ng/dl. At DM patients the low total testosterone value wasnegative correlated with increased waist circumference (> = 94 cm):452,5 ng/dl vs. 320,6 ng/dl, r = −0.30. The free testosterone value waslower in patient with DM and MS (70,58 pg/ml) vs. thouse only withMS (81,5 pg/ml). The IIEF-score was lower in T2DM (11,5) than inT1DM (18,5), but it was more influenced by the presence of metabolicsyndrome criteria (11,29 vs. 16), than the glycemic control (HbA1c8,85% in T2DM vs. 10,12% T1DM). Also the IIEF-score was strongcorelated with free-testosterone value: 101,66 pg/ml for normal erec-tile function(r = 0,36) and only 64,25 pg/ml for mild ED (r = 0,91).Conclusion: Our study showed that ED is frequently presented at dia-betics and it is more severe at thouse patients who associate metabolicsyndrome criteria. The free-testosterone value decrease even in mildED and for that reason the replacement treatement must be earlierstarted, to correct the androgen deficiency and also the metabolic disturbance.Policy of full disclosure: None

PP-02-170

Psychological variables and sexual functioning:Differences between a clinical and a non-clinicalgroup regarding cognitive schemas and personalityvariablesGomes, A.1; Nobre, P.21Mouriscas-Abrantes, Portugal; 2Universidade de Trás-os-Montes, Dep.Educação e Psicologia, Vila Real, Portugal

Objective: Although the well-known importance of cognitive and per-sonality variables involved in most emotional disorders, few studieshave shown the implication of these variables in sexual dysfunction.Some authors postulate the existence of certain personality traits, suchas Neuroticism, as vulnerability factors for the development of sexual

dysfunction in men (Costa, Fagan, Piedmont, Ponticas, & Wise, 1992;Fagan, Schmidt, Wise, & Derogatis, 1988; Schenk, Pfang, & Rausche,1983). Regarding cognitive schemas, only few authors have empha-sized the role of the cognitive structures in male sexual dysfunction(Andersen, Cyranowski, & Espindle, 1999; Nobre & Pinto-Gouveia,2006). The aim of this study was to investigate the importance of cog-nitive structures like Early Maladaptive Schemas and personality traitson men’s sexual functioning.Methods: 50 men diagnosed with sexual dysfunction from the Sexol-ogy Clinic of the Hospitais Universidade de Coimbra, and 50 individ-uals from the community without sexual dysfunction. Participantsanswered to the Sexual Dysfunction Inventory (SDI—male version;Sbrocco, Weisberg, & Barlow, 1992), International Index ErectileFunction (IIEF; Rosen, Riley, Wagner, Osterloh, Kirkpatrick, &Mishra, 1997), Brief Symptom Inventory (BSI; Derogatis & Spencer,1982), Beck Depression Inventory (BDI; Beck, Ward, Mendelson,Mock, & Erbaugh, 1961), Young Schemas Questionnaire (YSQ; Young& Brown, 1990), Questionnaire of Cognitive Schema Activation inSexual Context (QCSASC; Nobre & Pinto-Gouveia, 2006); NEOFive-Factor Inventory (NEO-FFI; Costa & McCrae, 1992).Results: Men with higher sexual functioning show more Openness toExperience (personality dimension) compared to men with lowersexual functioning. Regarding cognitive schemas, men with lowersexual functioning show significantly more Vulnerability schemas andactivate with significantly higher frequency Difference/Loneliness,Self-Depreciation, Incompetence and Undesirability/Rejection sche-mas when confronted to unsuccessful sexual situations, compared withmen with higher sexual functioning.Conclusion: Preliminary findings supported the importance of thecognitive structures, psychopathology and personality variables onsexual functioning.Policy of full disclosure: None

PP-02-171

Erectile function alterations in men treated withandrogen suppression plus radiation therapy for localor locally advanced prostate cancerHaliloglu, A. H.1; Yaman, O.2; Baltaci, S.2

1Ankara, Turkey; 2Ankara Universty, Urology, Turkey

Objective: To determine the erectile function alterations in mentreated with androgen suppression plus radiation therapy for local orlocally advanced prostate cancer.Methods: From November 2000 to November 2005, 47 patientsenrolled into this prospective study. After clinical staging all patientsreceived hormonal therapy (luteinizing hormone releasing agonist;leuprolide acetate or goserelin; every 3 months for a total of 3 enjec-tions) and at the seventh month of hormonal therapy radiation therapywas began (total 70 GY) for 7 weeks. Erectile functions were evaluatedbefore starting androgen suppression therapy and every 3 monthsthereafter with International Index of Erectile Function (IIEF) domainscores.Results: With the initiation of therapy gradual decrease in the IIEFscores was observed. The most significant decrease in the IIEF scoreswas in the first 9 months. Mean IIEF score decreased from 14.7 to 3.3during that period (p < 0.001). After 9 months a slight increase wereobserved but still in severe erectile dysfunction limits (Mean IIEFscore was 8.7 at 18th month).Conclusion: Our findings support observations of decreased erectilefunctions after neo-adjuvant hormonal therapy plus external beamradiation therapy for local or locally advanced prostate cancer.However it should be emphasized that these patients might havealready moderate erectile dysfunction at the beginning of the treatment.Policy of full disclosure: None


J Sex Med 2008;5(suppl 2):94–145

PP-02-172

Cognitive and emotional factors in female sexualdysfunction: Schemas and affectOliveira, C.1; Nobre, P.21Coimbra, Portugal; 2Universidade de Trás-os-Montes, Departamento deEducação e Psi, Vila Real, Portugal

Objective: In spite of the growing body of literature that has recentlyemerged, less is known about the role of cognitive-emotional factors(schemas and affect) on women’s sexual dysfunction. The purpose ofthe present study is to evaluate the presence and importance of thecognitive and emotional factors on the sexual function/dysfunction,specifically the way in which cognitive schemas and the differentdimensions of affect interact and influence women’s sexual function-ing, along with general psychopathology. The final goal is to postulateboth dimensions as vulnerability factors of sexual dysfunction. We thenhypothesized that women with sexual dysfunction present higher levelsof Psychopathology and activate more Early Maladaptive Schemas andother schemas when compared with normal women. Conversely, weexpect that women with sexual dysfunction show lower levels ofgeneral positive affect and higher levels of general negative affect com-pared to sexually healthy women. Finally, we hope to find significantcorrelations between affect-traits and schemas, as well between the dif-ferent cognitive-emotional factors and the different dimensions of psychopathology.Methods: A total of 150 women will participate in the study (a controlsample of 100 women and a clinical sample of another 50 women) andwill answer to a protocol composed by different instruments.Results: Results showed strong correlations between sexual function-ing and positive affect, cognitive schemas (deprivation, defective-ness/shame, vulnerability to danger, subjugation) and differentpsychopathology dimensions (somatization, anxiety, phobic anxietyand obsessive-compulsive). Women less sexually functional presentedsignificant higher levels of positive affect during sexual activity andhigher levels of insufficient self-control, emotional inhibition, socialisolation, abandonment, emotional deprivation and incompetenceschemas, when compared with a sexually functional group. They alsopresented more Psychopathology.Conclusion: Preliminary results supported that the cognitive andemotional factors, such as the schemas and affect, and the general psy-chopathology are related with the sexual functioning in generalwomen. Women with a poorer sexual functioning present a significantlack of positive affect, a stronger activation of different cognitiveschemas and higher levels of psychopathology.Policy of full disclosure: None

PP-02-173

Metabolic syndrome—a cause for erectile dysfunctionNita, G.1; Persu, C.2; Bancu, S.2; Cauni, V.2; Geavlete, P.2

1Saint John Clinical Hospital, Dept. of Urology, Bucharest, Romania; 2SaintJohn Clinical Hospital, Bucharest, Romania

Objective: Nowadays, metabolic syndrome represents not only a diag-nosis challenge, but also due to its deleterious effect over sexual func-tion, therapeutic strategy is of utmost importance. The aim of thisstudy is to evaluate the results of metabolic syndrome specific therapyover sexual function improvement.Methods: Between June 2003 and June 2007, 220 patients agedbetween 43 and 55 years old (mean 48 years old) with erectile dys-function persistent after Sildenafil 100 mg treatment, were evaluatedfor metabolic syndrome. The evaluation protocol was represented byserum tests: fasting glucose level, lipid panel, cholesterol, tryglicerides,testosterone, prolactine, along with blood pressure measurement, andIIEF-5 questionnaire. Patients with metabolic syndrome were refferedfor specific treatment to the internal medicine specialist.Results: After completion of diagnostic evaluation, 22, 7% (50/220)of patients met the metabolic syndrome criteria. 15% (33/220) ofpatients had low serum testosterone level, suggesting late-onsethypogonadism with a mean value of 4.8 (ranging between 4 and 7

ng/dl), and the rest of 62,3% (137/220) had other etiologies for erec-tile dysfunction. The IIEF-5 scores assessed in the metabolic syn-drome group ranged between 4–10 (mean 7) initially, and between8–22 (mean 18) after specific treatment. In the metabolic syndromegroup, 58% (29/50) of patients had IIEF-5 score more than 20, andremained free of Sildenafil therapy. The rest of 42% (21/50) of patientswith mean IIEF-5-15 score were prescribed Sildenafil 100 mg. 15/21of patients increased IIEF-5 score above 21, and the other of 6/21 hadno improvement of there sexual function.Conclusion: Erectile dysfunction associated to metabolic syndrome,was present in a severe to moderate form. Erectile dysfunction isimproved by metabolic syndrome specific therapy; therefore thecorrect diagnosis of this disorder represents the key of the manage-ment algorithm.Policy of full disclosure: None

PP-02-174

Graded association between vasculogenic erectiledysfunction, metabolic syndrome and aortic stiffnessRokkas, K.1; Vlachopoulos, C.1; Ioakeimidis, N.1; Samentzas, A.1; Pietri, P.1;Xaplanteris, P.1; Fassoulakis, C.1; Askitis, T.1; Stefanadis, C.11Cardiov. Dis. Sexual Health U., 1st Cardiology Department, Athens,Greece

Objective: Vasculogenic erectile dysfunction (ED) may be considereda clinical manifestation of a generalized arterial disease. Aortic stiff-ness is a marker of vascular changes associated with metabolic syn-drome (MetS). We evaluated associations between MetS, penilevascular damage and aortic stiffness in patients with ED of vascularorigin.Methods: 179 consecutive men with ED were evaluated for penile vas-cular disease severity by penile Doppler ultrasound: Cut-off value ofmean systolic velocity (PSV) to define ED as arteriogenic was 35cm/sec. A mean PSV between 25 and 35 cm/sec was considered toindicate borderline penile arterial function and below 25 cm/sec arte-rial insufficiency. Aortic stiffness was evaluated with carotid-femoralpulse wave velocity (PWV) using high-fidelity pulse wave analysis.Higher values of PWV indicate stiffer aorta and vice versa.Results: Patients with arterial insufficiency (n = 49) compared topatients with borderline penile arterial function (n = 55) and patientswith non arteriogenic ED (PSV > 35 cm/s, n = 75) had increased preva-lence of MetS (49 vs. 40 vs. 31% respectively, P < 0.05 for all), whereasdid not differ regarding age, body mass index and smoking. Carotid-femoral PWV increased and mean PSV decreased as the number ofcomponents of the MetS increased (P < 0.05, figure).Conclusion: In patients with vasculogenic ED the greater penile vas-cular damage, the higher prevalence of MetS. Furthermore there is anaugmentation in vascular damage of penile vasculature and large arterystiffness throughout increasing components of MetS. Our data shouldbe the foundation for the strong association between MetS, ED andgeneralized vascular disease and may provide a potential explanationfor the increase of cardiovascular risk in such patients.Policy of full disclosure: None


J Sex Med 2008;5(suppl 2):94–145

PP-02-175

Interrelationships between erectile dysfunction andsmoking in essential hypertensive patientsRokkas, K.1; Vlachopoulos, C.1; Ioakeimidis, N.1; Bratsas, A.1; Samentzas, A.1; Leontis, S.1; Fassoulakis, C.1; Askitis, T.1; Stefanadis, C.11Cardiov. Dis. Sexual Health U., 1st Cardiology Department, Athens,Greece

Objective: Despite the fact that smoking has numerous effects thatpromote erectile dysfunction (ED), the data regarding its associationwith ED in the setting of essential hypertension are rather scarce. Weinvestigated the interactions between smoking and ED in essentialhypertensive men.Methods: 159 treated non-diabetic essential hypertensive patients (59± 11 years) with ED (detected with history and score of the 5-itemSexual Health Inventory for Men-SHIM-5), were classified accordingto their smoking habits as current smokers (> or = 1 cigarette/day, n= 67), ex-smokers who had stopped at any time before completing thequestionnaire (n = 33) and the remaining subjects as non-smokers (n= 59). All subjects were submitted for penile Doppler ultrasonography.Metabolic profile, hsCRP and fibrinogen concentrations were alsoestimated.Results: Current smokers and ex-smokers compared to non-smokershad increased diastolic BP (P < 0.05 for all), whereas did not differregarding age, body mass index (BMI), duration of hypertension, b-blockers, diuretics and statines. Although groups exhibited no differ-ence regarding metabolic profile (P = NS), current smokers and also,ex-smokers compared to non-smokers were characterized by higherlevels of hs-CRP (2.9 vs 2.6 vs 1.9 mg/l, respectively, P < 0.05 for all)and fibrinogen (328 vs 317 vs 291 mg/dl, respectively, P = 0.01 for all).SHIM-5 score and mean peak systolic velocity (PSV) of cavernousarteries, were comparable among current smokers and ex-smokers butlower compared to controls (11 vs. 11 vs 15, respectively; P = 0.01 forall and 30 vs 33 vs 35 cm/s, respectively; P < 0.05 for all). These rela-tionships remained significant in multivariate analysis after adjustingfor age, mean pressure, length between hypertension documentationand ED onset, hsCRP and fibrinogen (P < 0.05 for both, byANCOVA). In current smokers mean PSV exhibited a negative cor-relation with pack-years index (r = −0.22, P < 0.05) indicating a strongassociation between penile vascular inflow impairment and intensity ofsmoking.Conclusion: Smoking in essential hypertension is associated withimpairment of erectile function and this association is strengthened asthe number of cigarettes increased. Our findings may partially eluci-date the complex mechanisms linking ED with increased cardiovascu-lar risk, in this setting.Policy of full disclosure: None

PP-03 Epidemiology and prevention

PP-03-176

Sexual life evaluation in urological male patientsBelinski, C.1; Manu Marin, A.1; Neamtu, M.1; Neicutescu, C.1; Vesa, E.1;Calomfirescu, N.1

1Gerota Hospital, Dept. of Urology, Bucharest, Romania

Objective: To evaluate the sexual life of the male patients, using theInternational Index of Erectile Function (IIEF) questionnaire in oururological clinic. We compare the results with those we obtained fromthe general population.Methods: Between 1st of January and 1st of May 2007 we asked theadmitted in the Department of Urology of Gerota Hospital to answerthe IIEF. A total of 168 questionnaires were distributed; 111 answered(66%). 38% were under 35 years old, 29% between 36 and 50, 21%between 51 and 65 and 22% were over 65 years old.Results: We analysed for each group of age the erectile function, thesatisfaction with intercourse, the orgasm, the sexual desire and theoverall satisfaction correlating them with the disease, urban/ruralbackground, BMI, marital status, education, alcohol behaviour andsmoking. The most common affections were BPH (18%), urolithiasis(15%), bladder tumours (10%) and urinary tract infections (7%).Conclusion: The urological patients had an increased percent ofsexual dysfunction compared with general population, with biggervalues for those with benign prostatic hyperplasia and bladdertumours.Policy of full disclosure: None

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Physiopathological mechanisms of priapism:Comparative analysis of their evolutionBondil, P.1; Bouraoui, K.1; Ozone, F.1; Demey, A.1; Adawi, F.1; Taccoen, X.1


Objective: The discovery of intracavernous injection of vasoactivedrugs (ICI) during the 1980–90th has led to a dramatic increase ofiatrogenic priapism. Since 10 years, both pharmacological progress andtherapeutic education have better controlled this major iatrogeniccomplication. Objective: to assess the reality of the reduction of iatro-genic post-ICI priapism.Methods: Method: to analyze the evolution of priapisms observed inour hospital by comparing their frequency, mechanism, aetiology andtreatment between two periods: 1985–1996 and 1997–7/2007.Results: Results: 1) 1985–1996: 46 cases (mean age: 39) all fromvenous origin including 35 iatrogenic (29 post-ICI), 5 haematologicaland 6 idiopathic. 10 cases (mean age: 40.5) from various aetiology(including 2 post-ICI) have been operated on after failure of medicaltreatment after a mean delay of 43 hours. 2) 1997–7/2007: 30 cases(mean age: 54) of various mechanism: a) 16 venous (7 iatrogenicincluding 2 post-ICI, 1 haematological, 8 idiopathic). 6 cases (meanage: 55) have been operated on after failure of medical treatment aftera mean delay of 42 hours, b) 4 post-traumatic arterial medically treated,c) 10 intermittent nocturnal of undetermined aetiology all medicallytreated.Conclusion: Conclusions: Our comparative analysis shows: a) 3expected facts: a clear decrease of post-ICI priapism, the priapismremains a rare condition and the venous priapism, an emergency, b)one unexpected fact: a clear change of physiopathological mechanismwith 47% of no venous origin. Theses changes reflect certainly a betterprevention of post-ICI priapism and likely, a better understanding ofno venous priapisms.Policy of full disclosure: None


J Sex Med 2008;5(suppl 2):94–145

PP-03-178

Identifying the need for a nurse-led service forerectile dysfunction in diabetesLockman, K. A.1; Boyd, M.1

1Royal Infirmary of Edinburgh, Department of Diabetes, United Kingdom

Objective: At least 50% of men with diabetes will suffer from erec-tile dysfunction at some time in their life [Fraser 2004]. Erectile dys-function is defined as either being either unable to obtain or tomaintain an erection suitable for sexual intercourse. The aim of thisaudit was to ascertain the prevelance of erectile dysfunction (ED) inour male population with diabetes, identify which groups are poten-tially most at risk of developing this condition and highlight the needfor an erectile dysfunction referral service.Methods: A total of 180 male patients attending the routine diabetes review clinic at the Royal Infirmary of Edinburgh betweenAugust 2005 and January 2006, completed an anonymous 14 pointquestionnaire.Results: 51.1% (n = 92) of men felt they had a problem either obtain-ing or maintaining an erection suitable for sexual intercourse. Thisgroup had a mean (SD) age of 57.6 (8.3) years and were more likelyto have Type 2 diabetes (p = 0.001). There was a positive correlationbetween the duration of diabetes and ED in this group (r = 0.354, p =0.002), however, no association was noted between ED and glycaemiccontrol. Almost 80% of these men were not receiving treatment fortheir ED and would be keen to seek help if it were available.Conclusion: This data highlighted the need to provide a service topatients with diabetes and ED. A protocol was designed and a nurseled erectile dysfunction clinic was set up.Referrals were initially takenfrom members of the multidisciplinary team within the secondary caresetting, however, this service has now been extended to primary carepractitioners to refer their patients with diabetes for education, assess-ment and treatment of their ED. To date [14 months after starting],this clinic has successfully treated 85 men with diabetes and ED.Policy of full disclosure: None

PP-03-179

Epidemiological evolution of a Portuguese clinicalpopulation with sexual dysfunctionCardoso, J.1; Pacheco, J.1; Gaspar, A.1; Pedrosa, G.1; Ingles, B.1; Morbeck, E.21Hospital Julio de Matos, Clinic of Sexology, Lisbon, Portugal; 2Hospital Júliode Matos, Lisbon, Portugal

Objective: The Clinic of Sexology and Marital Counselling of theJúlio de Matos Hospital, in Lisbon, began in 1979 and has workednon-stop to this day. Currently it receives an average of 350 patientsa year, the majority of whom are referred by their general practition-ers. This study aims to offer a socio-demographic and clinical charac-terization of the population that resorts to the Clinic with complaintsof sexual difficulty or dysfunction.Methods: We gathered a random sample of 300 subjects who attendedthe Clinic during the period of time between 2004 and 2006. Thesocio-demographic variables under analysis include the source of refer-ral, gender, age, marital status, number of children, length of the rela-tionship, type of sexual partner, qualifications and social and financialstatus. The clinical variables studied include the diagnosis, features ofthe sexual dysfunction, age at which the sexual dysfunction began,duration of the problem., associated organic and psychic pathologies,risk factors, use of medication with a negative impact on the sexualresponse, type of therapeutic intervention undertaken and averagenumber of sessions. At the same time, given the changes that occurredin the last few decades as regards sexuality in general and the thera-peutic breakthroughs in Sexology in particular, a comparative studywas also carried out, between the above sample and another, alsorandom sample, consisting equally of 300 subjects, that resorted to thisClinic two decades ago, that is, during the period between 1984 and1986.Policy of full disclosure: None

PP-03-180

Testicular volume and nutritional state as predictivefactors of fertility for cancer patients treated bychemotherapyChatzidarellis, E.1; Mazaris, E.2; Ioannidis, K.3; Chrisofos, M.2; Deliveliotis, C.2; Syrigos, K.41University of Athens, 2nd Urology, Greece; 2University of Athens, 2ndDepartment of Urology, Sis, Greece; 3University of Athens, 2nd DepartmentUrology, Sisman, Greece; 4University of Athens, 3rd Department of Medi-cine, On, Greece

Objective: To estalish the relationship between testicular volume andsomatometric parameters in male cancer patients at the time of diag-nosis, in order to determine its influence on fertility after chemother-apy. Low testicular volume supports the diagnosis of hypogonadism.Methods: Between January and November 2006, twenty-five malelung cancer patients aged 32–60 years old (median age 51) underwentultrasonographic testicular volume estimation. The resulting meas-urements were correlated with age, height, weight and body mass index(BMI) which reflect directly their nutritional state. Paired t test wasused to assess the relationship between right and left testicular volume.Comparisons of the measured variables were based on Spearman RankOrder Correlation Coefficient.Results: The median bilateral testicular volume (BTV) was 27.3 cm3

(range 13.75–37.3) with the right testis (median: 14 cm3) measuringlarger than the left (median: 13,3 cm3, p ≤ 0.05). The median heightwas 174 cm (range 162–187), the median weight was 74 kg (range55–97,5) and the median BMI was 25.35 kg/m2 (range 18.17–30.3).The bilateral testicular volume was significantly inversely correlatedwith the body mass index (Spearman correlation coefficient r =−0.4652, p = 0.019). A positive but not statistically significant correla-tion was found between BTV and height. Age and weight, wereinsignificantly inversely correlated to BTV.Conclusion: Nutritional state of male cancer patients of reproductiveage seems to influence the size of testes and may be important in theirreproductive evaluation before chemotherapy.Policy of full disclosure: None

PP-03-181

Evaluation of the population of men with erectiledysfunction in Poland. Sources of knowledge about sexualityDepko, A.1; Leonowicz, T.1; Raj, Z.2; Wieczerzak, Z.2; Jurgielewicz, A.3

1Sexological Outpatient Clinic, Sexology, Warszawa, Poland; 2SexologicalOutpatient Clinic, Gynaecology, Lublin, Poland; 3Pfizer Polska Sp.z o.o.,Medical Affairs, Warszawa, Poland

Objective: Knowledge about sexual functioning disorders determinespatients’ motivation to seek help. The study tried to evaluate sourcesof knowledge about erectile dysfunction (ED) among patients with EDin Poland who see the doctor.Methods: 8880 men at the age of 20–70 participated in the study con-ducted by urologists and sexologists in years 2005–2007. All menanswered questions contained in an especially prepared questionnaireconcerning their state of health, concomitant diseases, treatment of anunderlying disease, ED risk factors and applied methods of ED treat-ment as well as sources of knowledge about sexuality.Results: The knowledge about sexuality of a Polish patient comesfrom various sources: 43% of the studied has it from specialist doctors,32%—from the press, 27%—from the radio and TV, 26% from theinformation leaflets, 22%—from friends, 17%—from family doctorsand 13%—from the Internet. 13% patients with ED are men up to 40years old.Conclusion: Patients below 30 years of age were most open while themost reluctant to speak about their problems were men over 60 yearsold. The Internet as a source of knowledge about sexuality is a basictool used by patients up to 40 years old. For patients over 40—press,radio and TV and a specialist doctor are a basic source of knowledge.Despite the knowledge, only every third patient asks for advice and


J Sex Med 2008;5(suppl 2):94–145

treatment and only in case of 2 in 5 it occurs at their own initiative.The results show that there is a constant need of widespread educa-tion that will enable a factual dialog without a false shame.Policy of full disclosure: None

PP-03-182

Evaluation of the population of men with erectiledysfunction in Poland. Characteristics of treatmentmethods of erectile dysfunctionDepko, A.1; Leonowicz, T.1; Raj, Z.2; Wieczerzak, Z.2; Jurgielewicz, A.3

1Sexological Outpatient Clinic, Sexology, Warszawa, Poland; 2SexologicalOutpatient Clinic, Gynaecology, Lublin, Poland; 3Pfizer Polska Sp. z o.o.,Medical Affairs, Lublin, Poland

Objective: Collecting data concerning the duration of erectile dys-function (ED) before seeing a doctor and treatment methods used inthat period as well as after prescribing treatment by the specialistamong patients with ED in Poland.Methods: 8880 men at the age of 20–70 participated in the study conducted by urologists and sexologists in years 2005–2007. All menanswered questions contained in an especially prepared questionnaireconcerning their state of health, concomitant diseases, treatment of anunderlying disease, ED risk factors and applied methods of ED treat-ment as well as sources of knowledge about sexuality.Results: At the moment of seeing a doctor 24% patients suffered fromED for a period shorter than 1 year, 34% for 1–2 years, 26% for 3–4years and 15% for more than 4 years. 27% patients answered posi-tively at the question if they were already treated for ED. Patients withED are more often treated pharmacologically than not pharmacolog-ically (21% vs 7%) by a specialist. 27% patients are treated with OTCmedicines (herbs, diet supplements, etc.). 19% patients admittedbuying ED medicines outside the pharmacy. The main reason forbuying ED medicines on the illegal market was the embarrassmentconnected with the visit to a doctor and pharmacist. The main placeof buying medicines outside the pharmacy is a market and sex shop.Other illegal sources are the Internet and press advertisements.Conclusion: Commonness of OTC products advertising fosters usingthese drugs by patients with ED in self-medication and at the sametime prolongs the time of their visit to a specialist. It is alarming thata part of patients who were prescribed drugs buys them not at the phar-macy but from illegal sources. A shame barrier and still a low level ofknowledge about sexual health are the reasons why patients instead ofbeing treated by a specialist choose self-medication.Policy of full disclosure: None

PP-03-183

Prevalence of andrologic disease in schoolboys: Ourthree years experienceGranata, A. M.1; Cicalese, V.1; Maggio, U.1; Micheletti, G.1; Antonelli, L.1;Cicalese, A.1; Sambroia, P.1

1AO S.G.Moscati, Urology, Avellino, Italy

Objective: Many problems concerning sexual and reproductive men’shealth often start in adolescence. Aim of the study is to follow uro-genital development of schoolboys between 11 and 14 years, to iden-tify and to treat andrologic pathologies.Methods: During 2003–04, 2004–05 and 2005–06 school years, 3154,2383 and 3747 visits respectively, were performed in 71 schools. Theannual visit number includes visits to a group of 1835 students, fol-lowed once a year for all three years, consequently the total numberof students visited is 5614. For each student a medical record was filledin, including student’s details, personal and familiar main medicalhistory, general and genital examination. All data was recorded on anelectronic database. A letter with conclusions of the visit was send tostudent’s parents; in case of problems diagnosed, a second level visitwas organized inside the hospital.Results: During our 3 years experience, 2032 schoolboys out of 5614(36,2%) needed a second level visit for different problems and 3582(63,8%) resulted normal at the screening visit.

Conclusion: A wide prevention program could promote early diag-nosis and solution of these problems, avoiding future consequenceswith a big socio-economic impact.Policy of full disclosure: None

PP-03-184

Sexual education in conservative culturesJad, A.1; Obeid, A.1

1Riyadh Military Hospital, Urology, Saudi Arabia

Objective: How to overcome the obstacles in conducting sexual edu-cation in conservative population.Methods: Due to the religious and conservative culture of most ofMiddle East countries, there is lacking in sexual knowledge and this ismainly due to misunderstanding of what sexual education means andhow important it is. Islam is the only religion that provides a detailedsexual education in its Holy Book “Quran”, which reflects the impor-tance of this information in human life. We start a program of sexualeducation after several sporadic trial using deferent specialties such asandrologiest, psychiatrists, endocrinologists, general practitions andsocial workers under the umbrella of the Saudi Andrology Group. Ourprogram took inconsideration the religious bake ground of the popu-lation and target specific age groups.Results: The program has proven to be attractive to a vast amount ofOdeon as they realized that it is offering the proper information fromreputable trusted sores.Conclusion: We would like to share with you our latest experience toprovide our society with the correct sexual education.Policy of full disclosure: None

PP-03-185

Diabetes-related sexual dysfunctionsMalavige, L.1; Jayaratne, S. D.2; Kathriarachchi, S.3; Sivayogan, S.4; Fernando, D.5; Samaraweeraarachchi, U.6; Levy, J.1

1Oxford University, OCDEM, United Kingdom; 2University of SriJayawardenap, Department of Medicine, Nugegogoda, Sri Lanka; 3SriJayawardenapura University, Departement of Psychiatry, Nugegoda, SriLanka; 4University of Sri Jayawardenap, Community Medicine, Nugegoda,Sri Lanka; 5University of Sheffield, Diabetes and Endocrinology, UnitedKingdom; 6Colombo South Teaching Hspital, Medicine, Dehiwala, Sri Lanka

Objective: The extent of Diabetes related sexual problems are not welldocumented particularly in South Asia. Purpose of this study was toassess prevalence and inter relationships of erectile dysfunction (ED),problems with sexual desire, and premature ejaculation (PE) amongmen with type 2 diabetes in Sri Lanka.Methods: Two hundred and fifty three men with type 2 diabetes, agedbetween 20–80 years, who had opportunity for sexual activity andattending a diabetic clinic in Sri Lanka were recruited in the study.Data were collected using a structured interviewer administered ques-tionnaire and the erectile function was assessed using a translatedversion of International Index of Erectile Function (IIEF5). Partici-pants were asked to grade their general sexual desire from a four cat-egory scale. Those who suffer from persistent rapid ejaculation causingdistress to themselves and to their partners were considered as havingPE. Relevant physical examination and biochemical investigationswere carried out.Results: Mean age and mean duration diabetes of the participantswere 55.9 (SD ± 10.7) years and 7.2 (SD ± 6.5) years respectively. MeanHbA1c and cholesterol were 7.2% (SD ± 1.6) and 5.0 mmol/l(SD ±1.2) respectively. 185 (73.1%) had some degree of ED, 60 (23.7%) hadmild, 51 (20.2%) mild to moderate, 25 (9.9%) moderate and 49(19.4%) had severe ED. Only 87 (33%) graded their desire for sexualactivity as good, 102 (43%) as fair, 31 (12%) as poor, and 33 (13%) as very poor. 96 (37.9%) of the patients had PE. ED is significantlyassociated with PE (p < .001) and poor libido (p < .001). Sexual desireprogressively reduced with increasing severity of ED. However asso-ciation of PE and ED shows a non linier relationship. 70% of those


J Sex Med 2008;5(suppl 2):94–145

who had mild to moderate ED had PE as opposed to 20% among thosewho had normal erectile function.Conclusion: ED, poor libido and PE are significant complicationamong diabetic males in Sri Lanka. Awareness of close associationbetween ED, poor libido, and PE could have significant bearing inmanaging sexual dysfunction among men with diabetes.Policy of full disclosure: None

PP-03-186

Psychometric validation of the Spanish version of theaging males’ symptoms scale (AMSS) in a population-based sampleMas, M.1; EFA (ASESA) Study Group1

1University of La Laguna, Physiology & CESEX, La Laguna, Tenerife,Spain

Objective: The Aging Males’ Symptoms Scale (AMSS) is a 17-itemscale initially developed and validated in Germany (Heinemann et al,Aging Male 199; 2:105–14). It is used widespread, especially in Europe,to assess health related quality of life in older men and their responseto testosterone replacement. However, to our knowledge, no full psy-chometric validation has been conducted on representative populationsamples from other countries, with the exception of France (Myon etal, Health & QoL Outcomes 2005; 3: 20–6). The present study aimedto assess the psychometric properties of the Spanish version of theAMS scale in a suitable population sample and to compare its resultswith serum testosterone levels.Methods: In a stratified population sample of 612 men aged 40–79years from different Spanish cities the AMSS was administered andtheir serum levels of total testosterone (TT), SHBG and albuminmeasured in the same laboratory. Calculated free testosterone (cFT)and bioavailable testosterone (bioT) values were derived from theabove measures.Results: The mean values of the AMS total scores for the differentage groups were: 40–49 yrs (n = 211): 23.49; 50–59 yrs (n = 153): 27.75;60–69 yrs (n = 124): 27.45; 70–79 yrs (n = 114); 30.37. Cronbach’salpha for the whole scale was 0.917. This value decreased slightly afterdeleting each of the individual items, with the exception of “beardgrowth decrease”, corroborating their significant contribution to thescale. Principal component analysis using Varimax rotation suggesteda factorial structure somewhat different from the original description,to be discussed. The AMS total score and its subscales were signifi-cantly correlated with age and (negatively) with TT, cFT, and bioT,especially the latter, all of which also decreased significantly with age.Conclusion: The Spanish version of the AMSS shows high internalconsistency and is related to the aging-associated decrease in serumandrogens.Policy of full disclosure: This study was supported by a ResearchGrant from Bayer Schering Pharma to the EFA (Asociacion Españolade Andrologia-ASESA) Study Group

PP-03-187

Prevalence, bother, and impact on quality of life ofsexual problems, luts and incontinence: Results fromthe hospitalized and outpatients’ profiles andexpectations study (HOPES)Moisidis, K.1; Salpigidis, G.2; Hatzimouratidis, K.2; Apostolidis, A.2; Kirana, P.2; Hatzichristou, D.21Goldair, Athens, Greece; 2Aristotle University, Center Sex. and Repr.Health, Thessaloniki, Greece

Objective: To determine the frequency of sexual problems, LUTS andincontinence, their bother and impact on QOL in a random sample ofhospitalised patients.Methods: HOPES is a hospital-based survey investigating the rela-tionship between psychosocial profile, patient-centeredness, symp-

toms’ and health perception in a random sample of patients admittedto a general hospital. The sample consisted of a representative crosssection of each department, and equal numbers of subjects in each of6 design cells, defined by age (18–40, 41–60, 61–80 years) and gender.Perceived sexual functioning was measured by the SCSF (4-items),LUTS by IPSS (moderate or severe ≥8), incontinence by UI-Urineleakage at least once a week. Bother and impact on quality of life wereassessed by two single questions adjusted for each condition Analysisincluded descriptive statistics.Results: The sample (N = 317) consists of 61.8% males and 38.2%females (mean age 49 + 17). Fifty six per cent reported at least onesexual dysfunction (SD); 28.7% reported moderate or severe LUTSand 10.1% reported incontinence. Males reporting an SD were 30.6%,incontinence 4.4% and LUTS 17%. Women reporting an SD were25.2%, LUTS 11.7% and incontinence 5.7%. Prevalence of all con-ditions increased with age. Bother score was higher for those report-ing incontinence (2-some bother), followed by those reporting a SD(1-little bother) and LUTS (0-not at all bothersome). The impact onQOL of those with incontinence was 5-terrible, of those with a sexualproblem was 4-mostly dissatisfied, and those with LUTS was 3-neutral.Conclusion: Urological conditions are highly prevalent in hospital-ized patients, increasing with age. The most frequently reported con-dition is sexual problems. The impact of the condition on bother andQOL is higher for those with incontinence than the other two condi-tions. Physicians could be aware of such co-morbidities and shouldinclude relevant questions in medical history.Policy of full disclosure: None

PP-03-188

Evaluation of child offender’s sexual behaviours in asample of incarcerated adult malesPechorro, P.1; Vieira, R.2; Poiares, C.3

1Faculty of Medicine of Lisbon, Portugal; 2Faculty of Medicine of Lisbon, Sexology, Lisboa, Portugal; 3Universidade Lusofona, Criminology, Lisboa,Portugal

Objective: The purpose of this investigation was to obtain frequen-cies for a spectrum of sexual behaviours from a forensic sample formedby adult males arrested in several prisons of Lisbon. We also analysedsocial and demographic characteristics of the subjects.Methods: Cross-sectional descritive study. The sample consisted of 41portuguese males, range from 18 to 73 years, mean age: 42.8; DP =14.1. All the participants filled out a demographic and sexual behav-iours questionnaire composed by several parameters : sexuality (hetero,homo, bisexual), cultural bacground, number of sex offences, maturityof the victims, type of sexual behaviours engaged, incest vs no incestoffenders, agressive behaviour vs no agressive. SPSS for Windows V.14 was used for statistics procedures.Results: The number of knowk victims range from one to eight (M =2.0; DP = 1.8). In relation to the maturities of the victims 71.4%abused child under puberty, 16.7% above, and 9.5% both. Relativelyto the parameter sex of the child 54.8% abused opposite sex, 26.2%abused same sex child and 14.8% both sexes. According to the vari-able incest vs no incest offenders 40.5% were of the incest type, 47.6%abused child out of their familys and 2.4% were of both types. In rela-tion to the item violent offences vs no violent ones, 23.8% used agres-sive behaviour and 61.9% were no agressive. In the parameter sexualbehaviour engaged with the victims we found in the heterogroup:caressing 56.5%; frottage 27.3%; oral sex 27.3%; vaginal sex47.8%; anal sex 4.3%. In the homo group: caressing 45.5%; frottage27.3%; oral sex 27.3%; anal sex 72.7%. Differences statisticaly signif-icant were not obtained b/w the two groups in all the parametersexcept for the variable anal sex(Fisher-2 sided, p < .05).Conclusion: An extension of this series is warranting to better obtainthe prevalence rates and frequencies for a full spectrum of sexualbehaviours from an incarcerated and no incarcerated population ofabusers of both sexes.Policy of full disclosure: None


J Sex Med 2008;5(suppl 2):94–145

PP-03-189

Male sexual dysfunction—data from a databasecovering 2,928 consequtive patients between1994–2007Piha, J.1

1Medical Center Mehiläinen, Male Sexual Dysfunction Clinic, Turku,Finland

Objective: In February 1994, a private clinic for studying and treat-ing various kinds of male sexual dysfunction was founded in Turku,Finland. From the beginning up to date, the author has personallytreated each patient visiting the clinic. Patient data from the years1994–2007 are now compiled into a complete database allowing demo-graphic, clinical and follow-up analyses.Methods: A total of 2,928 individual patients have visited the clinicduring the 13-year period between February 1994 and March 2007.For analyses, the timeline was divided into three periods: 1994–1998(“ICI time”), 1999–2002 (“Viagra time”), and 2003–2007 (“threePDE5 inhibitors time”).Results: The number of patients was 1041, 1169 and 719 in1994–1998, 1999–2002, and 2003–2007, correspondigly. In the corre-sponding periods, reasons for consultation included erectile dysfunc-tion (ED) in 93%, 88% and 83%, hypogonadal symptoms (HG) in15%, 28% and 40%, premature ejaculation (PE) in 19%, 21% and19%, and retarded ejaculation (RE) in 5%, 4% and 3%. The mean ageof the patients at the first contact was 54.0 years in 1994–1998, 50.6years in 1999–2002 and 49.8 years in 2003–2007. From 1994–1998 to2003–2007, the proportion of patients aged over 60 years diminishedfrom 37% to 22%, and the proportion of patients aged under 40 yearsincreased from 17% to 25%. The mean duration of sexual symptomsat consultation was similar throughout the whole study period: 5 yearsfor ED and HG, and 17 years for PE. Approximately 50% of thepatients sought help in 3 years and 70% in 5 years.Conclusion: Between 1994 and 2007, 1) the mean age of the patientsseeking help because of sexual problems has declined; 2) hypogonadalsymptoms have become much more frequent, although erectile dys-function is still clearly the most common complaint. Every fifth patientsuffers from premature ejaculation; and 3) the duration of the symp-toms before consultation has remained unchanged.Policy of full disclosure: None

PP-03-190

Comparing treatment seeking behavior of patientswith sexual problems—luts and/or incontinence:Results from the hospitalized and outpatients’ profilesand expectations study (HOPES)Salpigidis, G.1; Moisidis, K.2; Apostolidis, A.2; Hatzimouratidis, K.2; Kirana, P.-S.3; Hatzichristou, D.21Goldair, Athens, Greece; 2Aristotle University, Center Sex. and Repr.Health, Thessaloniki, Greece; 3Aristotle University, Research Center forHealth Pro, Thessaloniki, Greece

Objective: To determine factors associated with treatment seeking forLUTS, incontinence and sexual dysfunctions in a random sample ofhospitalised patients.Methods: HOPES is a hospital-based survey investigating the rela-tionship between psychosocial profile, patient-centerdness, symptoms’and health perception in a random sample of patients admitted to ageneral hospital. The sample consisted of a representative cross sectionof each department, and equal numbers of subjects in each of 6 designcells, defined by age (18–40, 41–60, 61–80 years) and gender. Perceivedsexual functioning was measured by the SCSF (4-items), LUTS byIPSS (moderate or severe ≥8), incontinence by UI-Urine leakage atleast once a week. Bother and impact on quality of life (Qol) wereassessed by two single questions adjusted for each condition Treatmentseeking was measured by a single item: have you ever sought treatmentfor your sexual/urinary/incontinence problem. Analysis includeddescriptives and significance tests.

Results: The sample (N = 317) consists of 61.8% males and 38.2%females (mean age 49 + 17). Of those reporting a sexual problem 26.3%had sought treatment and this was not associated with demographics,nor Qol, but was significantly associated with bother (r = 0.491,p = 0).Of those reporting incontinence 46.9% had sought treatment and thiswas not associated with demographics, bother, nor frequency of urineloss, but was significantly associated wih Qol (r = 0.507, p = 0.021).Ofthose reporting LUTS 32.1% had sought treatment and this was sig-nificantly associated with higher age (r = 0.416,p = 0), bother (r =0.577,p = 0) and Qol (r = 0.442,p = 0). There was significant differ-ence in mean IPSS score of those who sought treatment (mean:12.47)compared to those who didn’t (mean:5.51).Conclusion: A minority of those reporting a urological condition seek treatment. Bother and impact on Qol seem to determine treat-ment seeking, while demographics play a minor role. Such informa-tion is of major interest for presentation and management strategiesdevelopment.Policy of full disclosure: None

PP-03-191

The Internet online urological consultationsScheplev, P.1; Shaderkina, V.21Moscow, Russia; 2Uroweb.ru Portal, Urology, Moscow, Russia

Objective: The purpose of the research was studying the qualitativeand quantitative characteristics of our urological on-line consultations.Methods: Delayed on-line urological consultations are organized onweb-site UroWeb.ru since 2003 by initiative group of urologists. Con-sultations are anonymous and free-of-charge. Any interested personcan set a question in a real time regime, filling the simple form.Results: We have performed the analysis of consultations for theperiod since August 2003 till August 2007 Totally 12.803 consultationsare made. 14.434 questions have been sent, 1.631 (11%) questionsfrom them were removed. A principal cause of removal of questionsare: not authorized advertisements, and also repeating and incorrectlyasked questions. Sexual structure of patients: men—9.234 (72%),women—3.569 (28%). Most of all questions are asked by men (72%).The mean age (11.248–88%) is from 15 till 46 years. The most of ques-tions to the urologist (878–7%) is addressed by people in the age of20 years. It is necessary to note, that questions in on-line consultationsare set by people of all age groups. Many people are interested inhealth of their relatives—children and parents. The greatest numberof questions concerned to problems of man’s sexual dysfunction(18,5%), sexualy transmitted infections (18%), infections of genitouri-nary systems (14%), to inflammatory prostate diseases (9%). Growthof quantity of using on-line consultations of the urologist is markedfor 4 years: for the first year 2260 consultations are executed, and forlast year—3859 consultations.Conclusion: The increasing quantity of people are using on-line con-sultations with the Internet development. On-line consultations areaccessible and inexpensive way to receive the professional urologicalhelp. We also need to prevent the low quality of Internet consultationsand to develop legal and ethical mechanisms for this purpose.Policy of full disclosure: None

PP-03-192

Initial survey for differences in erectile dysfunctionbetween continuous ambulatory peritoneal dialysisand hemodialysis patients in TaiwanTsai, W.1; Chiang, P.2; Yang, S.2

1Taipei, Taiwan; 2Mackay Memorial Hospital, Urology, Taipei, Taiwan

Objective: Erectile dysfunction (ED) is a common complication asso-ciated with end-stage renal disease (ESRD). Our previous studiesshowed that the prevalence of ED in hemodialysis patients was highin Taiwan. The purpose of this survey is to evaluate the differences ofprevalence, severity and related factors of erectile dysfunction betweenhemodialysis and continuous ambulatory peritoneal dialysis (CAPD)patients.


J Sex Med 2008;5(suppl 2):94–145

Methods: A total of 130 male ESRD patients, including 24 CAPDand 106 hemodialysis patients, were evaluated in our hemodialysisunits. The prevalence and severity of ED were assessed using the Inter-national Index of Erectile Function. The age of patients, life habits,and other co-morbidities were recorded. We also recorded the fre-quency of sexual attempt and sexual desire in both groups.Results: In comparison with the prevalence of ED in hemodialysispopulation (87%), the prevalence rate among CAPD patients waslower (71%). The average ages of patients were 58.5 and 47.5 years inthe hemodialysis and CAPD groups. As a whole, we found a signifi-cant difference of the EF domain score between the hemodialysis andCAPD groups (8 : 14, p = 0.005). But after stratification by age, thedifference became non-significant. Hypertension is the most commonco-morbidity in both groups. The average body mass index ofhemodialysis and CAPD groups were 21.5 and 23.8 (p = 0.01).Although the CAPD group has a better EF domain score, the fre-quency of sexual attempt is similar in both groups. But the decrease ofsexual desire is more obvious in hemodialysis group than CAPD group.Conclusion: Our data suggest that CAPD patients have a lower preva-lence rate of ED and are younger than hemodialysis patients. Althoughpatients in the hemodialysis group have lower EF domain than thoseof the CAPD group, the difference became insignificant after stratifi-cation by age. Besides, the CAPD group also has a fewer decrease insexual desire.Policy of full disclosure: None

PP-04 Diagnosis

PP-04-193

Relationship between IIEF score, erection hardnessscore and beck depression index in the evaluation oferectile dysfunctionTuncel, A.1; Atan, A.1; Tuglu, D.2; Aydin, O.1; Sipal, T.2; Basar, M.2

1Ankara Numune Hospital, 3rd Urology Clinic, Turkey; 2University ofKirikkale, Faculty, Urology, Ankara, Turkey

Objective: The aim of the present study is to evaluate the correlationwith IIEF, Erection Hardness Score (EHS) and Beck Depression Index(BDI) in patients suffered from erectile dysfunction with comparing tohealthy controls.Methods: A total of 304 male patients suffered from erectile dys-function age ranged from 20 to 77 years old (mean age 48.1 ± 11.2years old) without any risk factors for erectile dysfunction wereenrolled into the study. IIEF scale and BDI were by all participants,and EHS were classified from 1 to 4 according to patients’ descriptionof spontaneous erection on sexual intercourse. Additionally, 83 healthymale age ranged from 20 to 63 years old (mean age 40.5 ± 8.3 yearsold) were accepted as control groups, and same questioners were per-formed to them. Independent t and Pearson correlation tests were usedfor the evaluation of statistical analysis.Results: In patients with ED, average IIEF value was 12.5 ± 6.8, ESDscore 2.3 ± 1.0 and BDI score 11.8 ± 11.4. These values were 27.6 ±1.6, 3.8 ± 0.5 and 5.6 ± 4.0 in healthy subjects, respectively. There werestatistical meaningful differences in all parameters between two groups(pIIEF = 0.000, pEHS = 0.000, pBDI = 0.000). When the effect of agerestricted, EHS showed statistically meaningful positive correlationwith IIEF (r = 0.6617, p = 0.000), and negative correlation with BDI(r = −0.3002, p = 0.000). Moreover, IIEF showed meaningful negativecorrelation with BDI (r = −0.3551, p = 0.000). Also, we found signifi-cant negative correlation between ED degree and EHS in patients withmild, moderate and severe ED (r = −0.3436, p = 0.000).Conclusion: Our results showed that EHS can reflect patient’s EDdegree. Since EHS showed correlation with IIEF scores, and bothscores were affected by depressive mood of patients, EHS can be usedinstead of IIEF in the evaluation of sexual dysfunction of male.Policy of full disclosure: None

PP-04-194

Assesment of female sexual life by interview, clinicalevaluation and FSFI, in postmenopausal womenBucuras, D.1; Bucuras, C.2; Grigoras, D.3

1Timisoara, Romania; 2University of Medicine Timisoa, Clinic of Urology,Timisoara, Romania; 3University Of Medicine Timisoa, Clinic of ObGyn I,Timisoara, Romania

Objective: we tried to evaluate the differences in prevalence and sever-ity of female sexual disorders (FSD) among untreated postmenopausalwomen by selfreported concerns and questionnaires.Methods: We evaluated 320 untreated postmenopausal women, phys-iological (group A: 33,8% /105 cases) and iatrogenic-total hysterecty-omy and bilateral anexectomy (group B: 76%/215 females) induced,that came in the Menopausal Center Timisoara (January–august 2007).The patients were evaluated at least 6 month postsurgery. All patientswere requested to complete the FSFI questionnaire, besides clinical,biochemical and mamografical evaluation. Personal interview wereconducted will all females.Results: we observed no significant difference regarding age, waist,weight, menopausal onset, length of untreated estrogen deprivation.We observed a high incidence of low desire disorder (77,5%). Allaspects of female sexual quality were evaluated just in the sexual activesubjects. (73,3% versus 72,1%) involved in a stable relationship(89,6%, respectively 88,35%). The patients were upset by their globalsexual life in 45% of cases, 42% had orgasmic problems, desire wasdecreased compared to premenopausal period in 65,25% (154 cases).


J Sex Med 2008;5(suppl 2):94–145

Self reported unsatisfactory lubrication concerned 170 patients(72,03%). We observed no significant difference regarding the FSFIdomains between group A and B. But as we looked at the incidence,physiological menopause was associated with increased incidence ofFSD (77%) compared with iatrogenic climacterium (68%). Analyzingeach type of FSD, we observed a higher incidence of low desire,decreased libido, hypoorgasmia and pain disorders in females withspontaneous menopause. The prevalence of arousal problems wassimilar in both groups. Surprisingly, there was no correlation betweenpresence of FSD and age.Conclusion: untreated menopause is associated with high incidenceof FSD affecting all aspects of sexual quality, especially desire, arousallubrication and sensibility. In this study group, physiologic menopausedetermined higher incidence of FSD compared with surgical inducedclimacterium. There are differences between self reported prob-lems/concerns, FSFI questionnaire has lower values and higher inci-dence of dysfunctions compared with sefl reported problems.Policy of full disclosure: I have no affiliation to any funding agency

PP-04-195

Application of cardiac autonomous indices to thestudy of the neurogenic erectile dysfunction: First resultsCuzin, B.1; Pereira de Souza Neto, E.2; Abry, P.2; Loiseau, P.2; Baude, C.2;Frutoso, J.3; Gharib, C.3; Martin, X.1

1G E Herriot, Urology and Transplantation, Lyon, France; 2Ecole NormaleSupérieure de Lyon, Laboratoire de Physique, Lyon, France; 3Faculté deMédecine Lyon Grang, Laboratoire de physiologie, France

Objective: Main innervation of penis is autonomic, whose measure-ment is controversial with available electrophysiological tests. Spectralanalysis of fluctuations in the intervals between consecutive heart beats(RR intervals) (RRI) or in blood pressure (systolic blood pressure(SBP), diatolic blood pressure (DBP)), a non invasive procedure, arelikely to provide functioning of autonomic regulation.Methods: 15 patients with erectile function (ED), have been com-pared with a control group of 17 patient without ED. All patientsunderwent IIEF questionnaire, then patients with ED hormonal bloodlevels, neurophysiological testing, pharmacodoppler penile ultrasound,Patients with chronic diseases have been excluded, and includedpatients have <<idiopathic>> neuropathies. Recordings were per-formed continously supine, seated, standing. Data acquisition has beendone with software developed with LabVIEW 4.0.1 softwareTM. Foreach group, time domain measures of RRI, SBP, DBP, normalised fre-quency domain measures of RRI and SBP (normalised low frequency(LFn); normalised high frequency (HFn) and baroreflex sensitivity hasbeen determined.Results: The 2 groups were similar with respect to age, weight andbody mass index. In the frequency domain, our analysis shows analtered activity of the autonomic nervous system in patients with ED:increased activity of sympathetic activity, compared to control group.This is manisfested by the siginificant difference between groups inLF/HF ratio (3.22 ± 0.02/1.61 ± 0.07 ; p < 0.05) as well as in LFn (76± 11/62 ± 2 ; p < 0.05) and HFn (24 ± 11/38 ± 2 ; p < 0.05) in supineposition. There is no difference between groups in seated or standingposition.Conclusion: Further studies are required to validate these results, par-ticularly with respect to incident cardiovascular diseases, as in a previ-ous study, a group at increased risk of developing hypertension overthe subsequent 8 years as been identified with same kind of results asfound in our ED group (Thomas et al 2003).Policy of full disclosure: None

PP-04-196

Self image in individuals with sexual dysfunctionsZbranca, E.1; Gotca, I.2; Mogos, V.1; Cristea, C.1; Mocanu, V.1; Zbranca, E.1

1Universitate de Medicina Gr.T., Endocrinologie, Iasi, Romania; 2MentalHealth Center, Iasi, Romania

Objective: The aim of the study was to identify the self image char-acteristics in patients with sexual dysfunctions and their behavioralanalysis compared with controls, in order to know if sexual dysfunc-tions have self image abnormalities and which kind of abnormalitiesthey have.Methods: The study was performed over 62 patients with sexual dys-functions randomly selected, and 62 controls who were medically andpsychologically counseled between January 2006 and June 2007 in theDepartment of Endocrinology, University of Medicine and Pharmacyof Iasi and in the Mental Health Center “Dr.Ghelerter” Iasi. Patientswith sexual dysfunctions were aged 15 to 57 years (mean 32.8 years)and came from urban area-39 and rural area-23. In the control groupsubjects were aged 17 to 57 years (mean 31 years) and were from urbanarea/38 and rural area—24. Method. Both groups were investigatedusing a psychological questionnaire, Sexual Satisfaction Inventory,assays on construction based on geometrical figures and words, thebehavioral analysis of self image.Results: The sexual dysfunctions are associated with significant depre-ciation of self image. Global depression and depression with symptomsare more severe in patients with sexual dysfunctions. The severity ofsexual dysfunctions is significantly associated with the severity ofanxiety and a lower level of behavioral hostility. In patients with sexualdysfunctions sexual behavior is affected by the low level of self-esteem,with hyperexpression of emotions that induce inhibition. The com-parison with controls brings proofs that also metabolic problems seenin patients with sexual dysfunctions may affect self image, psycho-affective features and behavior in patients with sexual dysfunctions.Conclusion: The therapeutical intervention must simultaneouslyfollow the somatic and psychological aspects in their interrelationship.Policy of full disclosure: None

PP-04-197

Is it important to evaluate sympathetic activity duringthe intracavernous injection test?Hamsioglu, Z.1; Yalug, I.2; Duman, C.3; Ozkan, L.4; Culha, M.4;Ozkurkcugil, C.41Kocaeli University, Koceali, Turkey; 2Kocaeli University, Psychiatry, Turkey;3Kocaeli University, Biochemistry, Turkey; 4Kocaeli University, Urology,Turkey

Objective: Intracavernous injection (ICI) test plays an important roleamong studies directed towards the diagnosis of erectile dysfunction(ED). But, sympathetic activity that occurs during the ICI may affectthe result of the test. The aim of our study was to assess anxiety andhormonal discharge that occur during ICI and evaluate their effect onerection.Methods: ICI test was performed on 60 patients complaining ED.After a detailed history and physical examination, blood tests and noc-turnal penile tumescence (NPT) test was also performed. The generalanxiety was measured with State Trait Anxiety Inventory trait (STAI-trait) questionnaire in the first office visit and the state anxiety of thepatients was measured using the State Trait Anxiety Inventory state(STAI-state) anxiety criteria just after intracavernous injection. Urinenoradrenaline levels were assessed by using high performance liquidchromatography (HPLC).


J Sex Med 2008;5(suppl 2):94–145

Results: A positive correlation was calculated between urinary nora-drenaline values that were obtained in the first visit and the STAI-traitmeasurements but there was not any statistical significance. A signifi-cant relationship was observed between the urinary noradrenalinelevels that were obtained just after ICI test and the STAI-state anxietyquestionnaire and also the erection grade. When the anxiety andurinary noradrenaline increases, erection grade during ICI testdecreases significantly.Conclusion: Assessment of anxiety or catecholamine level during theICI test can help us to proper evaluation of the patient.Policy of full disclosure: None

PP-04-198

Assessing sexual function after radical prostatectomyshould be standardizedLehmann, K.1; Zahner, M.1; Mazzola, B.1; Casella, R.2

1Kantonsspital Baden, Urology, Switzerland; 2Regionalspital Biel, Urology,Switzerland

Objective: PSA is reliable to assess oncological outcome after radicalprostatectomy (RP). Reporting on potency should become as rigorousto prevent too optimistic reporting.Methods: Oncological and questionnaire based assessment on 63 menwith a median age of 59 years (range 56–63) 30 months after (retrop-ubic RP) was done. They underwent nerve sparing RP and had a pre-operative IIEF-5 (Index of erectile function, short version) score ≥17.Follow–up was done at 3, 6, 9, 12, 18, 24 and 30 months. The param-eter for oncological control was PSA and for erectile function theIIEF-5. The maximal score for the IIEF-5 goes up to score 25 with17–21 meaning mild and 22–25 no dysfunction.Results: Of 63 men 39 (62%; score 22–25: 24; score 17–21: 15) werepotent and 24 (38%) were not. One third of 39 potent men and 4among the 24 impotent men used PDE-5 inhibitors, respectively. Thepatho-anatomical stage, nerve sparing technique, catheter removal(6th postoperative day), margin status and patient age didn’t differ.Recovery from erectile function reaches a plateau after 12 months ata significantly lower level than preoperatively (IIEF-5 preop 24, postop21 p = 0.0006 and 6, p < 0.0001, respectively). Two men, one potent,one impotent had a PSA relapse.Conclusion: Standardized follow-up after RP is mandatory and willbe appreciated by actual and future patients. Undetectable PSA levelis a robust test fully understood by patients. IIEF is not that reliablebut also comprehensible and not rising too optimistic expectationsthan methods used in the past.Policy of full disclosure: None

PP-04-199

Arterial brachial flow predicts the best hemodynamicresponse to chronic Tadalafil treatment in erectiledysfunctionMancini, M.1; Guazzi, M.1; Vaccalluzzo, L.1; Colpi, G. M.1

1San Paolo Hospital, Andrology, Milan, Italy

Objective: Impaired penile endothelial function promote or maintainmany cases of erectile dysfunction (ED). Clinical and hemodynamicadvantages by chronic iPDE5 in ED patients with various form ofendothelial damage were reported. Brachial flow mediated vasodila-tion (FMD) reflects the endothelial status and is often impaired in ED.Our aim is to compare FMD and Cavernosal Peak Systolic Velocity(PSV), and to identify patients best responding to chronic treatmentwith iPDE5.Methods: Twenty-eight consecutive ED patients (mean age = 60.7 ±9.3 yrs.) underwent brachial FMD, IIEF questionnaire and dynamicduplex sonography of cavernosal arteries (DS). Exclusion criteria werepsychogenic, hormonal, neurogenic or anatomical disorders. To eval-uate endothelial function before treatment, the most promising datawere Delta Brachial Flow (Dbfmd), showing flow variation betweenbasal condition and post occlusive state. We designed 2 subgroups ofED men: Group A (n = 13; without diabetes and hypertension) andGroup B (n = 15; with diabetes and hypertension). All accepted to takeTadalafil 10 mg on alternate days, for thirty days, just before sleeping.All the patients treated underwent DS and IIEF after the end of treatment.Results: A significantly increased PSV (32 ± 9.8 vs 27.8 ± 8.7 cm/s; n= 28; p = 0.047) and IIEF (13.3 ± 7.1 vs 22.5 ± 8.2; n = 28; p < 0.0002)was found after Tadalafil treatment The iPDE5 oral treatment inducedan average PSV increasing of about 13%, called Delta PSV (Dpsv). Alinear regression in the entire population showed no statistical rela-tionship between Dpsv and Dbfmd (r2 = 0.0215). The relationshipbetween Dpsv and Dbfmd was found highly significant in Group Aand not significant in Group B (r2 = 0.729 and P = 0.0002 vs r2 = 0.0008and P = N.S.).Conclusion: After selecting ED patients without vascular risk factors,a direct correlation between Dpsv and Dbfmd was found. In this sub-group, the best Dbfmd predicts the best PSV increasing after onemonth iPDE5 treatment.Policy of full disclosure: None

PP-04-200

Is audio-visual sexual stimulation really important inperforming the Levitra-test?Mazo, E.1; Gamidov, S.2; Iremashvili, V.2

1Russian State Medical, University, Moscow, Russia; 2RSMU, Urology,Moscow, Russia

Objective: Although color Doppler ultrasonography with the intra-corporeal injection of vasogenic agents is considered a “gold standard”for diagnosis of vasculogenic erectile dysfunction (ED), this procedurecould also be performed after oral administration of phosphodiesterase5 (PDE-5) inhibitor with audio-visual sexual stimulation (AVSS). Theaim of this study was to evaluate the effect of individual selection of erotical scenes for AVSS on the results of CDUS of the penile arteries after ingestion of PDE-5 inhibitor Levitra (vardenafil)(Levitra-test).Methods: The study included 40 patients with ED. After a completehistory and physical examination patients underwent two sessions ofLevitra-test—with standard and selected AVSS. For individual selec-tion of AVSS we used original questionnaire, containing 4 questionsabout patients’ sexual preferences. During the second Levitra-testpatients were shown erotic films from one of three categories (pureerotic films, erotic films with some sexually explicit scenes, erotic films


J Sex Med 2008;5(suppl 2):94–145

with considerable amount of sexually explicit scenes) in accordancewith their answers to the questionnaire. The statistical analysis wasperformed using sign-test.Results: Mean peak flow velocity values obtained during Levitra-testwere significantly greater with individually selected AVSS comparingto standard method (29,3 +− 9,7 cm/sec vs. 24,5 +− 8,5 cm/sec respec-tively, p < 0.001). Utilization of the questionnaire for selection of AVSSalso lowered the number of patients with diagnosis of arteriogenic EDaccording to the results of Levitra-test in the sample group from 32(80%) to 27 (67.5%).Conclusion: Obtained results show that questionnaire for the assess-ment of individual sexual preferences allows to select erotic films,reviewing of which during Levitra-test results in greater patients sexualexcitement, thus increasing diagnostic value of this method. Wideapplication of this simple and convenient instrument will allow toachieve maximal reliability of Levitra-test results.Policy of full disclosure: None

PP-04-201

Influence of A 5androstenediol decline in aging male.On bioavailable testosterone calculationRaynaud, J.-P.1; Tichet, J.2; Bronsard, F.3; Born, C.2; Giton, F.4; Fiet, J.4

1Univers. Pierre et Marie Curie, Paris, France; 2IRSA, Recherche Clinique,La Riche, France; 3IUT de Cachan, Recherche, France; 4CHU HenriMondor, Centre de Recherche Clinique, Créteil, France

Objective: Detection of androgen deficiency in adult men was cur-rently based on Total Testosterone (TT) and Bioavailable Testosterone(BT) determinations. With aging, Sex Hormone Binding Globulin(SHBG) serum levels increase and consequently BT decreases. Thusa good determination of BT is of paramount significance. Variousstudies used BT calculation (cBT) from the mass action law whenothers assayed it (aBT) by immunoassay or mass spectrometry(GC/MS), after sulphate precipitation. The aim of the study was toevaluate the influence on cBT of androgens that bind to SHBG.Methods: 503 healthy untreated men aged 20–74 years were recruited.Androgens were assayed in the same laboratory: Total Testosterone(TT), Dihydrotestosterone (DHT), and ∆5-androstenediol (∆5-A-diol) were assayed by GC/MS, BT after ammonium sulphate SHBGprecipitation or calculated according to the Mass Action Law. SHBGwas measured by radio immunoassay (RIA).Results: Aging brings on decrease in TT (slight), BT (moderate) and∆5-A-diol (significant), no variation in DHT and an increase in SHBGserum levels. Among the 142 men under 40 years, the lower normallimit was between 2.25–2.70 nmol/L for aBT and 8.5 nmol/L for TT.The lower cBT limit calculated using Vermeulen’s formula was twofoldhigher than aBT. Even if by optimising the affinity constants, cBTvalues close to aBT could be obtained, when young and old subjectswere paired for the same SHBG and TT levels, a statistically signifi-cant lower aBT in old subjects was found pointing out the role of lowerserum ∆5-A-diol levels in old men.Conclusion: The lower normal serum aBT level in normal men isbetween 2.25 and 2.70 nmol/L. The two fold higher serum cBT levelsin men recently reported could be misleading and is due to an inap-propriate use of the law of mass action, not taking into account thepresence and variation of ∆5-A-diol.Policy of full disclosure: None

PP-04-202

“Aging male symptoms” questionnaire in normal andcomplaining menRaynaud, J.-P.1


Objective: To assess the relationship between sex hormone levels andAMS score in a large representative population of normal and com-

plaining men in order to differentiate the populations and identifysymptoms related to androgen deficiency.Methods: 903 healthy men were interviewed by phone, by a trainedinterviewer who completed the AMS questionnaire, other 539 healthymen consulting for a check-up in a health centre and 471 complain-ing men, who completed the AMS scale in clinical setting, wereselected. Serum levels of total and bioavailable testosterone were deter-mined in blood samples, in central or private setting offices.Results: AMS questionnaire completed in a clinical setting or using a calling up-line were comparable. In both cases, total AMS scores and sub scores were significantly dependent of age and correlated toincome. In normal men, total AMS score, somato-vegetative and psy-chological sub scores and testosterone levels remained constant withage. The only two variables that significantly varied with age were thesexual AMS sub-score and bioavailable testosterone. In complainingmen, total AMS scores and sub scores, significantly varied with agewhile testosterone levels remained unchanged. The mean levels of allvariables were significantly higher in complaining than healthy menand significantly different between the two populations. However,these differences weakened with increasing age.Conclusion: The AMS scale could be defined as a screening test todifferentiate normal and complaining men between fifty and sixty fiveyears of age. The sexual dimension of the AMS scale is the key vari-able to differentiate the two populations and to identify symptomsrelated to androgen deficiency.Policy of full disclosure: Scientific Advisor Pierre fabre Medicament

PP-04-203

Clinically meaningful improvement on the quality oferection questionnaire for erectile dysfunctionStecher, V.1; Hvidsten, K.2; Carlsson, M.3; Symonds, T.4; Levinson, I.5

1Pfizer Inc., Global Sexual Health Team, New York, USA; 2Pfizer Inc,Global Outcomes Research, New York, USA; 3Pfizer Inc, Project Statistician,New York, USA; 4Pfizer Inc, Global Research & Developm, Sandwich,United Kingdom; 5Pfizer Inc, New York, USA

Objective: Clinically meaningful improvement (CMI) is crucial forunderstanding the relevance of treatments on health status measures.Methods: We estimated the minimal CMI (MCMI) on the Quality ofErection Questionnaire (QEQ) using data from 558 patients in 2 ran-domized, double-blind, placebo-controlled trials assessing the efficacyand safety of a phosphodiesterase type 5 inhibitor for erectile dys-function (ED) treatment. Improvement in the Erectile Function (EF)domain of the International Index of Erectile Function (IIEF) was usedas an anchor, baseline to end of treatment (EOT) mean QEQ totalchange score was used to estimate CMI, and the lower limit of the95% CI of the mean was used to estimate MCMI. These were calcu-lated for men who improved by 1 ED severity category (anchor group),and for the difference between improvement by 1 ED severity cate-gory and no change (anchor group minus no-change group). A distri-bution-based approach (standard error of measurement [SEM] andstandard error of difference [Sdiff]) and a combined approach (effectsize) were also used. Effect sizes between 0.20 and 0.50 have generallybeen equated as being within the range of a MCMI.Results: Ninety-five men improved by one IIEF EF severity category,and 116 had no change. Anchor-based estimates for the QEQ CMIand MCMI total scores were 22 and 18 points, respectively, using datafrom the anchor group, and 18 and 12 points, respectively, using datafrom the anchor group minus the no-change group. According to thedistribution analyses, the baseline SEM = 7.99, the EOT SEM = 8.22,and Sdiff = 11.46. The effect-size calculations supported a proposedMCMI of 12 points (effect size: 0.53 [baseline], 0.35 [EOT], and 0.33[change]) rather than 18 points (effect size: 0.79 [baseline], 0.52[EOT], and 0.49 [change]).Conclusion: Convergence of anchor-based and distribution-based cri-teria supports at least a 12-point difference in QEQ scores as clinicallyimportant between treatments.Policy of full disclosure: Pfizer Inc, Employee


J Sex Med 2008;5(suppl 2):94–145

PP-04-204

Significant improvement in the quality of erectionquestionnaire in men with erectile dysfunction treatedwith sildenafil citrate 50 mg or 100 mgStecher, V.1; Stroberg, P.2; Tseng, L.-J.3

1Pfizer Inc., Global Sexual Health Team, New York, USA; 2Urohalsan,Skovde, Sweden; 3Pfizer Inc, Statistics, New York, USA

Objective: The Quality of Erection Questionnaire (QEQ) is a 6-item,validated questionnaire designed to evaluate satisfaction with thequality of erections in terms of hardness, onset, and duration; andassess changes in erection quality with successful erectile dysfunction(ED) treatment.Methods: The QEQ was used to assess dose-dependent satisfactionwith erection quality in a randomized, double-blind, placebo-con-trolled trial assessing the impact of sildenafil citrate, initiated at fixeddoses of 50 mg or 100 mg, on a broad range of outcomes. Assessmentswere made at baseline and at completion of double-blind treatment.Results: At the end of the double-blind phase, QEQ scores signifi-cantly improved over baseline in men taking sildenafil at either dosecompared with placebo (both P < 0.0001). Additionally, QEQ scorescorrelated significantly and positively with other patient-reported outcomes. Correlation coefficients of change in the QEQ total scorewith changes in other ED efficacy measures at the end of the doubleblind phase showed strong correlations with the International Index ofErectile Function domains for erectile function (0.80), overall satis-faction (0.68), and intercourse satisfaction (0.69). There were alsostrong correlations between change in the QEQ total score and changein the Self Esteem And Relationship questionnaire (0.80), change inthe Sexual Experience Questionnaire (0.88); as well as between theQEQ total score and the Erectile Dysfunction Inventory of TreatmentSatisfaction (0.85).Conclusion: The QEQ total score improved in men treated withsildenafil 50 mg or 100 mg for ED, and improvement in the QEQ totalscore strongly correlated with both functional and emotional patient-reported outcome measures. The results suggest that the QEQ can beused as a brief measure to assess ED treatment.Policy of full disclosure: Pfizer Inc, Employee

PP-04-205

Correlation between carotid and femoralatherosclerotic burden and vasculogenic erectile dysfunctionTsokanis, A.1; Vlachopoulos, C.2; Rokkas, K.2; Tsekoura, D.2; Ioakeimidis, N.2; Aznaouridis, K.2; Askitis, T.2; Stefanadis, C.21Athens Medical School, Greece; 2Athens Medical School, 1st CardiologyDepartment, Greece

Objective: Vasculogenic erectile dysfunction (ED) may be considereda clinical manifestation of a generalized arterial disease. The relationbetween scores incorporating intima-media thickness (IMT) from the carotid and femoral arteries and severity of ED has not been investigated.Methods: 29 consecutive non diabetic patients (mean age: 59 ± 12 yrs)affected by non-psychogenic and non-hormonal ED for more than 6months were evaluated for penile vascular disease severity by penileDoppler ultrasound. All participants were also invited to complete a5-item form of the International Index of Erectile Function (SHIM-5). Ultrasonographic assessments of IMT, lumen diameter and plaquesin the carotid and femoral arteries were evaluated and a score wasdeveloped.Results: Patients with high score (n = 11) had decreased mean peaksystolic velocity (35 vs 23 cm/s, P < 0.05) and longer duration of ED(4.5 vs 1.5 yrs, P = 0.001) compared with subjects with low score (n =18) while did not differ regarding age, systolic pressure, metabolicprofile and SHIM-5 score. Moreover, in the entire population, meanpeak systolic velocity exhibited a negative correlation with femoral (r= −0.47, P < 0.01) and carotid IMT (r = −0.32, P < 0.05).

Conclusion: Our study shows that in patients with vasculogenic ED,penile vascular damage and duration of ED correlate significantly withincreasing severity of structural changes in carotid and femoral arter-ies. This finding suggest that vasculogenic ED is closely related to sub-clinical atherosclerosis.Policy of full disclosure: None

PP-04-206

The link between erectile dysfunction, metabolicsyndrome and testosterone deficiency: Outcome ofdata analyses of 771 ED patientsYassin, A.1; Saad, F.21Segeberger Kliniken, Clinic of Urology & Andrology, Norderstedt,Germany; 2Gulf Medical College & Bay, Male Healthcare, Berlin, Germany

Objective: The metabolic syndrome, characterized by central obesity,insulin resistance, dyslipemia and hypertension, is highly prevalent.When left untreated, it significantly increases the risk of diabetes mel-litus and cardiovascular disease, pathologies associated with erectiledysfunction. Hypogonadism is a frequent occurrence in the metabolicsyndrome, which may be again an etiological factor in erectile dys-function often found in men with the metabolic syndrome which isexplained by endothelial dysfunction and oxidative stress, key elementsin the metabolic syndrome, affecting various components of the vas-cular biology of the penis.Methods: 771 patients consulting for erectile dysfunction over a two-year period received comprehensive screening for symptoms of themetabolic syndrome and for hypogonadism.Results: The average abdominal girth of these men was 104 cm (farabove the 2005 cut-off point of 94 cm). 18.3% of the men were hypog-onadal (testosterone < 12 nmol/L). In this hypogonadal subgroupabdominal girth was 112,2 cm. 35% of the 771 had diabetes mellitus,in eight men hitherto undiagnosed. 31% had arterial hypertension,twelve of them hitherto undiagnosed. 21% had dyslipemia, nine ofthem hitherto undiagnosed. 29% had BPH or LUTS. 14% had coro-nary disease, five of them hitherto undiagnosed.Conclusion: Erectile dysfunction is intertwined with the metabolicsyndrome and, in turn, with hypogonadism. Thus, erectile dysfunctionis a portal into men’s health, and a rational treatment of the erectiledysfunction of these men will be composed of treatment of underly-ing manifestations of the metabolic syndrome, and of associatedhypogonadism predisposing to both the metabolic syndrome and erec-tile dysfunction.Policy of full disclosure: None


J Sex Med 2008;5(suppl 2):94–145

PP-05 Pharmacology/pharmacotherapy

PP-05-207

Recovery of systemic levels of fibroblast growth factorin diabetic patients after treatment with sildenafil for3 monthsLouro, N.1; Cuevas, B.2; La Fuente, J. M.1; Cuevas, P.2; Cavadas, V.1; Saenz de Tejada, I.2; Angulo, J.2

1Hospital Santo Antonio, Urology, Porto, Portugal; 2Hospital Ramon y Cajal,Investigacion-Histologia, Madrid, Spain

Objective: Prolonged administration of type 5 phosphodiesterase(PDE5) inhibitors has been shown to improve endothelial function inpatients with erectile dysfunction (ED) and increase systemic levels ofendothelial precursor cells (EPCs). Fibroblast growth factor (FGF) isa key factor regulating endothelium growth and repair. We have eval-uated the impact of sildenafil administration on serum levels of FGFin diabetic patients.Methods: Type 1 (n = 9) and type 2 (n = 10) diabetic patients withED were treated with sildenafil (on-demand at 50 mg dose, at leasttwice a week) for 3 months. FGF-2 levels were determined by ELISAmethod in the serum of these patients before and after the treatmentperiod. FGF-2 levels were also determined in the serum from healthysubjects (n = 10) and in type 1 diabetic patients without ED (n = 10).Results: Baseline serum levels of FGF-2 in type 1 diabetic patientswith ED were slightly but not significantly lower than in healthy sub-jects (4.18 ± 0.75 vs 7.79 ± 2.68 pmol/ml) while in type 2 diabeticpatients with ED, FGF-2 concentration was significantly reduced (1.63± 0.63 pmol/ml; p < 0.05). Type 1 diabetic patients without ED dis-played FGF-2 levels not significantly different from those with ED orfrom control subjects (5.92 ± 1.67 pmol/ml). After 3 months of treat-ment with sildenafil, both type 1 and type 2 diabetic patients experi-enced a significant increase of FGF-2 levels (8.69 ± 1.25 and 5.48 ±1.31, respectively; p < 0.01 vs respective baseline values).Conclusion: Administration of sildenafil to diabetic patients with EDincreases serum FGF up to levels not different from healthy subjects.This action could contribute to the favourable long-term effects ofPDE5 inhibitors on endothelial and erectile functions.Policy of full disclosure: This work was partially supported by Pfizer-Portugal

PP-05-208

Comparison of treatment of erectile dysfunction with phosphodiesterase TYPE 5 inhibitors and other modalitiesChandrasekar, P.1; Krishnamurthy, G.1; Sundarajan, V.1; Potluri, B.1

1Princess Alexandra Hospital, Urology, Harlow, United Kingdom

Objective: We conducted a retrospective study to evaluate the treat-ment of erectile dysfunction with Phosphodiesterase 5 (PDE5)inhibitors (Sildenafil citrate, Vardenafil and Tadalafil) and compared itwith other treatment modalities (Transurethral suppositories, Intra-cavernosal injection, and mechanical devices).Methods: From June 2003 to Dec 2005, 181 patients were includedin the study. All of them filled the ED questionnaires and were evalu-ated with detailed history, physical examination, digital rectal exami-nation. All the treatment options were discussed with the patients(PDE5, Transurethral suppositories, Intracavernosal injection, andmechanical devices). Patients were reviewed after three months toevaluate the efficacy of the treatment.Results: Out of 181 patients 36 did not try any treatment. 26 (18%)patients opted either for transurethral suppository, intracavernosalinjections or mechanical devices and among them 17 (65%) respondedto treatment and 9 (35%) had no improvement. Remaining 119 (82%)patients opted for PDE 5 inhibitors 97 (82%) patients responded totreatment, while 22 (18%) failed. Among 97 responders (average age55 yrs), 15 (16%) had comorbid conditions (diabetes, blood pressure,hypercholesterolemia) and 26 (27%) smoked more than 5 cigarettes

per day. Out of 22 failures (average age 59 yrs) 15 (68%) had comor-bid conditions and 7 (32%) were smokers.Conclusion: The response rate for patients treated with PDE5 was82% compared to 65% treated with other methods. We found themain cause for the failure of PED 5 inhibitor treatment was comor-bid condition and smoking. There was no significant age differenceamong the responders and non responders (55 vs. 59).Policy of full disclosure: None

PP-05-209

Recovery of erectile function and veno-occlussivedysfunction after chronic sildenafil treatmentOzkan, L.1; Culha, M.1; Ozkurkcugil, C.1; Gokalp, A.1

1Kocaeli University, Urology, Turkey

Objective: Vascular factors are the most common cause of organicerectile dysfunction(ED). Patients with veno-occlussive dysfunctionand without any other pathology usually respond sildenafil. Aim of thepresent study was to evaluate the therapeutic role of sildenafil afterlong term treatment in patients with veno-occlussive dysfunction.Methods: 29 patients (aged between 26 and 46 years, mean 37) wereenrolled. All patients underwent Colour duplex ultrasonography(CDU), Dynamic infusion cavernosometry (DIC), and IIEF question-narie before and after sildenafil treatment. All other causes of ED werealso investigated. The patients were informed in detail of sildenafiltreatment. All patients were asked for taking at least once a week 50mg sildenafil citrate to make a successful intercourse. The study con-tinued 12 months, and patients were re-assessed during a regularfollow-up visit.Results: 26 patients were evaluated after 12 months. 21 patientsreported successful intercourse without sildenafil use. End diastolicvelocity decreased significantly in all patients in CDU. Full erectionswere achieved in all patients with 120–150 ml/sec infusion rate withinone minute and maintenance flow also decreased significantly durindDIC. There was also a significant improvement in IIEF scores.Conclusion: It seems that chronic sildenafil use makes improvementin erectile capacity of patients with veno-occlusive disease. Furtherstudies are needed to know much more about the possible encourag-ing alterations in penile tissue after long term sildenafil treatment.Policy of full disclosure: None

PP-05-210

Alternate-day tadalafil in the management ofhoneymoon impotenceGhanem, H.1; El Dakhly, R.1

1Cairo University, Dept. of Andrology, Egypt

Objective: The aim of this study is to report the outcome of alternate-day Tadalafil therapy in the management of HoneymoonImpotence. Honeymoon Impotence appears to be a significantmedical/social problem in conservative Middle-Eastern societiesaccounting for 8%–17% of visits to sexual health clinics (Ghanem, IJIR2006; Shamloul, JSM 2006; Meliegy, Sexologies 2004).Methods: This is a descriptive study comprised of a series of 45patients. The time frame was 2 years. Patients underwent a completemedical and sexual history as well as a focused physical examination.Investigations were ordered as necessary following a goal directedapproach. Education about the male and female genital anatomy andthe sexual response cycle was done. All patients were treated initiallywith alternate-day Tadalafil 10 mg therapy for 2 weeks. Treatmentduration was extended as needed. Main outcome measures include suc-cessful vaginal intromission and change in the IIEF-5.Results: Prevalence of Honeymoon Impotence among ED patientswas 8%. Sexual consultation revealed very poor basic sex knowledgeon the part of the patients. Of 45 patients included in our study 41(91%) were able to achieve to sexual intercourse. Thirty four patients(76%) needed Tadalafil for less than 1 month, Five (11%) for up to 3months and 2 (4%) for more than 3 months. Four patients (9%) wereunsuccessful. The IIEF-5 improved significantly with alternate day


J Sex Med 2008;5(suppl 2):94–145

Tadalafil treatment in this subgroup of patients. Treatment failureswere managed by intracavernous injection therapy, combined withpsychosexual therapy, depending on the cause.Conclusion: Alternate-day Tadalafil therapy appears to be effective asa short term treatment option in the management of HoneymoonImpotence. The prevalence of Honeymoon Impotence remains alarm-ingly high in our society and warrant serious public awareness and sexeducation programs.Policy of full disclosure: None

PP-05-211

Sexual rehabilitation for cardiac patients: the role of aspecialist clinicJackson, G.1; Waring, E.2; McLeod, C.3; McGing, E.3; Cooper, A.2

1London Bridge Hospital, United Kingdom; 2Guy’s & St Thomas’ NHS Fou,Cardiothoracic Centre, London, United Kingdom; 3Guy’s & St Thomas’NHS Trust, Cardiothoracic Centre, London, United Kingdom

Objective: Sexual functioning is an important aspect of quality of lifeand cardiac rehabilitation. The prevalence of erectile dysfunction (ED)is high in cardiac patients. Unspoken fears about ED and the safety ofresuming sexual activity are common after a cardiac event. The rela-tionship between ED and Cardiovascular Disease (CVD) is now wellrecognised however there is often fear when treating this group. Weaimed to set up a combined ED/CVD clinic to address these issues.Methods: Referrals were encouraged within the Cardiac Directorate,relevant specialties and from family doctors. A cardiologist assessedpatients. They were then risk stratified according to the British andPrinceton Consensus Panel guidelines. Patients/couple were assessedby a cardiac specialist nurse to determine the nature of their sexualproblem and discuss treatment options.Results: Since March 2001 833 patients have been referred and 701(84%) have attended. The cardiac history is presented in the table. 222(32%) of referrals were made by cardiac doctors; other referral sourcesinclude: 192 (27%) cardiac rehabilitation staff, 119 (17%) general prac-titioners, 36 (5%) other, 56 (8%) urologists, 34 (5%) cardiac special-ist nurses, 8 (1%) diabetic clinic. 52 (7%) patients were graded as highrisk, 89 (13%) intermediate and 560 (80%) low. 52% of high/inter-mediate risk have been restratified to low risk. We have been able totreat approximately 80% of low-risk patients with a PDE 5 inhibitor;no adverse cardiac events have been reported. In those not eligible forPDE 5 inhibitors and non-responders to PDE 5 inhibitors we havebeen able to offer alternative therapies. Of the patients followed-up todate 79% report treatment as very effective or effective.Conclusion: Appropriate assessment and management should enablecardiac patients to receive treatment for ED. Patients reported a pro-found impact on quality of life. Routinely assessing this sensitive issueand providing treatment can safely improve sexual relationships.Policy of full disclosure: None

Methods: 80 married men in age 35–45 years, suffered from astheniaalso erectile dysfunction (ED) were enrolled in study. 58 were treatedwith sulbutiamin for a month and 22 received placebo. Efficiency wasestimated with spermograms, monitoring of night penile tumescenceswith Rigi-Scan and analysis of 3 special questionnaires.Results: Significant increasing of both quantity and quality of sper-mies was found in sulbutiamin group, while in placebo group there wasnot any changes. Improvement of ejaculate was secondary—due to increasing of level testosterone in blood. Also the number and duration of night spontaneous erections in sulbutiamin group wasincreased. On the contrary in placebo group situation remained stable.Initially all patients had asthenia; reception of sulbutiamin during 1month allowed improving this sign in 97%. Self-estimation of thepatients their sexual potency has increased from 31,8 scores up to 47,2in sulbutiamin group and from 32,3 up to 34,1 in placebo group. Alsothe marital partners were interrogated concerning quality of sexual life(on 5-scores scale). Before the treatment 85,7% wives estimated theirrelations as “very poor”. After treatment significant improving was insulbutiamin group in 89,5% and in placebo group—in 22,2% only. Aswhole, results of the therapy like “Successful” were in sulbutiamingroup in 78,6% and 22,2%—in placebo group.Conclusion: sulbutiamin is safe and well-tolerated; it regulates metabolism, decreases asthenia, increases psychological condition ofpatients. Sulbutiamin promotes for couple to enjoy a satisfactory sexual experience that have a positive impact on QoL and partner relationship.Policy of full disclosure: None

PP-05-213

Emotional well-being in men using flexible-doseversus 100-mg fixed-dose sildenafil citrate for erectile dysfunctionMulhall, J.1; Stecher, V.2; Tseng, L.-J.3

1Weill Medical College of Corne, Urology, New York, USA; 2Pfizer Inc,Global Sexual Health Team, New York, USA; 3Pfizer Inc, Statistics, NewYork, USA

Objective: For most men, the sildenafil prescribing information rec-ommends 50 mg, increased to 100 mg or decreased to 25 mg based oneffectiveness and toleration (flexible dose). However, in dose-opti-mization studies, most men used 100 mg (Steidle et al. Int J Impot Res2007;19:154; Jiann et al. Int J Impot Res 2004;16:64). We comparedthe effect of flexible vs fixed doses on emotional well-being.Methods: Men with erectile dysfunction (score ≤25 out of 30 on theErectile Function [EF] domain of the International Index of ErectileFunction [IIEF]) who had taken ≤6 doses total and none within 6months of any phosphodiesterase type-5 inhibitor were assessed withthe Self-Esteem And Relationship questionnaire (SEAR) in 2 double-blind, placebo-controlled (DBPC) trials.Results: Across trials and treatments (≤1 dose per day of sildenafil 100mg [n = 99], sildenafil 50 mg [n = 94], or placebo [n = 95] in the fixed-dose trial [8 wk], and sildenafil [n = 104] or placebo [n = 105] in theflexible-dose trial [10 wk]), the ranges of mean age (50–53 years) andbaseline IIEF-EF domain score (15–16) were similar. Two men dis-continued sildenafil because of dyspepsia (100-mg fixed-dose) andheadache (100-mg flexible-dose), respectively. By DBPC end, 87% ofmen randomized to flexible-dose sildenafil had titrated to 100 mg. Theleast squares mean ± SE improvement in total SEAR score was 31.6 ±2.4 (100-mg fixed-dose), 24.7 ± 2.4 (50-mg fixed-dose), 20.8 ± 2.6(sildenafil flexible-dose), and 2.5 ± 2.4/6.4 ± 2.6 (placebo groups); P <0.0001 for sildenafil vs placebo. The least squares mean ± SE improve-ment was also significant for all other SEAR components (P < 0.03 forsildenafil vs placebo).Conclusion: Initiating sildenafil treatment with 100 mg resulted ingreater improvement in emotional well-being than initiating with 50mg and titrating to 100 mg. Initiating treatment with 100 mg may alsodecrease the need for dose titration and the risk of discouragement andtreatment abandonment because of inefficacy.Policy of full disclosure: Pfizer Inc, Consultant/Advisor

PP-05-212

Asthenia as cause of sexual dysfunction in married menKulchavenya, E.11Novosibirsk, Russia

Objective: Physical and psychical asthenia leads to violation ofpatient’s relationship with their family.


J Sex Med 2008;5(suppl 2):94–145

PP-05-214

Evaluation of the efficacy and safety of Zydena®(Udenafil) in males with erectile dysfunction andhypertension who are taking antihypertensive agentsPaick, J.-S.1; Kim, S. W.2; Park, Y. K.3; Hyun, J. S.4; Park, N. C.5; Lee, S. W.6; Moon, K. H.7; Chung, W. S.8

1Seoul National University, Urology, Republic of Korea; 2Catholic Univer-sity of Korea,, Urology, Seoul, Republic of Korea; 3Kyungpook National Uni-versity, Urology, Daegu, Republic of Korea; 4Gyeongsang NationalUniversity, Urology, Jinju, Republic of Korea; 5Pusan National UniversityHosp, Urology, Republic of Korea; 6Samsung Medical Center, Urology, Seoul,Republic of Korea; 7Yeungnam University Medical Ce, Urology, Daegu,Republic of Korea; 8Ewha Womans University Mok-Don, Urology, Seoul,Republic of Korea

Objective: We evaluated the efficacy and safety of udenafil in thetreatment of ED in men who were on antihypertensive medication forhypertension.Methods: This randomized, double-blind, placebo-controlled, paral-lel-design study was conducted at 8 centers in Korea from July 2006to March 2007. Following a 4-week screening period, 165 male sub-jects were randomly assigned to take placebo or udenafil at fixed-dosesof 100 mg or 200 mg as needed for 12 weeks. Endpoints were thechange from baseline in Erectile Function(EF) domain score of Inter-national Index of Erectile Function(IIEF), patients’ responses to thequestion 2 and 3 of Sexual Encounter Profile(SEP2 and SEP3), thepatients’ responses to Global Assessment Question(GAQ), and per-centage of shift to normal at 12 weeks in terms of potency. Any adverseevents were recorded for each subject throughout the study.Results: All patients were taking one to four antihypertensive agentsand randomized equally among treatment groups. A significantlygreater change from baseline in IIEF EF domain score was observedin patients treated with udenafil 100 mg and 200 mg compared withplacebo(8.71, 10.04 and 1.87, respectively, p < 0.0001). The numberof antihypertensive agents did not have a significant effect on thechange in IIEF EF domain score from baseline. Compared withplacebo, udenafil significantly enhanced the rates of successful penetration(SEP2, p < 0.005) and maintenance of erection(SEP3, p < 0.0001). Based on “yes” responses to GAQ, 78.8% and 85.2% of patients treated with udenafil 100 mg and 200 mg respectivelyimproved their erections compared to 41.2% in those with placebo.Of the patients receiving udenafil, 44.2% (100 mg) and 54.5% (200mg) achieved normal erectile function (EF≥26) at 12-week comparedto 15.7% in placebo (p < 0.0001). Treatment-related adverse eventswere generally mild to moderate with flushing, headache, dyspepsiaand conjunctival hyperaemia being the most common.Conclusion: Udenafil was an effective and well-tolerated treatmentfor erectile dysfunction in men taking antihypertensive agents.Policy of full disclosure: This study was funded by Dong-A Phar-maceutical Co., Ltd.

PP-05-215

Factors influencing patient satisfaction after 12months tadalafil treatment: Results from theDETECT studyPerimenis, P.1; Roumeguere, T.2; Heidler, H.3; Roos, E.4; Belger, M.5;Schmitt, H.61Univ. Patras, Urology, Greece; 2Univ. Erasme, Urology, Brussels, Belgium;3Univ. Linz, Urology, Austria; 4Univ. Antonius, Urology, Sneek, TheNetherlands; 5Eli Lilly, Statistics, Erl Wood, United Kingdom; 6Eli Lilly,Urology, Brussels, Belgium

Objective: To determine factors associated with patient satisfactionafter 12 months treatment.Methods: The DETECT study was a prospective 12 months Euro-pean observational study in patients with erectile dysfunction (ED) ini-tiating or changing treatment to tadalafil. 1900 eligible patients wereenrolled. Data were available from 1567 patients after 12 months ofwhich 1319 (84%) reported continued use of tadalafil. ED Inventory

of Treatment Satisfaction (EDITS) scores after 1,6 and 12 monthswere analysed for these patients. Mean EDITS scores (scale 0–4) weremultiplied by 25 to normalize them to a 100 point scale.Results: The table shows the evolution of the total EDITS and indi-vidual questions scores over 12 months. A generalised linear regres-sion model identified 12 month lower ED severity, more sexualattempts, higher change in IIEF EF score from baseline, treatmentwell tolerated, partner support, no relationships problems and higherbaseline treatment expectations as being associated with higher satis-faction at 12 months: Higher EDITS scores after 4 weeks were asso-ciated with treatment continuation at 12 months.Conclusion: High satisfaction with tadalafil treatment was associatedwith patients therapeutic response and treatment tolerance but alsopartner support. Patients satisfaction with tadalafil after one month ofuse was associated with continuation of treatment for 12 months.Policy of full disclosure: None

PP-05-216

Pharmacokinetic study of a novel testosterone-in-adhesive matrix patch during the 48 hours ofapplication to hypogonadal menRaynaud, J.-P.1; Aumonier, C.2; Gualano, V.2; Betea, D.3; Beckers, A.3

1Univers. Pierre et Marie Curie, Paris, France; 2Cephac, Recherche analy-tique, Saint Benoit, France; 3Centre Hospitalier Universitaire, Centre d’Endocrinologie, Liège (Salt-Tilman), Belgium

Objective: To assess the pharmacokinetic testosterone time profileand dose proportionality after application of a novel matrix testos-terone patch (30, 45, 60 cm2, containing 0.5 mg of testosterone percm2, delivering respectively 1.2, 1.8, and 2.4 mg per day).Methods: This open study was a single dose, three-period, crossovertrial with a randomized treatment sequence in 24 hypogonadal men,consisting in a single 48 h application of two patches of 2 × 30, 2 × 45,2 × 60 cm2, separated by a five-day wash-out. Testosterone and dihy-drotestosterone concentrations were determined during patch appli-cation and 1 and 3 hours after patch removal by GC/MS method. Doseproportionality was assessed on baseline corrected, dose normalizedparameters for Cav, corr/D, Cmax, corr/D and AUC (0–48),corr/D.Results: Testosterone concentration rose during the first 9 h follow-ing patch application, remained relatively sustained until 48 h and thendecreased abruptly after patch removal, with a half-life of 1.3 hours.Testosterone levels were maintained above 3 ng/mL for 42 h to 45 hwith all patches. Cav were 3.39, 4.03 and 4.58 ng/mL and Cmax (24 h) were 4.33, 5.29 and 6.18 ng/mL according to the doses. Dihydrotestosterone concentration paralleled testosterone profiles.The pharmacokinetics parameters (AUC, Cav, and Cmax) were dosedependent with mean ratios within the (0.70–1.43) acceptance range.The DHT/T ratio showed modest fluctuations.Conclusion: Dose linearity was demonstrated between the differentsurfaces of testosterone patches. Application resulted in dose propor-tional increases in serum T levels in hypogonadal men into the low tomid-normal range within the first hours and mean concentrations weresustained until the end of the 48-hour patch exposure.Policy of full disclosure: Consultant: Pierre Fabre Médicament

PP-05-217

Response to first month tadalafil treatment predicts12 month continuation in patients with erectiledysfunction: Results from the DETECT studyRoumeguere, T.1; Verheyden, B.2; Arver, S.3; Bitton, A.4; Eliasson, T.5;Belger, M.6; Schmitt, H.71Erasme Hospital, Urology, Brussels, Germany; 2University Hospital,Urology, Antwerp, Belgium; 3Karolinska Hospital, Urology, Stockholm,Sweden; 4Private Practice, Urology, Geneva, Switzerland; 5Umea Hospital,Urology, Sweden; 6Eli Lilly, Statistics, Erl Wood, United Kingdom; 7Eli Lilly,Urology, Brussels, Belgium

Objective: To determine effectiveness of tadalafil and factors associ-ated with continuation after 12 months treatment.


J Sex Med 2008;5(suppl 2):94–145

Methods: The DETECT study is a prospective 12 months Europeanmulti-centre observational study in patients with erectile dysfunction(ED) initiating or changing treatment to tadalafil. 236 sites from 8countries enrolled 1900 eligible patients. Data were available from1567 patients after 12 months. The 333 patients lost to follow-up areassumed missing at random. 1319 (84%) reported continued use oftadalafil. IIEF EF domain scores were analysed at each visit.Results: The table shows the improvement in ED severity andincrease in number of sexual attempts over 12 months. A multivariatelogistic regression model identified: ED severity (p < 0.0001), toler-ance to treatment (p < 0.0001) and number sexual attempts (p = 0.003)after 1 month; age <60 years (p = 0.008) and no history of pelvicsurgery (p = 0.03) as being associated with tadalafil continuation.Conclusion: 84% of patients reported sustained use of tadalafil after12 months. There was rapid, high and continued improvement ineffectiveness in these patients. The therapeutic response and treatmenttolerance after 1 month are the most important factors influencingtadalafil continuation.Policy of full disclosure: Unlimited grant from Eli Lilly

PP-05-219

Significant improvement in self esteem andrelationship questionnaire scores in men with erectiledysfunction treated with Sildenafil Citrate 50 mg or100 mgStecher, V.1; Stroberg, P.2; Tseng, L.-J.3

1Pfizer Inc., Global Sexual Health Team, New York, USA; 2Urohalsan, Uro-halsan, Skovde, Sweden; 3Pfizer Inc, Statistics, New York, USA

Objective: The Self-Esteem and Relationship (SEAR) questionnaire,a 14-item psychometric instrument specific to erectile dysfunction(ED), assesses self-esteem, sexual relationship, and confidence.Methods: The impact of sildenafil citrate, initiated at fixed 50 mg or100 mg doses to treatment-naive men with ED, on psychosocial well-being was assessed in a randomized, double-blind, placebo-controlledtrial. Assessments were made at baseline and at the completion ofdouble-blind treatment.Results: Figure 1.Conclusion: SEAR total, domain, and subscale scores were all signif-icantly improved by treatment with either dose of sildenafil comparedwith placebo. The SEAR total score, the Sexual Relationship domain,and the Overall Relationship subscale scores were significantlyimproved in men who initially received treatment with the 100 mgdose compared with those treated at 50 mg.Policy of full disclosure: Pfizer Inc, Employee

PP-05-218

Effects of sildenafil on Sertoli cell secretory functionSofikitis, N.1; Pardalidis, N.1; Grammeniatis, E.1; Giannakis, D.1; Gratsias,S.1; Giotitsas, N.1; Tsabalas, S.1; Gekas, A.1; Tsounapi, P.1; Baltogiannis, D.1;Miyagawa, I.21University of Ioannina, Urology, School of Medicine, Greece; 2Tottori Uni-versity, Urology, School of Medicine, Yonago, Japan

Objective: We evaluated the Sertoli cell secretory function (SCSF) inmen with bilateral obstructive azoospermia (BOA).Methods: BOA-men (n = 13) underwent epididymal fluid aspirationwith microsurgical techniques for assisted reproductive technologypurposes. Fluid was collected from the head (HE), body (BE), and tail(TE) of the epididymis of each man and processed for sperm identifi-cation, intraooplasmic sperm injection procedures, and evaluation ofthe androgen-binding protein (ABP; marker of SCSF), as well. Preg-nancies were achieved in four couples. The males from the remainingnine couples were treated with sildenafil (50 mg; daily) for more than12 weeks. Then they underwent a new epididymal micropuncture andthe collected epididymal fluid was processed for sperm identificationand ABP evaluation.Results: Within the group of the latter 9 BOA-men, ABP profiles inHE samples, BE samples, and TE samples were significantly largerafter sildenafil administration than prior to sildenafil treatment. Inaddition % motile spermatozoa in HE samples, BE samples, and TEsamples were significantly larger after sildenafil administration.Conclusion: It appears that sildenafil administration enhances SCSFaffecting positively the epididymal sperm maturation process. Moreresearch efforts are necessary to clarify whether the effect of sildenafilon SCSF is mediated through a direct inhibition of the phosphodi-esterase-5 (PDE-5) of Sertoli cells or through an effect of sildenafil onother intratesticular paracrine mechanisms regulating the SCSF.Policy of full disclosure: None

PP-05-220

Treatment satisfaction in men using flexible-doseversus 100-mg fixed-dose sildenafil citrate for erectile dysfunctionStecher, V.1; Mulhall, J.2; Tseng, L.-J.3

1Pfizer Inc., Global Sexual Health Team, New York, USA; 2Weill MedicalCollege of Corne, Urology, New York, USA; 3Pfizer Inc, Statistician, NewYork, USA

Objective: For most men, the sildenafil prescribing information rec-ommends 50 mg, increased to 100 mg or decreased to 25 mg based on effectiveness and toleration (flexible dose). However, in dose-optimization studies, most men used 100 mg (Steidle et al. Int J Impot Res 2007;19:154; Jiann et al. Int J Impot Res 2004;16:64). Wecompared satisfaction with flexible- vs fixed-dose treatment in 2 similarly-designed double-blind, placebo-controlled (DBPC) trials.Methods: Men with erectile dysfunction (score ≤25 out of 30 on theErectile Function [EF] domain of the International Index of ErectileFunction [IIEF]) who had taken ≤6 doses total (none within 6 mo) ofany phosphodiesterase type-5 inhibitor were assessed with the Erec-


J Sex Med 2008;5(suppl 2):94–145

tile Dysfunction Inventory of Treatment Satisfaction (EDITS Index[maximum 100] and percentage satisfied [EDITS Index >50; estimatedby logistic regression]).Results: Across trials and treatments (≤1 dose per day of sildenafil 100mg [n = 99], sildenafil 50 mg [n = 94], or placebo [n = 95] in the fixed-dose trial [8 wk], and sildenafil [n = 104] or placebo [n = 105] in theflexible-dose trial [10 wk]), the ranges of mean age (50–53 y) and base-line IIEF EF domain score (15–16) were similar. Two men discontin-ued sildenafil because of dyspepsia (100-mg fixed-dose) and headache(100-mg flexible-dose), respectively. By DBPC end, 87% randomizedto flexible-dose sildenafil had titrated to 100 mg. The least squaresmean ± SE EDITS Index was 78.4 ± 2.0 (100-mg fixed-dose), 73.0 ±2.0 (50-mg fixed-dose), 66.5 ± 3.3 (sildenafil flexible-dose), and 49.7 ±2.1/49.6 ± 3.2 (placebo groups), and 93%, 88%, 69%, and 46% weresatisifed with treatment, respectively.Conclusion: One-third more men were satisfied with sildenafil treat-ment initiated at 100 mg than initiated at 50 mg and titrated (to 100mg in almost 90% of men). Beginning treatment with 100 mg may alsodecrease the need for dose titration and the risk of discouragement andtreatment abandonment because of inefficacy.Policy of full disclosure: Pfizer Inc, Employee

PP-05-221

Significant Improvement in the erectile dysfunctioninventory of treatment satisfaction questionnaire scorein men with erectile dysfunction treated withSildenafil Citrate 50 mg or 100 mgStroberg, P.1; Stecher, V.2; Tseng, L.-J.3

1ED-Kliniken, Urohälsan, Skövde, Sweden; 2Pfizer Inc, Global SexualHealth Team, New York, USA; 3Pfizer Inc, Statistics, New York, USA

Objective: The 11-item Erectile Dysfunction Inventory of TreatmentSatisfaction (EDITS) questionnaire assesses patients’ satisfaction withtheir erectile dysfunction (ED) treatment. The EDITS Index, definedas the average EDITS question score × 25, ranges from 0 (extremelylow treatment satisfaction) to 100 (extremely high treatment satisfac-tion).Methods: The impact of sildenafil citrate, initiated at fixed doses of50 mg or 100 mg to 280 treatment-naive men with ED, on EDITSand other patient reported outcomes was assessed in a randomized,double-blind, placebo-controlled trial. Assessments were made at thecompletion of double-blind treatment. The least squares mean, stan-dard error, and P-values are derived from an ANCOVA model withterms for treatment group, center, duration of ED, etiology of ED,and patient age.Results: The patients’ mean age was 51 years (range 20–65 years), andmost had mild–to-moderate ED. The EDITS Index was significantlyhigher with sildenafil compared with placebo, and significantly higherafter treatment with sildenafil 100 mg than with sildenafil 50 mg(Table). 45.8% in the placebo group, and 88.0% and 92.5% in thesildenafil 50 mg and 100 mg groups, respectively, were satisfied withtreatment (EDITS Index >50). At either sildenafil dose, percent satis-fied was significantly greater compared with placebo (both P < 0.0001),but was not significantly different between sildenafil doses.Conclusion: Treatment satisfaction measured by the EDITS Indexwas significantly higher in men treated with either dose of sildenafilfor ED compared with placebo. Additionally, EDITS Index was sig-nificantly higher in men treated at the 100 mg dose compared withthose treated at 50 mg.Policy of full disclosure: Pfizer Inc, Investigator

PP-05-222

Significant improvement in the sexual experiencequestionnaire score in men with erectile dysfunctiontreated with Sildenafil Citrate 50 mg or 100 mgStroberg, P.1; Stecher, V.2; Tseng, L.-J.3

1ED-Kliniken, Urohälsan, Skövde, Sweden; 2Pfizer Inc, Global SexualHealth Team, New York, USA; 3Pfizer Inc, Statistics, New York, USA

Objective: Both functional and emotional elements contribute to andare important components of successful intercourse. The recently val-idated Sexual Experience Questionnaire (SEX-Q) assesses functional,emotional, and satisfaction-related aspects of the sexual experience andis also specific and sensitive enough to detect improvement that occurswith treatment.Methods: The SEX-Q was used in a randomized, double-blind,placebo-controlled trial designed to assess the impact of sildenafilcitrate initiated at fixed doses of 50 mg or 100 mg on a broad range ofoutcomes in men with erectile dysfunction (ED). Assessments weremade at baseline and at completion of the double-blind treatmentphase.Results: Change from baseline SEX-Q scores at the end of the doubleblind phase showed that SEX-Q scores were significantly improved inmen taking sildenafil at either dose compared with men taking placebo(P < 0.0001). Additionally, the sildenafil 100 mg group had a statisti-cally significant improvement in the SEX-Q total and domain (Relationship, Erection, and Satisfaction) scores compared with thesildenafil 50 mg group (P < 0.05). SEX-Q scores correlated signifi-cantly and positively with other patient-reported outcomes, includingthe International Index of Erectile Function, the Quality of ErectionQuestionnaire, the Self Esteem And Relationship questionnaire, andthe Erectile Dysfunction Inventory of Treatment Satisfaction.Conclusion: The SEX-Q total and domain scores significantlyimproved in men treated with sildenafil 50 mg or 100 mg for ED, andthe SEX-Q strongly correlated with both functional and emotionalpatient-reported outcomes. The results suggest that the SEX-Q canbe used as a brief measure to assess the impact of ED therapy on thefunctional, emotional, and satisfaction-related aspects of the sexualexperience.Policy of full disclosure: Pfizer Inc, Investigator

PP-05-223

Giving patients with erectile dysfunction (ED) theopportunity to try all three available PDE-5 inhibitorswill result in better longterm treatment compliance—results of a two year follow-upStroberg, P.1; Ljunggren, C.1; Salomonsson, K.1; Hedelin, H.2

1ED-Kliniken, Urohälsan, Skövde, Sweden; 2FoU-Center, Kärnsjukhuset,Skövde, Sweden

Objective: One described way to improve the compliance with PDE-5 inhibitors is to let the patient try all the available (Sildenafil, Varde-nafil, Tadalafil) and prescribe the drug(s) he and his partner desires.The aim was to study the discontinuation rate of PDE-5 inhibitortreatment among patients two years or more after they had had theopportunity to try all three. To identify reasons for drop-out, studytreatment frequency and behaviour (changes?) in those who still con-tinued their treatment.Methods: The men who during 2003 were enrolled in a treatmentregime, where they got the opportunity to test all the three drugs andchose the one(s) they preferred, were 2006 interviewed by telephoneconcerning their ongoing ED-treatment.Results: Of the 138 men, mean age 60 years (36–79 years), who hadbeen enrolled in the three drug regime, 127 (92%) could be reached.The mean follow up time was 27 months (23–34 months). Of the 127as many as 109 (86%) were still using PDE-5 inhibitors. A few (8%)used > 2 tablets per week. The majority (44%) used 1–2 tablets perweek or 1–2 per month (43%) the others (5%) less often. The causesfor discontinuation were varying. The most common reason (n = 7)was return of a satisfactory non-assisted erection. 75% of the men used


J Sex Med 2008;5(suppl 2):94–145

only one drug, the others switched between a short and long actingdrug depending on the situation. It was not uncommon (25%) that thepreference had changed during the three years of PDE-5 inhibitor use.Conclusion: To let patients with ED test the three available PDE-5inhibitors results in an unusually high compliance even under anextended period of time (>2 years). A significant number want to haveaccess to both a more short acting and a more long acting drug, whichshould be considered when counseling the patient.Policy of full disclosure: None

PP-05-224

Does the long-acting PDE5 inhibitor tadalafil havelonger-lasting or more severe side-effects than theshort-acting PDE5 inhibitors?Taylor, J.1; Storey, A.2; Walker, R.2; Cartledge, J.2; Eardley, I.2

1York, United Kingdom; 2St James’s University Hospital, Department ofUrology, Leeds, United Kingdom

Objective: Tadalafil has a much longer duration of action than theother PDE5-inhibitors. Whilst the types of side-effect seen withtadalafil are well documented, there is currently no information onwhether this longer duration of action is associated with a longer dura-tion of side-effects. The aim of this study was to investigate whetherthere are any differences in the duration or severity of side effectsbetween tadalafil and the short-acting PDE5-inhibitors.Methods: Treatment-naïve men were recruited from a specialist erec-tile dysfunction clinic. After counselling they were given a free choiceof which drug they wished to take. Data on the type and duration ofside-effects were collected prospectively. Levels of bother wereassessed with a visual analogue scale.Results: Data were obtained from 403 consecutive men with a meanage of 57. 85.6% reported a successful treatment outcome. 43% expe-rienced side-effects, the commonest being headache, flushing and indi-gestion. Observed frequencies were comparable to published data.There was no difference in side-effects between drug responders andnon-responders. Duration of side-effects ranged from 10 minutes to120 hours, with means of 14.9 hours, 4 hours and 8.4 hours fortadalafil, sildenafil and vardenafil respectively. The majority of side-effects settled within 6 hours for all PDE5-inhibitors, but the propor-tion lasting longer than 6, 12 and 24 hours was significantly greaterfor tadalafil (p < 0.01). Indigestion was the most bothersome symptom(median VAS 35) and flushing the least bothersome (median VAS 16).There was a positive correlation between duration of side effect andlevel of bother (r = 0.61, p < 0.01) but no significant difference inbother levels between drugs.Conclusion: In keeping with its longer duration of action, men takingCialis are at risk of significantly longer, but not more severe side-effects. However, the majority will still settle in less than six hours.Policy of full disclosure: None

PP-06 Surgery and Peyronie’s disease

PP-06-225

Distal hypospadias: Does it require surgicalintervention?Goddard, J. C.1; Peters, R. T.1; Tank, S.1; Khan, M. A.1

1Leicester General Hospital UHL, Urology, United Kingdom

Objective: Hypospadias has an incidence of 1 in 300 live male births.The abnormal location of the external urethral meatus is most com-monly distal. It is usually corrected in the early years of life. However,surgery for distal hypospadias can lead to complications in upto 15%of cases including, urethral stricture, fistula, poor cosmesis and needfor re-operation. Our object therefore, was to determine whether thisintervention is necessary.Methods: All adult males admitted with unrelated urological condi-tions and coincidental hypospadias were asked a series of standardquestion. These assessed psychosexual aspects, fertility and urinaryfunction.Results: A total of 23 men were surveyed, median age 72 (36–90).Fifteen cases were coronal, four were in the distal penile shaft, threewere glandular and one was in the mid penile shaft. None were trou-bled by their hypospadias, some were unaware their anatomy wasabnormal. No patient felt the condition had led to embarrassment.There had been no sexual problems encountered and 19 of the 23(83%) had fathered children. Of the remaining four, one was unmar-ried and one subfertile with testicular maldescent. All were able to voidwhilst standing. None of the men expressed a desire to have their distalhypospadias corrected.Conclusion: In this small study we were unable to find any adult malewith untreated distal hypospadias who found the condition affectedtheir quality of life or wished for correction. We therefore feel thatparents should be advised against surgical correction for distalhypospadias unless clinically indicated and hope that this informationmay be helpful in their counselling.Policy of full disclosure: None

PP-06-226

Patient and partner satisfaction in penile prosthesisimplantationGumus, B.1; Sahin, A.2; Cakmak, O.3; Demir, O.4; Can, E.2; Celen, I.5;Bolukbasi, A.3; Esen, A.41Istanbul, Turkey; 2Tepecik Training Hospital, Urology, Izmir, Turkey;3Atatürk Training Hospital, Urology, Izmir, Turkey; 4Dokuz Eylul Univer-sity, Urology, Izmir, Turkey; 5Celal Bayar University, Urology, Manisa,Turkey

Objective: Implantation of penile prosthesis (PPI) becomes the treat-ment of choice when other previous treatments have failed in the man-agement of erectile dysfunction (ED). We aimed to evaluate the patientand partner satisfaction after PPI.Methods: Forty seven patients who had undergone implantation of apenile prosthesis for organic ED and their partners from for UrologyClinics (Tepecik and Atatürk Teaching Hospitals, Celal Bayar andDokuz Eylül University Medicine Schools) included in the study. Dataof PPI and demographics was collected by face to face interview withpatients and their partners. Male patients were evaluated with Inter-national Index of Erectile Function (IIEF) questionnaire and partnerswere evaluated with Female Sexual Function Index (FSFI) for sexualfunction. The sexual satisfaction after PPI was evaluated with five scalequestion (very dissatisfied, moderately dissatisfied, about equally satis-fied and dissatisfied, moderately satisfied, very satisfied).Results: he mean age of patients and their partners were 59.4 (38–79)and 53.7 (32–71) years, respectively. The mean duration of prosthesisimplantation was 28.6 months. Education level ratios of patientsprimary, middle and high was 60%, 32%, and 8%, respectively. Satis-faction level ratios of patients very dissatisfied, moderately dissatisfied,about equally satisfied and dissatisfied, moderately satisfied and verysatisfied were 6.4%, 4.3%, 10.6%, 63.8% and 14.9% and same ratios


J Sex Med 2008;5(suppl 2):94–145

for partners were 8.5%, 4.3%, 10.6%, 70.2% and 6.4%, respectively.Female sexual disorder was diagnosed in 44.7% of partners accordingto FSFI.Conclusion: High mean values of IIEF and FSFI of patients and theirpartners compared to normal population at same ages is an evidencefor the success of treatment. PPI is very effective treatment model forpatients and their partners.Policy of full disclosure: None

Methods: From January 2005 to February 2007, four young patients,18, 22, 31 and 33 years old were treated for penile deviation by mod-ified Nesbit technique. Two patients were suffered of lateral curvatureand two of ventral curvature. They had no signs of penile fracture andthey have noticed curvature before puberty. Our surgical approach tothese patients was to shorten the convex aspect of the penis by modi-fied Nesbit technique. The modified Nesbit procedure involves plica-tion suture on the convex aspect of the penis before tunica albuginearesection.Results: No intraoperative complications or hypercorrection werereported. Our patients had spontaneous and full erections. Penileshortening was not diminishing the degree of patient’s satisfaction.Conclusion: It is scientific accepted that patients with congenital cur-vature of the penis were best managed with a plication technique andnot grafting techniques. The size of the erect penis is not a problemin patients with congenital curvature and the inevitable shortening isnot diminishing the degree of satisfaction for plication techniques.Policy of full disclosure: None

PP-06-229

Surgical characteristics of rupture area in fracturedpenisNale, D.11Clinic of Urology, Urology, Belgrade, Serbia

Objective: To assess surgical characteristics of site and direction ofrupture in tunica albuginea and to estimate if there is a typical locali-sation where rupture occurs.Methods: Prospectively, 13 surgically treated patients with penilefracture were evaluated. Mean age were 41 ± 7,65 years (rang: 23–52).Intraoperatively localisation of rupture, involvement of one and/orboth corpora cavernosa, presence of urethral injury and direction ofruptured area in tunica albuginea were registered. Surgical approachin 5 patients was circumferential incision with denudation of penis andin 7 pts anterior scrotal incision with aversion of penis.Results: Significantly most frequently site of rupture was registeredin proximal and mid of penile body. Involvement of only one corpuscavernosum was registered in 10 (76,93%) pts. Concomitantly urethralinjury was found in 2 (15,4%) pts. With respect to longitudinal axis oferectile penis, transversal direction of ruptured area was registered inall observed cases.Conclusion: With respect to longitudinal axis of erectile penis direc-tion of ruptured area is always transversal. This finding implicates thateven though there is no typical localisation of rupture, somehow,minor physiologic penile curvature might be site of low resistancy dueto unstable structural integrity of tunica albuginea.Policy of full disclosure: Direction of ruptured area in the penis isalways transversal—“bycicle conctruction”.

PP-06-230

Mechanism of urethral stricture in insertion of aninflatable penile prosthesisPark, J. K.1; Lee, S. W.2; Park, B. H.1; Lim, J. H.1; Cui, W. S.1; Park, J. S.1

1Chonbuk National University, Urology, Jeonju, Republic of Korea;2SungKyunkwan University, Urology, Seoul, Republic of Korea

Objective: The aim of this study was to find the mechanism and toprevent the urethral stricture occurred by implantation of a three-pieceinflatable penile prosthesis (Mentor Corporation, Santa Barbara, California).Methods: During the implantation with the three-piece inflatablepenile prosthesis, we draw two longitudinal lines parallel to the longaxis on the proximal cylinder and tubing leading from each cylinderduring the preparation of the cylinder into the cavernosal space toprevent the rotation of the cylinder of 360 degree.Results: From September 1993 through February 2007, a total 86three-piece penile prosthesis implantations were done in 70 patients.Urethral stricture was occurred in 5.8% (5/86) of the prosthesis oper-

PP-06-227

Penile abscess and urethro-cutaneous fistula ascomplications of intracavernous injection: Diagnosisand treatmentIconaru, A. V.1; Voinescu, V.1; Muresan, M.1; Ateia, A. H.1; Hristea, D.1;Persu, S.1

1University Hospital Th Burghel, Dept of. Urology, Bucharest, Romania

Objective: Intracavernous injections (still) represent a diagnostic andtreatment tool in Erectile Dysfunction. Penile abscess and urethro-cutaneous fistula represent rare complications of this therapy. Theobjective is to present diagnosis and treatment of such complications.Methods: It is presented a 49 years old patient who developed a penileabscess after an intracavernous injection of papaverine. The sonogra-phy of penis and puncture of the abscess confirmed diagnosis. Aurethro-cutaneous fistula developed after surgical treatment (evacua-tion of abscess removal of the abscess sheath). The treatment of fistula,extremely difficult, was performed three months latter (cystostomy,Orandy urethroplasty).Results: At the 14th day postoperatively (second operation), the fistulawas completely closed, penis appeared normal.Conclusion: Penile abscess and urethro-cutaneous fistula are unusualcomplications following intracavernous injection; their surgical treat-ment is difficult and complex operations may be necessary.Policy of full disclosure: None

PP-06-228

Congenital penile curvatureKartsaklis, P.1; Konstantinidis, C.2; Palaiodimos, I.3; Andreadakis, S.3;Gekas, A.3

1General Hospital of Patras, Greece; 2National Institution of Rehabi,Urology, Athens, Greece; 3General Hospital of Patras, Urology, Greece

Objective: Patients with congenital curvature of the penis can haveventral, lateral or dorsal curvature. We report on three young patientswith congenital penile curvature who consulted us for penile deviationcausing difficulty or inability to achieve vaginal penetration.


J Sex Med 2008;5(suppl 2):94–145

ations. The urethral stricture was not developed after drawing of lon-gitudinal lines at the proximal cylinder or pump.Conclusion: Successful outcome was achieved in the patients, whoreceived penile implantation with the three-piece penile prosthesismarked with longitudinal lines. The rotation of cylinder may cause thecompression on the urethra by tubing’s leading from cylinder or pump,which crossover the urethra resulting in urethral stricture. Thedrawing of longitudinal lines at the proximal cylinder and tubingleading from the cylinder could prevent the urethral stricture inducedby tubes twisted by cylinder rotation.Policy of full disclosure: None

PP-06-231

A case of Fournier’s gangrene with extensive loss of integumentary tissue: The necessity ofmultidisciplinary integration to obtain optimal resultsPassavanti, G.1; Pizzuti, V.2; Bragaglia, A.2; Brauzzi, M.2; Tanasi, P.2;Pagni, M. R.2; Norgini, E.2; Aloisi, A. M.3; Carlucci, M.3; Paolini, R.21Misericordia Hospital, Dept. of Urology, Grosseto, Italy; 2Misericordia Hos-pital, Serv. HOT, Grosseto, Italy; 3University of Siena, Physiology, Italy

Objective: Fournier’s gangrene is a severe condition requiring surgery,advanced dressings and systemic therapy. Here we describe a case withextensive loss of integumentary tissue.Methods: A 43-year-old man was admitted to hospital on account ofsevere sepsis with necrosis of the scrotal and perineal integumentarytissue as far as the ischial spine. The initial treatment was radical clean-ing of the necrotic tissues and preparation of a colic lateral anus. Thesubsequent application of advanced dressings and hyperbaric oxygentherapy (HOT) resulted in tissue cleanness and the preservation oftissue vitality. After covering the penis with the foreskin, we pocketedthe testicles in the thigh root. We then incised skin flaps to cover theperineum. The remaining bare perineal area was covered with a cadav-eric skin graft.Results: After all the flaps had taken root, the perineal plane appearedcompletely covered with trophic and regular dermo-epidermic tissue,without any anelastic scars.Conclusion: Fournier’s gangrene is a necrotising fascitis involving theintegumentary tissues of the scrotum and perineum. During the acutephase, it is necessary to maintain the basic vital elements, to planantibiotic therapy and to completely remove all necrotic tissue. Theuse of advanced dressings and supportive therapies (HOT) assuresgood preparation of the dissection bed, preserving the vitality of resid-ual tissues. In this way, it will be possible to continue the reconstruc-tion, probably using autologous skin flaps and, possibly, a cadavericskin graft. Our experience (9 cases in 4 years, 8 of which resolved)shows that the combination of the above-mentioned methods providesunexpectedly good results in both the acute and reconstructive phases.Thus, it is possible to have a perineal lining with vital tissues and toavoid anelastic scars, which can compromise the patient’s quality of life.Policy of full disclosure: None

PP-06-232

Penile paraphinoma secondary to Omega 3 injectionKreizman, M.1; Rub, R.1; Marazka, H.1; Erlich, N.1

1Hillel Yafe, Urology, Hadera, Israel

Objective: In the past and nowadays, the presence of a large sexualorgan is regarded as a symbol of strong body composition, especiallywith regard to sexuality. Foreign body injection into the penis for thepurpose of augmenting the penile contour used to be culturallypopular in some communities. The practice has continued in someparts of the world such Asian and eastern Europe countries. Wepresent a group of patients who injected an oily material to their penisin purpose of augmentation and enhancing sexual pleasure.Methods: Between the years 2005–2007 ten men with a mean age of27 years (25–40) were admitted to the Urology Department. All wereoriginally from Thailand and all were uncircumcised. The presenting

symptoms were fever, pain, edema and tenderness of all penile skinespecially the prepuceal skin. All men were injected with Omega 3 oil.The oil was injected to six patients two weeks prior to hospitalizationand to the others 1.5 month–18 months before. Treatment includedantibiotics. analgesics and local cooling.Results: Four patients were operated upon due to lack of improve-ment or exacerbation of their medical condition. The surgery consistedof longitudinal incision of the dorsal penile skin (dorsal slit) in orderto release the reactive phimosis. Six patients improved under conser-vative treatment. Patients were discharged with recommendation forsurgical removal of the oily material and reconstruction of penile skin.All were lost from follow-up.Conclusion: In spite of our recommendation none of the patientschosed to be operated. This fact might point their satisfaction fromthe cosmetic and functional results although they were aware of thelate possible complications. Increased physician and public awarenessare needed for prevention and treatment of complications of this phys-ically and psychologically debilitating and destructive problem.Policy of full disclosure: None

PP-06-233

Analysis of alternative technologies in treatment ofstrictures of anterior urethra using complex method ofcomparative assessmentScheplev, P.1; Plutnitsky, A.2; Garin, N.3; Gvasaliya, B.3; Gameeva, E.3

1Moscow, Russia; 2Health Department, Klin. Administry, Moscow, Russia;3RMAPE, Urology, Moscow, Russia

Objective: To make a decision about choosing technologies throughmany variants it is necessary to use some methods. It is important totake into account not only clinical efficiency, but also economic andsocial patient’s satisfaction. Usually those methods are used separatelyand to make a global conclusion in public health is very difficult. Wecombined clinical, economic methods and method of assessmentpatient’s satisfaction to calculate the integral efficiency of two methodsof urethral strictures treatment.Methods: Totally we analized 237 cases of anterior urethra atrictures1,5–2,5 cm. The patients were devided into 2 groups: 159 underwentinternat urethrotomy (technology 1) and 78 underwent substitute ure-throplasty with buccal mucousal graft (technology 2). Mean follow-upwas 4,2 years. Comparative study was performed using the method ofcomplex comparative assesment of alternative technologies. The basicprinciple is calculating the integral efficiecy coefficient. After the long-term follow-up the results of these 2 types of operations were similar.K (integral) = K (med) * K (saf) * K (cost) * K (soc) K (integral)—inte-gral efficiecy coefficient K (med)—medical efficiecy coefficient K(saf)—safety coefficient K (cost)—cost coefficient K (soc)—social sat-isfaction coefficient.Results: We revealed that after 1 year (t = 1) Kintegral./tech1 = 0,87vs Kintegral./tech2 = 0,87. After factor analysis Ksaf/tech1 = 0,99 vsKsaf/tech2 = 1,00; Ksoc/tech1 = 0,99 vs Ksoc/tec2 = 1,00). Kmed/tech1= 0,67 vs Kmed/tech2 = 1,32; Kcost/tech1 = 1,33 vs Kcost/tech2 = 0,66.The percentage of recurrent urethral strictures was 51,6% after usingtechnology 1 and 5,12% after technology 2. The mean number ofadditional internal utrethrotomies after using technology 1 was 3,13.Conclusion: The method is simple and effective to be used by urol-ogists and public health specialists.Policy of full disclosure: None

PP-06-234

Soft prosthesis implant (10 mm) and relaxingalbugineal incision with PELVICOL grafting forsurgical therapy of Peyronie’s disease: A 1-yearfollow-up and our preliminary experienceSedigh, O.1; Paradiso, M.1; Graziano, M. E.1; Liberale, F.1; Cucchiarale, G.1; Ferrando, U.1



J Sex Med 2008;5(suppl 2):94–145

Objective: Conservative surgical therapies used for Peyronie’s diseaseproduces good results but cause penile shortening and late angulations.The authors propose the modified Austoni’s surgical technique thatuses the oversizedintracavernous soft prosthesis, axially rigid in con-sistency, in association with corpora relaxing incisions and Intexen bio-material grafting, in this exact sequence.Methods: Between March 2006 and March 2007, 3 patients with Pey-ronie’s disease and mild ED (therapy with Levitra) underwent this sur-gical procedure (one of those refused vacuum rehabilitation aftergrafting conservative surgery). Complete plaque excision was neces-sary only for 1 patient; in the remaining 2, a single incision was placedin one, and double incisions were used for second patient. Penilelength was measured intraoperatively, after drug-hydraulic erection,then at the later control visits. Androsexuologist follow-up rangedfrom a minimum of 6 months to a maximum period of 1 year (mean8 months); the later follow-up period was possible for 2 patients. Allpatients and partners with at least 6 months follow-up were asked toanswer a questionnaire administered at 6 months post-surgery.Results: Average penile lengthening was approximately 1.5 cm. All of3 patients answered the questionnaire: both 3 expressed complete sat-isfaction. No major complications were noted; for all patients circum-cision was performed.Conclusion: This technique contrasts successfully albugineal retrac-tion, caused by traditional surgery for Peyronie’s disease. The tech-nique is easy to carry out, has low risks of complications and ensuresvery high rates of patient satisfaction. Patients, before this kindsurgery, must be carefully informed about the corpora retraction anduse of rehabilitation in order to understand the reason of the choicebeetwen soft tissue implantation instead of conservative surgery.Policy of full disclosure: None

PP-06-235

Fracture of penis: Review, analyses and treatmentoutcomes of 26 casesYassin, A.1; Shamsodini, A.2; Prasad, K.2; El Fadil, A.2; El Malik, M.2;Yassin, A.1; Al Ansari, A.2

1Segeberger Kliniken, Clinic of Urology & Andrology, Norderstedt,Germany; 2Hamad Medical Corporation, Dept. of Urology, Doha, Qatar

Objective: To analyze the demographic pattern, mechanism of injury,diagnosis and management of this condition in Qatar and compare thepattern of injury with literature reports.Methods: Review of hospital records of 26 patients with fracture peniswho were treated in our department for a period of ten years.Results: Injury was found to be more common in expatriate popula-tion. Forceful manipulation of the penis during masturbation wasfound to be the commonest cause of injury in this predominantly single(bachelor or living away from partner) category of patients. A clinicaldiagnosis was possible in all the patients. Twenty-three patients under-went surgical repair of the tunical tear, while three patients weretreated conservatively (refused surgery 2, late presentation 1). In theimmediate post-operative period, superficial skin necrosis occurred inone patient and a small penile hematoma occurred in another. Followup was possible in 23 out of 26 patients, including 3 who were treatedconservatively. One patient in the surgical group developed a palpableplaque at the site of repair, while a second patient had palpable plaquewith erectile dysfunction. One patient in the surgical group com-plained of chordee. In the conservative group, one patient had palpa-ble plaque with erectile dysfunction.Conclusion: Fracture penis is apparently common in Qatar, parti-cularly in the expatriate population. The pattern of injury is signifi-cantly different in Middle East comparing to literature reports. Thediagnosis is easily established by history clinical examination. Investi-gations such as Ultrasound, X-ray, Cavernosography and MRI can berequired in unclear or complicated cases. Surgical repair is the stan-dard treatment advocated, providing good results with a low rate ofcomplications.Policy of full disclosure: None

PP-06-236

Outcome and satisfaction rates of three-piece penileprosthesis implantation for treatment of erectiledysfunction: single center experienceTomada, N.1; Lopes, I.2; Diniz, P.2; Guimaraes, M.2; Vendeira, P.2

1Hospital S. Joao, Urology, Oporto, Portugal; 2Hospital S. João, Urology,Oporto, Portugal

Objective: Three-piece inflatable penile prostheses create flaccidityand an erection that comes close to normal and present a better cos-metic result. Our objective was to investigate the eight year outcomeof patients with organic erectile dysfunction (ED) treated with three-piece inflatable implant and its impact on patient-partner satisfactionin our department.Methods: Since 2001 to 2007, 21 patients with ED received a threepiece penile implant (Mentor Titan®). Two patients were lost forfollow-up. Data was obtained from medical records, clinical evaluationand telephone interview, and all patients and partners were assessedwith a questionnaire about life quality and satisfaction. Mean age atsurgery was 55 years (38–73 yrs). Median time follow-up was of 28months (3–77 months).Results: Diabetes mellitus (47.6%) and radical prostatectomy (47.6%)were the main reasons for dysfunction in this patient group. Fourpatients (19%) had peri-operative and early postoperative complica-tions. One patient (4.7%) presented with penile implant infection andthe prosthesis was removed and not re-implanted. There were noreports of mechanical failure or prosthesis revision. Patients and part-ners reported prosthetic erections as excellent, satisfactory or poor in10 (55.5%), 7 (38.9%) and 1 (5.6%) cases, and in 12 (66.7%), 5 (27.7%)and 1 (5.6%) cases, respectively, with a mean monthly number of sexualintercourses of 7. Reasons for patients’ complaints included post-oper-ative penile shortening in 7 (38.9%) cases and poor glandular engorge-ment in 6 (33.3%) cases. Partners’ main complaint was unnaturalnessof the prosthetic erection, a factor reported by 5 (27.8%) subjects. Themajority of patients were satisfied after surgery, with significantimprovement in libido and relationship with partners.Conclusion: Three-piece penile inflatable implant is the gold stan-dard in treatment of patients with ED in our department. The com-plication rate is low, and the global satisfaction of the patients and theirpartners after surgery is high. However post-operative penile short-ening and poor glandular engorgement were the causes of some com-plaints among the patients as well as the unnaturalness of prostheticerection among female partners.Policy of full disclosure: None

PP-06-237

Anatomical radical retropubic prostatectomy inpatients with a preexisting three-piece inflatableprosthesisBriganti, A.1; Doha, F.2; Briganti, A.1; Gallina, A.1; Salonia, A.1; Zanni,G.1; Capitanio, U.1; Strada, E.1; Petralia, G.1; Sacca, A.1; Rigatti, P.1; Montorsi, F.1

1Vita Salute University, Urology, Milan, Italy; 2Vita Salute University,Milan, Italy

Objective: To assess the feasibility and safety of anatomical radicalretropubic prostatectomy (RRP) in patients with clinically localizedprostate cancer and a previously implanted three-piece inflatablepenile prosthesis (IPP).Methods: Four patients previously submitted to IPP implant forsevere erectile dysfunction underwent RRP for organ confinedprostate cancer. Patients charts were carefully reviewed to investigatepre and perioperative details. Patients were evaluated by the Interna-tional Index of Erectile Function (IIEF) preoperatively and at 6months postoperatively. Patients were then contacted to assesslongterm functional and oncological outcome.Results: The outcome of the procedures was comparable to a normalpopulation in terms of operating time, estimated blood loss, hospital-ization time and pathological outcome. No injury to the preexisting


J Sex Med 2008;5(suppl 2):94–145

penile implant was reported. Continence was obtained in 3 (75%)patients at catheter removal, and in 1 (25%) patient at the 1 monthfollow-up date. No major intra and post-operative complications werereported. All patients were able to use their prosthesis after RRP. Nostatistical difference in EF domain scores was found between beforeand after RRP.Conclusion: The presence of a IPP in patients with prostate canceris not a contra-indication to perform an anatomical RRP. Surgery canbe performed safely without injuring the implant and the clinicaloutcome in these patients is satisfactory. Postoperative implant use isnot affected by RRP.Policy of full disclosure: None

PP-06-238

Surgical treatment of severe la Peyronie disease withPelvicol graftBargao, P.1

1Lisbon, Portugal

Objective: Pelvicol®, a colagenio acelular matrix made of dermissuine, could be nowadays be used with security in diverse clinical sit-uation and with good results. The authors describe its utilization inthe surgical handling of the severe form of the La Peyronie diseasewith curvatures equal or over 90° and in patients without erectile dysfunction.Methods: The technic consists in the achievement of an incision ofrelaxation in “I” in the plate to create a defect and consequent appli-cation of the Pelvicol® graft, permitting not the shortening of thepenis and a good esthetic result.Results: The application of Pelvicol® associated to the surgicaltechnic presented is considered a good option, as well as, an effectivealternative to the synthetic stuff, many times associated with compli-cations, as infections with rejection and need of removal of the graft.By another way the scrap of Pelvicol®, progressively incorporated andrevascularizated by the connective tissue, enables in case of infection,the use of antibiotics and its preservation, maintaining the structuralintegrity and the tensil force. The immunological rejections describedare rare, showing the elevated biocompatibility and security in its uti-lization.Conclusion: The application of Pelvicol® associated to the surgicaltechnic presented is considered a good option, as well as, an effectivealternative to the synthetic stuff, many times associated with compli-cations, as infections with rejection and need of removal of the graft.By another way the scrap of Pelvicol®, progressively incorporated andrevascularizated by the connective tissue, enables in case of infection,the use of antibiotics and its preservation, maintaining the structuralintegrity and the tensil force. The immunological rejections describedare rare, showing the elevated biocompatibility and security in its uti-lization.Policy of full disclosure: None

PP-06-239

Use of cephalic vein grafting in Peyronie’s disease: Aneffective option?Bitelli, M.1; Pietrantuono, M.2; Maraone, A.2; Ranieri, M.2; Pietrantuono, F.3; Zucchi, A.4; Valitutti, M.5; Virgili, G.3; Vespasiani, G.3

1Rome, Italy; 2Cassino Hospital, Urology, Italy; 3Tor Vergata University,Urology, Rome, Italy; 4University of Perugia, Urology, Italy; 5Aurelia Hos-pital, Urology, Rome, Italy

Objective: Actually we have many different materials for substitutionof albuginea in Peyronie’s disease but no one of them represents thereal gold standard. Vein graft, especially saphenous graft, gave the bestresults in terms of biocompatibility, elasticity and functional outcomesin the long term. The cephalic vein is used for vascular access forhaemodialysis and coronary bypass grafting. Our objective was to eval-uate long-term results of autologous venous grafts utilizing a venouspatch from the cephalic vein in treating penile deformity caused byPeyronie’s disease.

Methods: From april 2003 to june 2006 three patients with Peyronie’sdisease underwent venous grafting using cephalic vein. 2/3 pts hadbeen previously operates of bilateral saphenectomy and 1/3 monolat-eral saphenectomy: this last one had a recent angioplasty after ischem-ical heart attack. All patients were evaluated preoperatively andpostoperatively with the IIEF-5 scoring, angle measurement of erec-tile penis. All patients had stable Peyronie’s disease and a mean (range)penile deformity of 48.3 (35–70). The mean follow up was 14 months.Postoperative sildenafil + vacuum device was used for 3 months in 2/3pts and vacuum device only in 1/3 pts.Results: A satisfactory result was obtained in all patients with com-plete straightened of the penis. One patient developed mild postoper-ative erectile dysfunction (already present previously). No penileshortening at 14 months in all 3 pts. No complications on the armwhere cephalic vein was taken.Conclusion: The Cephalic vein graft seems to be effective option inthe surgical management of Peyronie’s disease in selected patients inwhich saphenous vein can’t be used. Although a greater number ofpatients is necessary to have valid long term data and, like all penilegrafts, penile shortening after surgery remains a risk.Policy of full disclosure: None

PP-06-240

Does diabetes mellitus exaggerate the clinicalsymptoms of Peyronie’s disease?Park, H.1; Park, N.1; Lee, C.1; Yoon, C.2; Chon, W.11Pusan National Univ. Hospital, Urology, Busan, Republic of Korea

Objective: Although various studies have attempted to identify a rela-tionship between Peyronie’s disease (PD) and associated comorbiditesincluding Diabetes mellitus (DM), little is known about the effect ofDM on the natural history of PD. We investigated the clinical char-acteristics of patients with PD and DM to improve our understandingof this association.Methods: Patients with PD and DM (group 1) and those with no DM(group 2) were compared by age, duration of PD, size and location ofthe plaque, severity of the penile deformity, presence of pain with anerection, and the severity of erectile dysfunction with IIEF-5. Penilecurvature was objectively measured and stratified according to theKelami classification.Results: Among the 93 patients with PD (22 in group 1 and 71 ingroup 2) the mean age of patients in group 1 and group 2 was not dif-ferent (56.8 ± 7.7 vs. 57.0 ± 8.2 years). In addition, the mean durationof PD in group 1 and group 2 was not different (8.6 ± 4.2 vs. 7.2 ± 3.7months). However, the size of the plaque in group 1 was significantlybigger than that in group 2 (2.2 ± 1.6 vs. 1.7 ± 1.3 cm), whereas thelocation of the plaque was not different. The mean degree of penilecurvature in group 1 was significantly greater than in group 2 (31.4 ±8.7° vs. 24.9 ± 6.6°). The rate of severe penile curvature (>60°) wasmore frequent in group 1 (22.7% vs. 8.6%). Pain on erection was sig-nificantly greater in group 2 (31.8% vs. 49.2%). The rate of moderateto severe ED (IIEF-5 ≤11 score) was significantly greater in group 1(54.5% vs. 32.3%), whereas mild ED (IIEF-5 ≤21 score) was not dif-ferent in comparisons between groups (81.8% vs. 74.6%).Conclusion: This study suggests that the presence of DM in patientswith PD exaggerates the severity of PD by affecting the size of theplaque, penile deformity and ED.Policy of full disclosure: None

PP-06-241

Ourcomes of combined theraphy of electromotivedrug administration and colchine in peyronie diseaseTahmaz, M. L.1; Irkilata, H. C.1; Yildirim, I.1; Basal, S.1; Dayanc, M.1

1Gülhane Military Medical Acade, Urology, Ankara, Turkey

Objective: We prospectively analysed the outcomes of conservativemanagement of Peyronie’s disease with combined theraphy of electro-motive drug administration (EMDA) and colchicine.


J Sex Med 2008;5(suppl 2):94–145

Methods: The study involved 40 patients with Peyronie’s disease whowere treated at our institute between 2004 and 2007. Patinets who havepenile pain in shot period (less than 4 months) and have 2 cm plaque.EMDA was applied with verapamil and dexametasone in 16 week.Colchicine was applied 1 × 2 tablet/day in 3 months. We assessed theefficacy of combined EMDA and colchicine theraphy for theimprovement of the symptoms, the development of penile curvatureand erectile dysfunction.Results: Penile pain disaapeared and IIEF did not change in all ofthem. We observed a % 50 decrease in penile curvature and %65reduction in plaque size.Conclusion: We recommend at least a trial of combined EMDA andcolchicine theraphy with a safe, inexpensive, and well-tolerated agent,as early-stage disease is reputedly more likely to respond better thanpatients with established, longstanding Peyronie’s plaques.Policy of full disclosure: None

PP-06-242

Cavernous venous dysfunction, cause of erectilefailure, in penile fibrosisVaccari, R.1; Pezzoni, F.11Center of Andrology, Milano, Italy

Objective: Objectives: veno-occlusive dysfunction (VOD), in not clas-sified in a precise nosolo-gycal condition, but like a multifactorial ethi-ology syndrome. The “venous-leakage” (VL) constitues a complexfenomenon interesting structural abnormalities in corpora cavernosaand/or in the tunica albuginea. Were valued patients with erectile dy-sfunction (ED) affected with fibrosis or Peyronie’s disease. They werestudied by Color-duplex Doppler-ultrasound (CDDU) and Opticprobe video-capillaroscopy (OPVC), focusing the relation betweencapillaro-perfusion and pathological collageno-genesis. All under-went to a specifical antibody screening, like in collagen vasculardisease, such as Systemic Sclerosis (SS).Methods: Design and Methods: were valued 180 patients with diag-nosis of VOD (studied by Dynamic Infusion Cavernosometry (DIC)and Dynamic Infusion Cavernosograpy (DIC/G), negative for radio-logical diagnosis of VL. All underwent to OPVC, focusing onmicroangiotectonis, capillary density, appearance of capillaries and seratested for complement breakdown products (C3-C4 factors), immuno-globulines dosages, and identification of auto-antibody anti:mitochon-dria, nuclear membrane, smooth muscle, endoplasmic reticulum. Allunderwent to a treatment strategy comprehending: Laser-Hydro-Electrophoresis, 02/03 therapy (major auto-haemo transfusion),Trans-Epidermal Barrier (TEB) therapy (by local “vasoactive patch”application), aging on microvascular damage, anti-oxydating therapy.Results: Results: in all the 180 patients OPVC demonstratedmicrovascular damage (district microangiotectonics damage, presenceof apical microaneurisms, abnormal capillary tortuosity, presence ofsub-ischaemic and ischaemic areas, aggregations of red cells, etc.). Thedescription is similar to that called “Scleroderma pattern”, rescontredin various collagen vascular diseases. Serology resulted positive for 1or more factors in 30% of cases (54/180); 4 patients also presentedpalmar Dupuytren’s disease (2.2%). After 4 months of therapy 90%(162/180) reported amelioration or disappearance of pain with con-comitant ecographic response of pathology partial regression or stabi-lization. ED benefied of PDE5 inhibitor (Vardenafil) in 70%(126/180). 30% (54/180) underwent to penile prostheses implantationsand correction of the penile curvature by corporoplasty.Conclusion: microvascular damage, in our opinion, can justified thepathological-collageno-synthesis, like is known for other auto-immunemechanisms diseases (SS, Raynaud’s henomenon, Lupus Erythemato-sus, etc), favoured by ischaemic conditions. It would be verisimilar thatmicroangiologic alterations are fundamental causes in a lot of VODethiopathogenesis and precisely in with “structural intracavernousabnormalities” ones.Policy of full disclosure: None

PP-06-243

Dorsal Nesbit corporoplasty procedure and relaxingscrotoplasty for complex penoscrotal deformitycurvature after skin urethroplastyShamsodini, A.1; Al Naimi, A.2; Sedigh, O.3; Said, S.4; Al Ansari, A.4

1Hamad Medical Corporation, Urology, Doha; 2Hamad Medical Corpora-tion, Doha; 3Dept. of Urology, Molinette G, Urology, Torino, Italy; 4HamadMedical Corporation, Urology, Doha, Qatar

Objective: Aim of study: We report the result of an original penilestraitening Procedure, designed to correct an congenital penile curva-ture and severe scrotal fibrosis and Urethral cordee in past skin ure-throplasties. Ventral straitening grafting or other options (Urethralisolation) was not possible due to Neo- Urethra attachment to the ure-thral plate. We have carried a dorsal Nesbit elliptical excision of tunicaalbugenia for correction of penile curvature in a patient with severescrotal deformation, who underwent several operations for peno-scrotal hypospedias using the scrotal skin.Methods: Method and result: A young male who underwent severaloperations for repair of the peno-scrotal hypospedias presented to ourclinic complaining of ventral penile curvature of 80 degree that causinghim embarrassed and actually penetration impossibility to get married.After consultation with patient and taking an informed consent thepatient agreed to undergo operation. The penile skin was deglovedwith much difficulty due to adhesions of skin with the created urethra,defending and enfetizing urethra with Foley before. Isolating theventral skin from the dartos covering the neo-urethra. Artificial erec-tion showed 80 degree ventral curvature. The neurovascular bundlewas isolated carefully and two elliptical excision of the tunica albuge-nia at dorsal aspect was carried out archiving a reasonable straighten-ing of the penis. Neither residual curvature nor hypercorrection wererecorded. Regarding erectile function, which was evaluated in thispatient, preoperative average International Index of Erectile Function-5 score was 17.83 +/− 4.17, where as postoperatively it was 19 +/− 4.63(p = 0.036 Neurovascular bundles was fixed with not running Vicryl4/0 sutures. An elongation scrotoplasty made a cordee relaxation of thepenoscrotal shaft and better cosmetic penoscrotal results.Conclusion: Conclusion : Nesbit procedure is the gold standard foryoung patients and complex penile deformities in order to preserveerectile function and can be considered in the cases of recurrent oper-ation on penis that causing penile curvature. At 3 months follow-upphoto documentation in erection demonstrates the complete straiten-ing and patient satisfaction 1. The most important quality factors weresurgical technique and early postoperative rehabilitation (daily stretch-ing with vacuum device).Policy of full disclosure: None


J Sex Med 2008;5(suppl 2):94–145

PP-07 Hormones

PP-07-244

Effects of long-term use of anti-aging hormonedehydroepiandrosterone on androgenic dependentorgans: prostate and testis of ratsSah, C.1; Aridogan, I. A.1; Erdogan, S.2; Doran, S.1

1University of Cukurova, Urology, Adana, Turkey; 2University of Cukurova,Pathology, Adana, Turkey

Objective: People try to prevent the factors cause aging and the prob-lems appear during this process, to improve their quality of life, eitherbehaviorally or medically which is called anti-aging. Although they arecommonly used and fairly popular, there is no enough data about theeffects of the long term usage of dehydroepiandrosterone and dehy-droepiandrosterone-sulphate. In this study, it is aimed to determinethe effects of long term usage of DHEAS on rats’ prostate and testisas well as serum testosterone and DHEAS levels.Methods: Thirty-seven Wistar Kyoto male rats, weighed 300–400 grand aged 4–5 months were used in this study. The first group of 7 ratswere in sham, 10 rats were in control and 20 were in the experimen-tal group. Five mg/kg per day of DHEAS suspension per rat was orallygiven to 20 rats in the experimental group for 5 times a week, whilesaline was given concurrently to the rats in the control group. At theend of the study, the rats were sacrificed and their prostates and testeswere removed. Intracardiac blood samples were drawn to determinetheir hormone levels and the histological samples were evaluated underlight microscopy.Results: At the end of the 6 months of the study period, there was astatistically significant difference in the percentage of the atrophyscores between the control and the study groups (p = 0.05 ve p = 0.03).Atrophy scores were significantly lower in the study group. However,no significant difference was observed in stroma-gland ratio, papillarycomponent, and hyperplasia scores between the three groups. Therewas no difference in testis structure. Serum total testosterone andDHEAS levels of the rats in the study group were significantlyincreased (p < 0.001).Conclusion: In our study, we determined that the long-term use ofDHEAS does not have any detrimental effects on prostate and testis,on the contrary it protects the prostate from atrophy, which is imper-ative for continuation of fertility and also increase the serum testos-terone and DHEAS levels.Policy of full disclosure: This study is sponsored by the AcademicResarch Projects Unit of University of Cukurova (TF2005 LTP7).

PP-07-245

Hemochromatosis, a rare cause of hypogonadism—clinical caseCavadas, V.1; Borges, R.1; Masso, P.1; Vila, F.1; Osorio, L.1; Louro, N.1; Silva-Ramos, M.1; Carvalho, L. F.1; Marcelo, F.1

1Hospital Geral Santo Antonio, Urology, Porto, Portugal

Objective: Hemochromatosis is a common genetic disorder butuncommon clinical identity. Iron deposition occurs slowly and silentlyinvolving liver, heart and endocrine tissue, thus being responsible formultiple clinical signs and symptoms. We intend to review hemochro-matosis as a rare cause for hypogonadism apropos of a clinical case.Methods: A 45-year-old Caucasian male was referred to our Androl-ogy unit for loss of libido and erectile dysfunction for the last 2 years.He had been diagnosed with idiopathic hemochromatosis 4 years prior(already showing incipient signs of cirrhosis on liver biopsy and beingtreated for diabetes mellitus) and was being submitted to regular phle-botomies. The physical examination revealed normally sized testes.Results: Laboratory results displayed low free-testosterone levels of0.3 pg/mL (N: 13–40) and diminished LH levels of 0.5 mUI/mL (N:1.2–7.8). MRI depicted a significant decrease in signal intensity of theanterior pituitary gland, suggestive of iron deposition. The patient wasinitiated on monthly intramuscular mixed testosterone esters, recov-ering libido and sexual function.

Conclusion: Hypogonadism, usually hypogonadotrophic in origin, isthe most common non-diabetic endocrinopathy in hemochromatosisand can present as loss of libido, erectile dysfunction or osteoporosisin male patients. It is usually secondary to iron accumulation in pitu-itary cells leading to impaired gonadotrophin secretion, but there mayalso be hypothalamic dysfunction and direct testicular damage causedby iron deposition. The effects of both diabetes and hepatic cirrhosisshould not be neglected as well. Testosterone replacement can signif-icantly improve the quality of life and restore sexual function in mensuffering from hypogonadotrophic hypogonadism in the context ofhemochromatosis as shown by the present case.Policy of full disclosure: None

PP-07-246

Effect of hyperprolactinemia in male patientsconsulting for sexual dysfunctionCorona, G.1; Mannucci, E.2; Fisher, A. D.1; Lotti, F.1; Ricca, V.3; Balercia,G.4; Petrone, L.1; Forti, G.1; Maggi, M.1

1Andrology Unit, University of Florence, Italy; 2Diabetes Section GeriatricUni, University of Florence, Italy; 3Psychiatry Unit, University of Florence,Italy; 4Endocrinology Unit, Polytechnic University of Marc, Ancona, Italy

Objective: The physiological role of prolactin in male sexual functionhas not been completely clarified. Aim of this study is the assessmentof clinical features and of conditions associated with hyperprolactine-mia in male patients consulting for sexual dysfunction.Methods: A consecutive series of 2146 (mean age 52.2 +/− 12.8 years)male patients with sexual dysfunction was studied. Several hormonaland biochemical parameters were studied along with validated struc-tured interviews (ANDROTEST and SIEDY). Mild hyperprolactine-mia (MHPRL; PRL levels 420–735 mU/l or 20–35 ng/ml) and severehyperprolactinemia (SHPRL, PRL levels >735 mU/l, 35 ng/ml) wereconsidered.Results: MHPRL and SHPRL were found in 69 (3.3%) and in 32(1.5%) patients respectively. Mean age and the prevalence of gyneco-mastia were similar in the two groups and in subjects with normal pro-lactin values. MHPRL was not confirmed in almost one half of thepatients, after repetitive venous sampling. Hyperprolactinemia wasassociated with the current use of antidepressants, antipsychotic drugsand benzamides. SHPRL was also associated with hypoactive sexualdesire (HSD), elevated TSH, and hypogonadism. The associationbetween HSD and SHPRL was confirmed after adjustment for tes-tosterone, TSH levels and use of psychotropic drugs (HR =8.60[3.85–19.23]; p < 0.0001). In a 6-months follow up of patients withSHPRL testosterone levels and sexual desire were significantlyimproved by the treatment.Conclusion: Our data indicate that SHPRL, but not MHPRL, is arelevant determinant of HSD. Gynecomastia does not help in recog-nising hyperprolactinemic subjects, while the use of psychotropic med-ications and HSD are possible markers of disease. In case of MHPRL,repetitive venous sampling is strongly encouraged.Policy of full disclosure: None

PP-07-247

Should hormone replacement mimic normalchronobiology?Diver, M.1

1University of Liverpool, Clinical Chemistry, United Kingdom

Objective: The human endocrine system is characterised by periodicsecretion of hormones. These resultant variations in chronobiologyoccur in many biological processes, e.g. the diurnal rhythm displayedby many hormones. Other infradian rhythms such as those displayedthroughout the menstrual cycle are perhaps better known. It is unlikelythat the various events during the menstrual cycle would occur wereit not for the variability in hormone secretion. In males the onset ofpuberty is characterised by nocturnal pulsatile LH secretion, thus stim-ulating testosterone production by the testes. From this time testos-terone is secreted with a diurnal variation and remains lifelong with a


J Sex Med 2008;5(suppl 2):94–145

minimum peak to nadir difference of 43% in our groups of 10 youngmen and 8 middle-aged men. Methods: We measured short-term control of testosterone secretionthroughout the day. Results: Sampling at 30 minute intervals over 24 hours failed to showany correlation between LH and testosterone in our groups. We alsohave found that some eugonadal men may show a hypogonadal levelof total testosterone but normal levels of both free and bioavailabletestosterone. Furthermore we find that total, bioavailable and freetestosterone vary considerably from day to day and suggest that morethan one estimate of testosterone may be advisable before suggestinga diagnosis of hypogonadism. Conclusion: Thus it would appear that normal physiological hormonesecretion describes a variable pattern with little evidence that constantsecretion is preferred. To this end it would seem a reasonable preceptthat in replacing deficient hormones, attempts should be made tomaintain this pattern.Policy of full disclosure: Funding for attendance at the conferenceis supported by Mattern Pharmaceuticals.

PP-07-248

Efficacy of long-term injectable testosteroneundecanoate in late onset hypogonadism patients for54-week follow-upMoon, D. G.1; Yu, J. W.11Korea University Hospital, Urology, Seoul, Republic of Korea

Objective: To assess the effects of long-acting injectable testosteroneundecanoate (TU, Nebido) in late onset hypogonadism (LOH)patients, we investigated the changes in AMS symptom scale andserum testosterone concentration.Methods: A total of 33 patients (mean age of 55.8 ± 6.35 yrs) with LOHdefined as serum testosterone level less than 3.5 ng/mL were injectedwith 1000 mg of TU (4 ml/ample) on day 1, followed by another injec-tion after 6 weeks and every 3 months thereafter for a total of 54 weeks.Compared to pretreatment, changes of AMS scales (Aging Males’Symptoms scales), serum total testosterone, lipid profile, CBC, PSA,prostate volume by TRUS and body habitus (waist and body weight) at18 and 54 weeks after treatment were analyzed by paired t-test.Results: Compared to pretreatment, serum total testosterone level wassignificantly increased at 18 and 54 weeks (p < 0.01), but there was nodifference between 18 and 54 weeks. TU also significantly improvedAMS score, especially sexual domain (p < 0.01). Other data excepthematocrit were not changed significantly. No patient reported anyother adverse events.Conclusion: TU effectively elevated serum total testosterone leveland maintained stable concentration until 54 weeks. TU significantlyimproved the total AMS score but no significant changes in the bodyhabitus and lipid profiles. TU did not show harmful effect on prostateuntil 54 weeks. TU increased the total testosterone and total AMS butwell-controlled, long-term study should be followed to assess the effectof TU in LOH patients.Policy of full disclosure: None

PP-07-249

The efficacy and safety of long-acting injectabletestosterone undecanoate (Nebido) in late onsethypogonadism patients: A Korean multicenterprospective studyMoon, D. G.1; Park, J. K.2; Park, K. S.3; Kim, S. W.4; Park, N. C.5; Paik,J. S.6; Seo, J. T.7; Ahn, T. Y.8; Yang, D. Y.9; Lee, S. W.10; Kim, J. J.1

1Korea University Hospital, Urology, Seoul, Republic of Korea; 2CheonbukUniversity, Urology, Seoul, Republic of Korea; 3Cheonnam University,Urology, Seoul, Republic of Korea; 4Catholic University, Urology, Seoul,Republic of Korea; 5Pusan University, Urology, Seoul, Republic of Korea;6Seoul University, Urology, Republic of Korea; 7Kwandong University,Urology, Seoul, Republic of Korea; 8Ulsan University, Urology, Seoul, Repub-lic of Korea; 9Hallym University, Urology, Seoul, Republic of Korea;10Sungkyunkwan University, Urology, Seoul, Republic of Korea

Objective: The efficacy and safety of long-acting injectable testos-terone undecanoate (TU, Nebido) in late onset hypogonadism (LOH)patients were assessed.Methods: In 133 patients of LOH defined as serum testosterone levelless than 3.5 ng/mL were injected with 1000 mg of TU (4 ml/ample)on day 1, followed by another injection after 6 weeks and 18 weeks.Follow-up serum biochemistry for testosterone and safety profileswere done at 12 and 24 wks. Primary efficacy was evaluated withchanges of International Erectile Function Index (IIEF) from initialvisit to final visit (24 wk) and from each visit (wks 6/12/18) to final visit(wk 24). Secondary efficacy was assessed with changes of Aging Male’sSymptoms (AMS) Scale at same visit and GEQ for improvement oferectile function. Paired t-test was done by Intent-to-treat (ITT) andPer Protocol (PP) analysis.Results: Mean age of patients was 54 ± 9.6 yrs. Compared to pre-treatment, serum total testosterone and free testosterone were signif-icantly increased at 12 weeks and maintained until 24 weeks (p <0.001). TU significantly decreased cholesterol (p < 0.0001). TU sig-nificantly improved total IIEF, all 5 domain scores of IIEF (p < 0.0001)and total AMS, all 3 domain scores of AMS (p < 0.0001). On GEQ,TU improved erectile function in 76.9% of subjects. On safety profile,TU significantly elevated Hb, Hct and PSA at 24 weeks. AMS score,especially sexual domain (p < 0.01). No serious adverse reactions wereobserved. Drop-out rate was 13.5%.Conclusion: TU effectively elevated serum total and free testosteroneand maintained stable concentration until 24 weeks. TU significantlyimproved the both AMS and IIEF score. TU elevated Hct and PSAbut did not show harmful effect until 24 weeks. These results suggestthat TU was effective, safe and tolerable until 24 weeks in KoreanLOH patients. Further well-controlled, long-term study should be followed.Policy of full disclosure: This study was supported by ScheringKorea.

PP-07-250

Variation of male serum estradiol (E) afteradministration of morphine cloridrate (MC)Passavanti, G.1; Pizzuti, V.1; Aloisi, A.2; Carlucci, M.2; Bragaglia, A.1;Mengoni, F.1; Paolini, R.11Misericordia Hospital, Dept. of Urology, Grosseto, Italy; 2University ofSiena, Physiology, Italy

Objective: It’s already confirmed that Morphine Chloridrate reducevery much plasmatic testosterone; we attempted to verify if MC mod-ifies serum estradiol.Methods: 10 patients, aged 23–79 (m.63,5 years), underwent urolo-gyc surgery (8 prostatic adenomectomy, 1 pyeloureteral anastomosis,1 laparocele). Before operation we measured the serum testosteroneand estradiol. Immediately afterwards we gave the pts MC 20 mgduring 24/hs. 24–36 hs after operation we measured again estradioland total testosterone (TT).Results: Total testosterone pre-operation was 4,38–7,87 ng/ml (m5,51 ng/ml), and TT after operation was 0,57–3,25 ng/ml (m.1,75)with significant difference (z.2,75). Estradiol pre-operation was 11–58pg/ml (m32,4) and E after operation was 8–49 pg/ml (m.20,5) with asignificant difference (z.2,24).Conclusion: In male 80% of estradiol derives from testosterone aromatization and in case of organic stress or obesity the aromatasicfunction increases with reduction of TT and growth of serum estradiol. The present casuistic would show that opiates reduce serum TT without modifiing the cithocrome P450 function and furthermore would conferm the hypothesis that MC interfers withhypothalamic-pituitary-gonadal axes and with gonadal synthesis ofTestosterone.Policy of full disclosure: None


J Sex Med 2008;5(suppl 2):94–145

PP-07-251

Comparative study of androgens serum levels inhypogonadal men treated with transdermal or oralpreparations of testosteronePujos-Gautraud, M.1; Colle, M.2; Lemaire, A.3; Giton, F.4; Raynaud, J.-P.5

1Private Office, Saint Emilion, France; 2Private Office, Endocrinologie, Bor-deaux, France; 3Private Office, Andrology, Lille, France; 4CHU HenriMondor, EMI Inserm 03-37, Creteil, France; 5Université Pierre et MarieCur, DRIT, Paris, France

Objective: To compare mean serum total testosterone (TT), bioavail-able testosterone (BT), and dihydrotestosterone (DHT) levels over thefirst and last 48 hours of a 22-day treatment with testosterone patch(Testopatch®) versus a 22-day oral treatment with testosterone unde-canoate (Pantestone®).Methods: 53 men over 18 years with TT ≤2.5 ng/mL and PSA <2ng/mL were included in that multicentre, randomised, open-label,cross-over study, One arm applied 2 patches every 48 hours in themorning, the other one took 2 capsules of testosterone undecanoate40 mg bid. Outcome was mean TT level of 4 blood samples over thelast 48 hours of each treatment period, other androgens and SHBGwere also assayed at the same time.Results: The mean TT before inclusion was 1.99 ng/mL and meanage 49. Mean TT over the last 48 hours was superior with patches thanwith oral T (: 4.64 vs. 2.58 ng/mL p < 0.001). TT trough levels at theend of each period were higher for patches than for oral T (3.15 vs.2.45 ng/mL, p < 0.01). BT levels over the first and last 48 hours weregreater with patches than with oral treatment (p = 0.001 and p < 0.01)and similar at trough. Average DHT levels over the first and last 48hours of treatment (0.71 vs. 1.05 ng/mL and 0.68 vs. 0.89 ng/mL) andat trough (0.59 vs. 0.96 ng/mL) were lower with patches than with oralcaps (p < 0.001, p < 0.05, p < 0.001). SHBG levels decreased with oral testosterone but were not affected by patches (p < 0.001 betweentreatments).Conclusion: Patches was more efficient than oral testosterone toincrease TT and BT serum levels in hypogonadal men as early as thefirst few days and throughout 3 weeks of treatment. However, oraltestosterone increased more DHT and decreased SHBG.Policy of full disclosure: Study’s investigator supported by PierreFabre Laboratory

PP-07-252

Effects of oral versus transdermal testosteronetreatment in hypogonadal men on SHBG, LH, FSH,and AMS scoresPujos-Gautraud, M.1; Colle, M.2; Lemaire, A.3; Raynaud, J.-P.4

1Private Office, Saint Emilion, France; 2Private Office, Endocrinologie, Bor-deaux, France; 3Private Office, Andrology, Lille, France; 4Université Pierreet Marie Cur, Drit, Paris, France

Objective: Comparison over the first and last 48 hours of treatmentwith testosterone either patches (Testopatch®) or oral (Pantestone®)of SHBG, LH, FSH serum levels, hypogonadal symptoms related andsafety.Methods: 44 patients (>18 years, testosterone ≤2.5 ng/mL, haemat-ocrit <51%, PSA <2 ng/mL) were included in that multicentre, ran-domised, open-label, cross-over study with 2 consecutive periods of 22days separated by 14 days wash-out. Patients applied two 60 cm2

patches in the morning every 2 days or took two 40 mg capsules in themorning and two in the evening. At the end of each period, changesfrom baseline in SHBG, LH, FSH serum levels, in AMS scores andAE were noted.Results: Baseline testosterone was 1.99 ng/mL. LH, FSH decreasedduring the 2 periods. SHBG levels decreased with oral testosterone,not with patches (p < 0.001). Patches were more effective than oraltestosterone at improving AMS total score (−10.3 vs −8.9; p < 0.05),somatic subscore (−4.4 vs −3.2), psychological subscore (−2.3 vs −1.7),and sexual subscore (−3.7 vs −3.3). No noticeable change in biologicalvariables, vital signs, and PSA levels was found. Most AEs with patches

concerned local reactions (6) and gastrointestinal (4) and nervoussystems (5) problems with oral testosterone. Local patch tolerabilityindicated few skin reactions of mild intensity (84% of patients with nolocal reaction).Conclusion: The safety of both products was good with no severe AE.Transdermal patch which releases testosterone by a smooth and pro-longed way provides a greater improvement of clinical state measuredby AMS scores. The overall clinical benefit/risk ratio appears in favourof transdermal testosterone supplementation.Policy of full disclosure: Study’s Investigator Supported by PierreFabre Pharmaceutical.

PP-07-253

Efficacy and safety of a new testosterone-in-adhesivematrix patch applied every two days for one year tohypogonadal menRaynaud, J.-P.1


Objective: To study long term efficacy and safety of a novel testos-terone-in-adhesive matrix patch, in which testosterone is dissolved ina non-alcoholic drug solvent (diethyltoluamide) to avoid skin irrita-tion, and incorporated in a pressure sensitive adhesive for applicationon intact non-scrotal skin.Methods: Randomised, open label, multi-centre, 1-year study. 224hypogonadal patients were included. 188 received 2 patches of 60 cm2every 48 hours and 36 patients had testosterone enanthate intramus-cular injection every 3 weeks. Blood samples were collected in themorning at 0, 3, 6 and 12 months. Total Testosterone (TT), Bioavail-able Testosterone (BT) (after sulphate precipitation), Dihydrotestos-terone (DHT) were assayed using validated time resolved fluoroimmunoassays after separation by chromatography. Routine RIA kitswere used for Estradiol (E2) LH, FSH and Sex Hormone BindingGlobulin (SHBG) Clinical symptoms were assessed with validatedquestionnaires (AMS and MSF-4).Results: In the patch group, T serum levels were above 3 ng/ml in85% of patients and remained stable over time. BT, DHT and E2levels were restored within physiological range. A significant correla-tion was found between T, BT and the MSF-4 changes. BT levels weresignificantly related to total AMS score. PSA values showed a mean(SD) increase of 0.13 (0.38), 0.23 (0.79) and 0.30 (1.47) ng/mL at Week14, 27 and 53 respectively. The patch was well tolerated with no neg-ative impact either on lipid profile, or red blood cells. Administrationsite reactions occurred in 35 patients (18.8 %). Adhesiveness was good(3 75 %) in more than 90 % patients over the 1-year application period.Conclusion: Two 60 cm2 patches delivering 4.8 mg testosterone/day,allowed stable physiological levels of sexual hormones over time. Thepatch was well tolerated, easy to use, well accepted by the patients anddisplayed a good adhesiveness. Clinical efficacy was more related toBT than to T.Policy of full disclosure: scientific advisor: Pierre Fabre Medicament

PP-07-254

Pharmacokinetic study of a novel testosterone-in-adhesive matrix patch during the 48 hours ofapplication to hypogonadal menRaynaud, J.-P.1


Objective: To assess the pharmacokinetic testosterone time profileand dose proportionality after application of a novel matrix testos-terone patch (30, 45, 60 cm2 containing 0.5 mg of testosterone per cm2,delivering respectively 1.2, 1.8, and 2.4 mg per day).Methods: This open study was a single dose, three-period, crossovertrial with a randomized treatment sequence in 24 hypogonadal men, consisting in a single 48 h application of two patches of 2 × 30,2 × 45, 2 × 60 cm2, separated by a five-day wash-out. Testosterone anddihydrotestosterone concentrations were determined during patch


J Sex Med 2008;5(suppl 2):94–145

application and 1 and 3 hours after patch removal by GC/MS method.Dose proportionality was assessed on baseline corrected, dose nor-malized parameters for Cav, corr/D, Cmax, corr/D and AUC (0–48),corr/D.Results: Testosterone concentration rose during the first 9 h follow-ing patch application, remained relatively sustained until 48 h and thendecreased abruptly after patch removal, with a half-life of 1.3 hours.Testosterone levels were maintained above 3 ng/mL for 42 h to 45 hwith all patches. Cav were 3.39, 4.03 and 4.58 ng/mL and Cmax (24h) were 4.33, 5.29 and 6.18 ng/mL according to the doses. These phar-macokinetics parameters where dose dependent with mean ratioswithin the predefined (0.7–1.43) acceptance range. Dihydrotestos-terone concentration paralleled testosterone profiles.Conclusion: Dose linearity was demonstrated between the differentsurfaces of testosterone patches. Application resulted in dose propor-tional increases in serum T levels in hypogonadal men into the low tomid-normal range within the first hours and mean concentrations weresustained until the end of the 48-hour patch exposure.Policy of full disclosure: scientific advisor; Pierre Fabre Medicament

PP-07-255

“Aging male symptoms” questionnaire in normal andcomplaining menRaynaud, J.-P.1; Igigabel, P.2; Born, C.3; Giton, F.4; Fiet, J.4

1Univers. Pierre et Marie Curie, Paris, France; 2Société ALTI, Rechercheclinique, Angers, France; 3IRSA, Recherche clinique, Angers, France;4Hôpital Henri Mondor, Centre de Recherche clinique, Créteil, France

Objective: To assess the relationship between sex hormone levels andAMS score in a large representative population of normal and com-plaining men in order to differentiate the populations and identifysymptoms related to androgen deficiency.Methods: 903 healthy men were interviewed by phone, by a trainedinterviewer who completed the AMS questionnaire, other 539 healthymen consulting for a check-up in a health centre and 471 complain-ing men, who completed the AMS scale in clinical setting, wereselected. Serum levels of total and bioavailable testosterone were deter-mined in blood samples, in central or private setting offices.Results: AMS questionnaire completed in a clinical setting or using acalling up-line were comparable. In both cases, total AMS scores andsub scores were significantly dependent of age and correlated toincome. In normal men, total AMS score, somato-vegetative and psy-chological sub scores and testosterone levels remained constant withage. The only two variables that significantly varied with age were thesexual AMS sub-score and bioavailable testosterone. In complainingmen, total AMS scores and sub scores, significantly varied with agewhile testosterone levels remained unchanged. The mean levels of allvariables were significantly higher in complaining than healthy menand significantly different between the two populations. However,these differences weakened with increasing age.Conclusion: The AMS scale could be defined as a screening test todifferentiate normal and complaining men between fifty and sixty fiveyears of age. The sexual dimension of the AMS scale is the key vari-able to differentiate the two populations and to identify symptomsrelated to androgen deficiency.Policy of full disclosure: None

PP-07-256

Enlargement of penis in patients with hypogonadism.Complex approach to the clinical practiceSokolschik, M.1; Petrovich, R.2; Gagarina, S.2; Vaziev, Y.2; Sadakova, I.21CC MRRA, Moscow, Russia; 2CC MRRA, Andrology, Moscow, Russia

Objective: Besides the social importance, the size of penis is also areflection of the general health of the man, in particular the state ofendocrine system. The matter is that the length of penis depends ona level of sexual hormones (first of all testosterone and its derivatives)during the puberty when the most intensive growth of external geni-tals is observed.

Methods: In our clinical practice we used complex approach for penisenlargement in patients with hypogonadism, which included hormonaltherapy and extender ANDROPENIS. All the patients were treatedwith testosterone undecanoate (NEBIDO) intramuscular injectionswithin 1 year. In majority of patients we could not start extender usingsimultaneously with hormonal therapy because of insufficient lengthof penis and impossibility to fix the extender.Results: From 2005 to 2007 50 patients with hypogonadism addressedto the clinic for the penis enlargement. The age of patients was withinthe limits of 16–54 years. The sizes of penises were within the limitsof 2–4 cm (3.5 cm in average) in flaccid condition, 5–9 cm (6.5 cm inaverage) within erection. We examined all patients after they reachedthe stable result of penis enlargement after 1 year of hormonal replace-ment therapy. All patients demonstrated development of the second-ary sexual characters and enlargement of penis up to 4 cm in averageduring erection. Thus, the average size of penis was 6.5 cm in theflaccid condition and 10.5 cm during erection. For 6 months 44persons used extender and continued hormonal therapy. In half a yearwe estimated the result: augmentation of the sizes of penis by 2.5 cmin average during erection.Conclusion: In our opinion patients with hypogonadism show bestresults when they use extender after the physiological growth of penisas a result of long-acting injections of testosterone undecanoate.Policy of full disclosure: None

PP-07-257

Analyzing “real time” total s-testosterone togetherwith the ADAM-questionnaire—A method to identifylate onset hypogonadism (LOH) in clinical practice?Stroberg, P.1; Ljunggren, C.1; Oden, A.21ED-Kliniken, Urohälsan, Skövde, Sweden; 2Mathematical sciences,Chalmers University, Göteborg, Sweden

Objective: Late Onset Hypogonadism (LOH) is often missed due tothe vague symptoms presented and patients are neglected a testos-terone supplement they may benefit from. The aim was to study if theADAM-questionnaire together with “real time” total s-testosterone(T-T) using, a small photospectrometric analyzer (FAST-PACK-system® by Qualigen®), is a method to identify patients with possi-ble LOH in clinical practiceMethods: All consecutive males, who didn’t have testosterone treatment, attending a urologic outpatient clinic, answered a self-administered questionnaire, including the reason for visit, presence of concomitant diabetes and/or hypertension, and the “ADAM-questionnaire”. Blood-pressure, waist-circumference and BMI wasrecorded. Regardless of time of day T-T was analyzed at the clinic atthe time of the visit, using the FAST-PACK-system®. All patients with a T-T < 12 mmol/ml and at least one positive answer on theADAM-questionnaire were re-tested with a morning T-T. Those who still had a T-T < 12 mmol/ml were considered having a possibleLOH.Results: Of 402 men, mean age 60.4(20–88), 159(40%) had a first T-T <12 mmol/ml and 131(31%) also had at least one positive answeron the ADAM-questionnaire and were retested. Eighty-five, still(21%) had a low T-T. Of these 85 age 59,5(21–83), 16% had diabetes,47% had subjective erectile dysfunction(ED), a mean waist-circum-ference of 102.4 cm (81–132), a mean BMI 26.0(18–40) and 84% hadmore than one positive answer on the questionnaire. Of the remain-ing 317 males age 61,5(20–88)(p < 0.001), 12 % had diabetes, 40% hadself-reported ED, a mean waist-circumference of 99.4 cm (77–147)(p= 0.0124) mean BMI 26.7(16–42) and 88 % had more than one posi-tive answer on the questionnaire. Multivariate analysis showed signif-icance difference in age(p = 0.0013) and body-weight(p = 0.0124)between the two groupsConclusion: In clinical practice a significant number of patients withconsistent low T-s-T and symptoms indicating LOH are identified,when “real time” T-T is analyzed using the FAST-PACK-system®together with the ADAM-questionnaire.Policy of full disclosure: The study have been supported by grantsfrom Qualigen and Prostrakan pharmaceuticals.


J Sex Med 2008;5(suppl 2):94–145

PP-07-258

Does testicular volume alter under testosteronetherapy?Yassin, A.1; Haider, A.2; Shamsodini, A.3; Saad, F.4; Alkadi, S.3

1Segeberger Kliniken, Clinic of Urology & Andrology, Norderstedt,Germany; 2Urology Office, Bremerhaven, Germany; 3Hamad Medical Cor-poration, Dept. of Urology, Doha, Qatar; 4Gulf Medical College & Bay, MaleHealthcare, Berlin, Germany

Objective: To evaluate if testis volume alters or shrinks under testos-terone therapy with long-acting injectable t-undecanoate in patientswith LOH (late onset hypogonadism) and ED (erectile dysfunction).Methods: 34 patients with average age 57 +/− 2,1 and mean follow-up of 21 months received injectable TU 1000 mg (Nebido, Bayer-Schering, Berlin/Germany). They underwent monitoring protocolincluding testicular volume control by ultrasound 7,5 Mhz (Sonoace6000 c, Marl/Germany) at baseline and 3-monthly. This cohort wascompared with control group of 29 subjects with similar characteris-tics and mean age 55 +/− 2,7. Choosing ultrasound and no othermethod like orchidometer was determined to avoid artefacts like in thepresence of hydroceles.Results: The control group subjects have constant testicular volumeat 24,2 +/− 2,22 ml at baseline and during control time. Patients’ group(LOH/ED) whose testicle volume at baseline was in mean value 23 +/−1,2 ml showed after 3 months: 22,4 +/− 1,52 ml, after 6 months: 20,7+/− 1,4 ml, after 12 months: 19,8 +/− 2 ml, after 21 months: 19,7 +/−1,1 ml. Remarkable volume reduction was recorded after 6 months(19,6 %) under TT and remained constant afterwards. 4 subjects whoreported subjective volume reduction had 6 +/− 0,9 ml less volume.Conclusion: 1) Subjects with T-deficiency have primarily lower tes-ticular volume than eugonadal ones (−9 %). 2) Exogenous testosteronereduces testicle volume around 19,6 % in the first 6–9 months oftherapy but remains afterwards. 3) Only 4 patients reported subjectivefeeling of reduced testicular volumes. 4) No testicular atrophy wasnoticed so farPolicy of full disclosure: None

PP-07-259

Gender issues on sexual desire: implications frommedical, psychological and dyadic adjustmentCarvalho, J.1; Nobre, P.21Vila Real, Portugal; 2Universidade de Trás-os-Montes, Departamento deEducação e Psi, Vila Real, Portugal

Objective: Sexual desire has been defined as the sum of the forcesimplicated on the search, but also on the escape, of sexual behaviour,and it comprehends the interaction between biological, psychologicaland cultural factors (Levine, 2003). Several dimensions may play a dif-ferent role on sexual desire, inhibiting or promoting it, according toone’s developmental context and gender. Considering that men showgreater intensity and frequency of sexual desire than women (Regan &Atkins, 2006), it is essential to clear witch differences both sexespresent in their sexual desire response and what role do these differ-ences play. Deficient sexual desire is generally associated to hormonaldeficits in both genders (Schiavi, Schereiner-Engel, White & Mandeli,1991; Apperloo, Stege, Hoek & Schultz, 2003), although psychologi-cal and relationship factors might also play a privileged role on sexualdesire (Myscow, 2002; Brezsnyak & Whisman, 2004; DeLamater &Sill, 2005). The aim of the present study is to characterize both gendersalong several dimensions in order to predict which of them are relatedto lower and higher levels of sexual desire.Methods: 102 men and 127 women will be analysed regarding to 1)medical factors (Medical History Formulation; Wincze & Carey,2001), 2) cognitive-emotional factors (The Sexual Modes Question-naire; Nobre & Pinto-Gouveia, 2003), 3) psychopathology (BriefSymptom Inventory; BSI, Derogatis & Spencer 1982) and 4) relation-ship adjustment (Dyadic Adjustment Scale; DAS, Spanier, 1976).Results: Preliminary findings showed that psychopathological dimen-sions are associated to reduce levels of sexual desire in women but not

in men. Regarding cognitive factors, both genders presenting negativeautomatic thoughts during sexual activity have significantly less sexualdesire. On the other hand, only female sexual desire is related to dyadicadjustment. According to medical factors, pelvic inflammation was thesingle dimension related to sexual desire; pharmacological consumewas not related to both genders’ sexual desire.Conclusion: Men and women sexual desire responses seem to differalong the psychopathological and relationship dimensions, but notalong the medical or cognitive dimensions.Policy of full disclosure: None

PP-07-260

Sexual functioning versus risk factors ofatherosclerosis and changes in hormonal levels ofyoung menSlowikowska-Hilczer, J.1; Kula, K.1; Marchlewska, K.1; Oszukowska, E.1; Guminska, A.1; Jastrzebska, S.1; Kramek, E.1; Zawadzka, E.1;Walczak-Jedrzejowska, R.11Medical University, Andrology & Reproductive Endoc, Lodz, Poland

Objective: Assessment of male sexual function in relation to hormonalchanges has been studied in aging population. Less research hasfocused on young men.Methods: Here sexual life questionnaire was applied to investigate 80men aged 20–39 years. Body weight, height, waist and hip circumfer-ences were measured. Serum levels of total cholesterol (TCh), LDLcholesterol (LDL-Ch), HDL cholesterol (HDL-Ch), triglicerydes(TG), sex hormone binding globulin (SHBG), FSH, LH, total testos-terone (TT), dehydroepiandrosterone sulphate (DHEA-S) and estra-diol were determined. Body mass index (BMI), waist/hip ratio (WHR)and free testosterone index (FTI), representing bioactive testosterone,were calculated.Results: Mild erectile dysfunction (ED) was reported by 31,4% of 20-year-old men and by 15,6% of 30-year-olds, and severe ED by 3,1%of 30-year-olds. Mild orgasmic dysfunction (OD) was found in 15,8%of 20-year-olds and 9,4% of 30-year-olds, while severe OD was presentin 3,1% of 30-year-olds. With advancing age SHBG increased, whileestradiol and FTI decreased. Metabolic syndrome was diagnosed in17,5% of men (13,6%—20-year-olds, 22,2%—30-year-olds). Level ofsexual needs negatively correlated with age (p = 0,04), and positivelywith DHEA-S (p = 0,04). General satisfaction of relationship withsexual partner (GSRP) correlated positively with sexual satisfaction(SS) (p = 0,02), BMI (p = 0,04), WHR (p = 0,04), TCh (p = 0,009),LDL-Ch (p = 0,01) and TG (p = 0,03), and negatively with TT (p =0,009) and DHEA-S (p = 0,03). SS significantly increased with age (p= 0,02) and was the most important factor influencing GSRP. ExceptSS, the most discriminative for GSRP were lower TT (<17,1 nmol/l)and higher waist circumference.Conclusion: In men below 40, ED appears mainly in mild form, butis more frequent than reported before. Decrease of FTI with age andatherosclerosis risk factors are present already before 40. These maycontribute to the present and future sexual dysfunction. Sexual needsdecreases with age, but SS increases despite lowering of bioactiveserum testosterone.Policy of full disclosure: None


J Sex Med 2008;5(suppl 2):94–145

PP-08 ED and ejaculatory disorders

PP-08-261

Erectile dysfunction and Peyronie’s disease in patientswith retroperitoenal fibrosisAkbal, C.1; Tanidir, Y.1; Özgen, M. B.1; Simsek, F.11Marmara University Hospital, Dept. of Urology, Istanbul, Turkey

Objective: The purpose of this study is to examine and determinewhether the coincidence of erectile dysfunction (ED) and Peyronie’sDisease in patients with Retroperitoenal Fibrosis (RPF) and tocompare this with the control group.Methods: Ten of 17 male retroperitoneal fibrosis patients in ourdepartment formed the basis of this study. Patient’s age, concomitantdiseases were recorded. The diagnosis of PD was based on a palpablepenile plaque or acquired penile curvature. All of the patients hadundergone objective measurement of curvature and penile plaque withultrasound. Age matched eighty-eight patients who were admitted toour outpatient clinic with elevated PSA level served as the controlgroup. All patients were asked to complete the IIEF-5 questionnaire.The severity of the erectile dysfunction (ED) was classified into fourcategories: severe (5–7), moderate (8–16), mild (17–21), and no ED(22–25). Statistical analyses were done by the Fisher’s exact test and anunpaired sample-t test.Results: Patients with severe ED or no sexual intercourse in the studygroup and the control group during the study period were found to besix and 14 respectively. The median IIEF-5 score in RPF patients andthe control group was 9.8 (min: 5–max: 23) and 19 (min: 5–max: 25),respectively. The differences between groups were statistically signif-icant (p: 0.002). In particular, ED was reported in eight RPF patients(80 percent) which was severe in six (60 percent) and moderate in two(20 percent). ED was reported in 45 patients in the control group (51percent) which was severe in 14 (15.9 percent), mild in 25 (28.4percent), and moderate in six (6.8 percent). Patients with RPF had asignificant tendency for severe ED compared with the control group(p: 0.0042). Two patients in the RPF group (20 percent) and onepatient in the control group (1.1 percent) were found to have a penileplaque (p = 0.0279). Relative risk for developing a penile plague wasfound to be 0.8 in RPF.Conclusion: RPF patients are found to be more prone to developerectile dysfunction and penile plaque compared with normal popula-tion. This can either be due to the primary underlying pathology or itcan be a result of the pathological changes following the RPF process.Policy of full disclosure: None

PP-08-262

The impact of low dose-rate prostate brachytherapyon erectile function—a chronological process?Bannowsky, A.1; Bäurle, L.1; Loch, A.1; Paul, U.1; Loch, T.11Ev.-Luth. Diakonissen Hospital, Dept. of Urology, Flensburg, Germany

Objective: To evaluate the effect of low-dose rate prostate (LDR)brachytherapy on erectile function in correlation to the time intervalsafter seed implantation.Methods: 32 patients with localized prostate cancer and a median ageof 74 years (range 65–83) were treated with permanent seed implan-tation from November 2004 to December 2006. Erectile function wasassessed by means of a validated questionaire (IIEF-5) before and at12, 24 and 36 months after treatment. No patient received supple-mental external beam radiation therapy or antiandrogen therapy. Ofthe 32 patients, 26 (81%) completed and returned the questionaire.None of the patients used PDE-5 inhibitors or intracavernousal injec-tion therapy.Results: Before treatment, 15 patients (58%) had no erectile dys-function (ED) (score 22–25) or mild ED (score 17–21), 11 (42%) mildto moderate or severe ED (score 0–16). Overall, before seed implan-tation the mean IIEF score was 14.4. The mean IIEF score decreasedby 4.4 points 12 months after treatment, 3.1 points 24 months aftertreatment and 9.8 points 36 months after treatment (p < 0.05). In the

group of no or mild ED, the mean IIEF score dropped by 9.7 pointscompared to a decrease of 1.4 points in the group of mild to moder-ate or severe ED.Conclusion: Most of the patients treated with LDR brachytherapysuffered an ED in correlation to the time interval with a significantloss in the third year after treatment. In this study, the most signifi-cant loss occured in the groups which had no or only mild erectile dys-function before treatment.Policy of full disclosure: None

PP-08-263

Is there a place for the external vacuum device (VED)in the treatment of post-radical prostatectomy (RRP)patients who fail PDE5 inhibitors?Chen, J.1; Keren-Paz, G.1; Greenstein, A.1; Bar-Yosef, Y.1; Mabjeesh, N. J.1;Matzkin, H.1

1Tel-Aviv Sourasky Medical Center, Urology, Israel

Objective: To evaluate efficacy of VED in the treatment of post-RRPpatients who fail oral PDE5 inhibitors.Methods: We evaluated medical files of 32 patients aged 63 years(range 49–75 years) who suffered from erectile dysfunction 3–6months following RRP and did not respond to all three available oralPDE5 inhibitors and/or intracavernosal injection (ICI). All patientscompleted the IIEF and GaQ questionnaire before and after beingtreated with VED. Satisfaction rates of treated patients’ sexual part-ners were also assessed. Data on preoperative sexual performancestatus, stage of disease, concomitant disease and pre and post treat-ment PSA levels and sexual partners satisfaction rate were recorded.Performance status after VED treatment was also evaluated.Results: Of 32 evaluated patients, 26 (81%) were successfully treatedwith VED and 6 (19%) failed VED. Sixteen (50%) patients were suc-cessfully treated with VED only and 10 (31%) ended up with a com-bination treatment: 5/10 using VED+ICI and 4/10 using VED+PDE5iand one patient using both (VED+ICI and/or VED+PDE5i). Mostpatients (25/32) (78%) and 15/23 (65%) of the partners were satisfiedwith the treatment. There was significant improvement in Erectilefunction, (p < 0.001); Intercourse satisfaction (p < 0.001) and Overallsatisfaction (p < 0.001) domains of the IIEF score. Treatment outcomecorrelated with the preoperative sexual status. There was no correla-tion between the patients’ age, stage of disease, PSA. No significantcomplications were reported following VED treatment.Conclusion: VED as a single or combined treatment seems to have a significant beneficial effect, yielding high satisfaction rates frompatients and their sexual partners. This treatment should be offered topost-RRP patients who failed medical treatment before referral for ICIor insertion of a penile prosthesis, during the rehabilitation period andas single or part of combination therapyPolicy of full disclosure: None

PP-08-264

Simultaneous implantation of inflatable penileprosthesis and bone anchored bulbourethral slingafter radical prostatectomyPinto, R.1; Guimaraes, M.1; Oliveira, R.1; Silva, A.1; Cruz, F.1; Dinis, P.11Hospital de Sao Joao, Urology, Porto, Portugal

Objective: Stress urinary incontinence (SUI) and erectile dysfunction(ED) are major complications after radical prostatectomy. The firstoption of treatment is conservative, with pelvic floor exercises andpharmacotherapy. For cases with mild to moderate SUI, refractory toconservative management, bone anchored bulbourethral slings arenow being considered as first treatment option in lieu of artificialurinary sphincters. However, as these patients also may need an inflat-able penile prosthesis for correction of ED, some concerns exists aboutthe possibility of combining the two procedures. In the present workwe describe the successful placement of the two devices in the sameoperative session.


J Sex Med 2008;5(suppl 2):94–145

Methods: Five patients (54–64 years old) with refractory mild to mod-erate SUI and ED following radical prostatectomy were submitted,between 2005 and 2007, to simultaneous implantation of boneanchored bulbourethral sling and a penile inflatable prosthesis. Thesling was implanted through a small perineal incision and the penileprosthesis through a penoscrotal one. Patients were evaluated withhistory, physical examination, urodynamics and cystourethroscopy.Satisfaction was evaluated with a simplified verbal questionnaire.Results: After a mean follow-up of 1 year (1–2 years), all five patientswere continent. All were sexually active, satisfied with penile implant.There were no noticed prolonged urinary retention or new onset ofurgency. After surgery, one patient reported persistent scrotal numb-ness. Another one had prolonged urinary residual volume, resolvedspontaneously.Conclusion: There are some advantages of simultaneous implant ofmale sling and penile prosthesis: single anesthetic event; decreaseoverall recovery; minor risk of bacterial infection; contribution ofinflatable penile implant for continence. Our series shows that patientswith mild to moderate SUI who are candidates for penile implant canbe successfully treated in one single operative session.Policy of full disclosure: None

PP-08-265

Erectile dysfunction screening: First step on detectingother more severe pathologyPorav-Hodade, D.1; Crisan, N.1; Feciche, B.1; Mihaly, Z.-A.1; Jalaizadeh, B.1; Petrut, B.1; Coman, I.1

1Clinical Municipal Hospital, Urology, Cl-uj-Napoca, Romania

Objective: To evaluate the prevalence of risk factors as hypertension,diabetes mellitus, cardiologic pathology, smoke and alcohol on erec-tile function for male population over 40 years old during a erectiledysfunction screeningMethods: During the CLuj-Napoca PrOStatic CancER Screening(CLOSER) Program patients completed also optionally the IIEF anda questionnaire about some risk factors. The patient were grouped infour category concerning the age: group A—patient between 40–49years, group B—patient between 50–59 years, group C—patientbetween 60–69 years, group D—patient over 70 years.Results: A total of 543 patients fulfill the IIEF test and responds aboutthe presence of other comoridities and the risk factors. From group Aonly 36% of patients presented normal erectile function, 24% fromgroup B, 11%from group C and 2% from group D The prevalence ofother comorbidities and risk factors determined in the study groupwere:

Group A Group B Group C Group D over

40–49 50–59 60–69 70 yearsyears years years

Hypertension 22.70% 32% 57.51% 47.80%Diabetes mellitus 9% 3.90% 11.90% 21.60%Cardiologic pathology 14% 11.80% 29.70% 32.40%Smoke 45% 27.63% 16.60% 10.80%Alcohol 18.18% 28.90% 30.90% 27.02%

Conclusion: The prevalence of erectile dysfunction and all the studiedcomorbidities increased with age. Only the number of the patientsdecreased with age. An erectile dysfunction screening program can bea tool to discover new undetected disease.Policy of full disclosure: None

PP-08-266

Penile rehabilitation and recovery of penile lenghtfollowing radical prostatectomy: 6 years follow-upParadiso, M.1; Abbona, A.1; Sedigh, O.1; Graziano, M. E.1; Liberale, F.1;Giovanni, P.1; Ferrando, U.1


Objective: After Radical Prostatectomy (RP), patients report decreasein penile lenght. This randomized prospective study evaluate the effi-

cacy of rehabilitation for restoration of penile lenght and patientpotency compliance.Methods: 86 men; mean age 57. Two groups: Nerve Sparing RP: 46patients; 40 non-NS RP. Penile rehabilitation started after 4 weeks:Vardenafil 20 mg × 2/week & ICI 2 times/week in N.S.-group for 4months; bi-weekly ICI and daily vacuum exercising for the same periodin both groups. IIEF-5, dynamic colour dupplex and penile lenghtmeasurement were performed before RP and 4 months after.Results: 78/86 patients had complete compliance (4 months). Penilelenght was statistically shorter in both groups after 8 weeks. Meanlenght at month 4 was significantly increased compared to week 8measurement (p: 0.005), but shorter than before surgery. Patients withbilateral NSRP had significant increasing in penile lenght (1.5 cm;0.4–1 cm in non NS) at week 8 and month 6. In NS-group 70% ofpatients at 6 months had good erections with Vardenafil only. Non-NS group had good compliance with ICI in 75%. In non-NS group,only 25 patients made a daily use of vacuum. PGE1 non-responders(17%) were treated with Trimix. 5% of patients are candidate forpenile prosthesis implantation.Conclusion: PDE5-i therapy before 2 months is unuseful; ICI startedbefore 30 days is often painful, so patients abandon the rehabilitation.NSRP with correct rehabilitation can restore partially penile lenght.57 or older patients demonstrated better compliance (VCD 90%, ICI75%); there is significant association between age and compliance forICI at 24 months evaluation. Early ICI therapy induces a better actionof Vardenafil after 3 months in PDE5-i non-responders patients, andreduces the ICI minimum dose in responders. Penile prosthesisimplantation must be considered in young, non responder and moti-vate patients after 6 months, in order to implant a normal size device.Policy of full disclosure: None

PP-08-267

Vardenafil improves erectile function and quality of life in men with benign prostatic hyperplasia: A randomised, placebo-controlled studyStief, C.1; Porst, H.2; Neuser, D.3; Beneke, M.4; Ulbrich, E.5

1Ludwig Maximilians-University, Department of Urology, Munich,Germany; 2Private Urological Practice, Hamburg, Germany; 3BayerHealthcare AG, Bayer Healthcare AG, Wuppertal, Germany; 4Bayer VitalGmbH, GBL Urology, Leverkusen, Germany; 5Bayer Vital GmbH, BayerVital GmbH, Leverkusen, Germany

Objective: Benign prostatic hyperplasia (BPH) is often concomitantwith erectile dysfunction (ED) and impacts on quality-of-life (QoL).This randomised, double-blind, placebo-controlled study investigatedthe effects of vardenafil on erectile function and QoL in men withBPH.Methods: Men aged 45–65 years with BPH and an InternationalProstate Symptom Score (IPSS) ≥12 were randomised to receive 10mg vardenafil or placebo twice-daily for 8 weeks. The primary objec-tive of the study was to assess the effects of treatment on lower urinarytract symptoms (these results have been published previously). Erec-tile function was assessed using the erectile function domain score ofthe International Index of Erectile Function (IIEF-EF). The presenceof ED was not required for entry into the study. QoL was assessedwith the UrolifeTM QoL-9 questionnaire. Data for the intention-to-treat population were analysed using a last-observation carried forwardapproach and an analysis of covariance.Results: The least square (LS) mean baseline IIEF-EF score was 15.9in both the vardenafil and placebo groups, indicative of moderate ED.Treatment with vardenafil resulted in a nominally significant improve-ment in LS mean IIEF-EF scores compared with placebo after 8 weeks(7.5 and 1.5 points, respectively; difference: −6.0 [95% CI: −7.8 to −4.2]; p = 0.0001). Absolute LS mean IIEF-EF scores at 8 weeks were23.4 and 17.4 in the vardenafil and placebo groups, respectively. Var-denafil treatment was associated with an improvement in overall QoL(total UrolifeTM QoL-9 score, difference vs placebo: −9.3 [95% CI: −12.8 to −5.7]; p < 0.0001). Nominally significant improvements in the‘perceived sexual life’ UrolifeTM QoL-9 subscore were also observed(difference: −6.1 [95% CI: −7.7 to −4.5]; p < 0.0001).


J Sex Med 2008;5(suppl 2):94–145

Conclusion: In men with BPH, vardenafil treatment significantlyimproved erectile function when compared with placebo. Improve-ments in sexual life and overall QoL were also associated with varde-nafil treatment.Policy of full disclosure: This study was sponsored by Bayer Scher-ing Pharma AG. Professor Porst has acted as a speaker and consultantfor Bayer Healthcare, Pfizer, and Lilly ICOS. Dr Neuser is anemployee of Bayer Healthcare AG. Dr Beneke and Dr Ulbrich areemployees of Bayer Vital GmbH.

PP-08-268

Early penile rehabilitation after laparoscopic andretropubic radical prostatectomyUsta, M. F.1; celik, O.1; Erdogru, T.1; Kol, A.11Akdeniz University, Urology, Antalya, Turkey

Objective: Recently the concept of early post-operative penile reha-bilitation with vasoactive intracavernosal injection (ICI) was sugesstedto improve spontaneus erectile function in patients with localizedprostate cancer who underwent radical retropubic prostatectomy(RRP).Methods: Men with pre-operatively normal erectile function wereinstructed to perform ICI treatment (50 mg papaverine) three times aweek after (post-operative 3rd week) either laparoscopic or openradical prostatectomy. Patients completed International Index of Erec-tile Function (IIEF) questionnaire preoperatively and 3., 6., 9., 12., 15.,18. months postoperatively. Furthermore, patients who were able toachieve erection with ICI switched to use oral PDE-5 inhibitors.Results: There were 64 patients in the laparoscopic RP group and 37in the open RP group. There was no differences in mean patient age,comorbidity profile, intraoperative nevre sparing status between thetwo groups. Additionally, statistical analyses showed also that there wasno differences between the two groups in pre-post (18th month) oper-ative IIEF and in the percantage of patients who was able to achivesexual intercourse without any medication or with PDE-5 inhibitors.Conclusion: Our results showed that early use of ICI was able toimprove erectile function in prostate cancer pateints who underwenteither laparoscopic or open radical prostatectomy. However, these pre-liminary data needs to be supported by studies which include largenumber of patiens and placebo groups as well.Policy of full disclosure: None

PP-08-269

A case of treatment of lifelong ejaculatory inadequacyin a man with a mild learning disabilityAthanasiadis, L.1; Anastasia, K.2; Dimitrios, M.3; Stamatis, P.4; Magiria, m.5; Kaprinis, G.5

1Thessaloniki, Greece; 2University of Thessaloniki Med, Psychiatry, Greece;3Private Practice, Psychiatry, Thessaloniki, Greece; 4University of Thessa-loniki, CSRH, Greece; 5University of Thessaloniki, Psychiatry, Greece

Objective: The authors looked at whether poor masturbatory andintercourse skills may account for a total lifelong lack of ejaculation ina man with a mild learning disabilityMethods: A 32 years old, single, heterosexual man with a mild learn-ing disability presented with a lifelong lack of ejaculation reported asoccurring under all circumstances (sleep, masturbation, intercourse).His parents reported that—to their knowledge—this account wasaccurate. The patient was very cooperative and seemed to be able togive a reliable history of his problem. His sexual drive and erectilecapacity were normal. The clinical and laboratoty (ultrasound) exam-ination did not detect any abnormalities other than a smaller thannormal r. testicle and epididymis, which however could not accountfor the dysfunction. Retrograde ejaculation was excluded. Usually thepatient did not present considerable performance anxiety during sexualactivity. He appeared to have very poor masturbatory skills, great dif-ficulties in using sexual fantasies and he did not touch the tip of thepenis during sexual stimulation. The authors attempted to treat thepatient by using conventional sexual skills training techniques. The

patient was offered sexual education, and he was instructed to changethe source of stimulation (introduce X films) and the pace and contentof sexual stimulation during masturbatory exercisesResults: He presented disappointed following initial failures, he wasencouraged to carry on and he finally achieved ejaculation two weekslater. In a three month follow up he continued to be able to ejaculate8/10 times he masturbated. Until that time he had not attemptedsexual intercourse and he did not report night emissionsConclusion: It appears that in some cases lifelong long ejaculatoryinadequacy under all circumstances may not necessarily be due toorganic causes but may account for poor sexual skills. Psychosexualmanagement may be effective in enabling the patient to establish anormal ejaculatory functionPolicy of full disclosure: None

PP-08-270

The efficacy and safety of tamsulosin 0.2 mg/day onsexual function in BPH: A multicenter studyMoon, D. G.1; Lee, S. W.2; Moon, K. H.3; Ahn, T. Y.4; Jeong, W. S.5; Yang,D. Y.6; Kim, J. J.1

1Korea University Hospital, Urology, Seoul, Republic of Korea;2Sungkyunkwan University, Urology, Seoul, Republic of Korea; 3YoungnamUniversity, Urology, Seoul, Republic of Korea; 4Ulsan University, Urology,Seoul, Republic of Korea; 5Ewha University, Urology, Seoul, Republic ofKorea; 6Hallym University, Urology, Seoul, Republic of Korea

Objective: Alpha 1-adrenoceptor antagonists have been reported as beneficial on both LUTS and sexual function but higher rate(4.5–11%) of abnormal ejaculation with 0.4 mg/day of tamsulosin.Unlike BPH patients of Western countries, the effective dose of Tam-sulosin is 0.2 mg/day in most Asian countries. This open-label, non-comparative, observational, Phase IV, multicenter prospective studywas done to assess the efficacy and safety of Tamsulosin, 0.2 mg/dayon sexual function in Korean BPH patients.Methods: 116 patients of BPH or LUTS (prostate volume > 20 gm)were enrolled in this study and 0.2 mg of Tamsulosin was adminis-trated every night for 3 months. Primary efficacy was evaluated withchanges of IIEF, GEQ and abnormal ejaculation, e.g. decreased ejac-ulate, decreased ejaculation force, anejaculation, painful ejaculation,retrograde ejaculation, delayed ejaculation and decreased ejaculationsatisfaction. Secondary efficacy parameters were changes of IPSS andQoL, Qmax and PVR, changes of total IIEF and IIEF domain scoreaccording to the severity of IPSS. Paired t-test was done by ITT(intention to treat) analysis and PP (per protocol) analysis.Results: Mean age of patients was 60(49–76) yrs. Hyperten-sion(30.2%), diabetes(14.7%), and hyperlipidemia(8.6%) were accom-panied. Before treatment, patients of moderate IPSS(8–19) and severeIPSS(20–35) were 56% and 44% and QoL <3 and QoL >3 were 33.6%and 66.4%, respectively. In primary efficacy evaluation, total IIEFscore was significantly increased from 37.0 ± 18.2 to 40.5 ± 18.9 (p <0.01). All domains of IIEF except erectile function were significantlyimproved. GEQ showed improvement of erection in 34.4% and inter-course ability in 30.1%. Abnormal ejaculation was occurred in 2patients (2%). In secondary efficacy evaluation, IPSS was significantlydecreased from 18.4 ± 6.9 to 12.9 ± 6.7(p < 0.01) and QoL was sig-nificantly improved from 3.8 ± 1.1 to 2.7 ± 1.4 (p < 0.01). Qmax sig-nificantly increased from 14.2 ± 8.3 to 16.5 ± 11.3 ml/sec (p < 0.01).Total IIEF score and EF domain score significantly improved (p < 0.01)in patients of moderate IPSS but no improvement in severe patients.No serious adverse reactions were observed.Conclusion: Tamsulosin, 0.2 mg/day was effective for the improve-ment of LUTS and sexual function for Korean BPH/LUTS patients.Unlike Western population, 0.2 mg/day is effective and safe dose inAsian and rate of retrograde ejaculation was 2%.Policy of full disclosure: None


J Sex Med 2008;5(suppl 2):94–145

PP-08-271

The epidemiology peculiarity of the prematureejaculation in the territory of Latvia, generatingfactors and the medical treatment possibilitiesPozarskis, A.1; Erenpreiss, J.2

1Private Medical Practice, Daugavpils, Latvia; 2Riga Stradina University,Andrology Laboratory, Latvia

Objective: The objective of the presented paper was to establish whatis the prevalence of the primary and secondary PE in Latvia, to testthe efficiency of the different medical treatment methods.Methods: 23 patients, who addressed to the doctor’s AnatolijsPozarskis medical practice with the diagnosis of the PE in the timeperiod during 1999–2006 were included in the study. In the case of theprimary PE following treatment was applied: clomipramin 10–25mg/d, sertralin 50 mg/d (6 patients, group I); cognitive—behavioralpsychotherapy(1 patient, group II); clomipramine in combination withthe cognitive—behavioral therapy (2 patients, group III). In the caseof the secondary PE:only treatment of the prostatitis was used in 6cases (group IV); the treatment of the prostatitis with clomipramin l0mg/d, alprazolam 0,25 mg/d (6 patients, group V); only clomipramin,sildenafil (2 patients, group VI).Results: Nine patients (39%) have the primary PE, 14 patients (61%)-the secondary PE. In the group I the positive treatment outcome meas-ured as a prolongation of the IELT, was observed in 3 cases (50%), inthe group II in 1 case (100%), in the group III in 2 cases (100%), in the group IV in 5 cases (83%), in the group V—in 4 cases (66%),in the group VI—in 1 case (50%).Conclusion: Psychotherapy alone or in combination with medicamenttreatment is more effective PE treatment as the medicament treatmentalone. Prostatitis is a causative factor in the majority of the secondaryPE patients, its treatment is highly effective PE treatment in thesepatients. Bigger study is necessary to confirm these results.Policy of full disclosure: None

PP-08-272

Sexual counseling for patients with dysfunctionalejaculationVasto, S.1; Italiano, E.2; Lanzarone, C.3

1Biopatologia, Palermo, Italy; 2Azienda Ospedaliera, Villa sofi, Palermo,Italy; 3Università di Palermo, Dipartimento di Psicologia, Italy

Objective: In the last years, sexual disorders and in particular dys-functional ejaculation are on a rise and interestingly Erectile disordershave been found one of the most frequent problem discussed. Thispathology is increasing exponentially showing a 30% of incidence ofthe whole patients coming at the Urology Operative unit of Villa Sofiahospital in Palermo. Among those, patients with delayed or impossi-ble ejaculation (anejaculation/anorgasmia) have been described regu-larly. Patients with dysfunctional erectile disorders undergo sexual,pharmacological, pathology and objective analysis exams which arecombined with patients or couple information to find out the bestcounseling formulaMethods: From 2000 to today we have managed a list of 460 patientswith ejaculation disorders. Of these patients, 70% showed fast ejacu-lation with range variability from ante PORTAM to few minutes, while25% of patients presented delayed or impossible ejaculation and theremaining 5% had various sexual disordersResults: Over the patients with fast ejaculation 40% presented pro-statitis condition and needed antibiotic therapy, these patients reportedan improvement of the management of the ejaculation conditionwithin a period of about 2 months. 30% of the patients exhibited aninflammation of the prostate or inflammation of the prostate skin inthis case the antibiotic therapy has not changed the ejaculation timingand it was necessary to integrate a cycle of behavioural therapy of ejac-ulatory reflex. 30% of patients which did not present organic causeshave requested behavioural therapy advise. Among the patients withdelayed ejaculation over 50% was accountable to pharmacological

therapy, while the remaining cases had psychological problems andwere advised to follow analytical therapy.Conclusion: Our working group is formed by andrologist, urologistsand psychotherapists which team work has allowed a resolution of theproblem in a percentage of 80% of the patients with a better responsein the cases of fast ejaculation problems.Policy of full disclosure: None


J Sex Med 2008;5(suppl 2):94–145

PP-09 Psychotherapy, desire, and arousal

PP-09-273

Sexual life evaluation using FSFI questionnaire ingynecological and urological female patientsBelinski, C.1; Popa, E.2; Crisan, M.2; Manu Marin, A.1; Vesa, E.1; Calomfirescu, N.1

1Gerota Hospital, Dept. of Urology, Bucharest, Romania; 2Bucur Hospital,Gynaecology, Bucharest, Romania

Objective: To evaluate the sexual life of women patients from gynae-cology and a urology clinic, using Female Sexual Function Index(FSFI). We compare the results with those we obtained in the generalpopulation, from a previous study (ESSM Congress—Vienna, 2006).Methods: Between 1st of May and 1st of August 2007 we asked thewomen admitted at the Department of Gynaecology Bucur Hospitaland the Department of Urology Gerota Hospital to answer to FSFIquestionnaire. A total of 162 questionnaires were distributed; 107answered (66%). 25% of them were under 25 years old, 35,5%between 26 and 35, 20,5% between 36 and 45 and 19% over 45 yearsold. We compared the satisfaction of sexual life of the gynaecologicaland urological female patients with that of the general population. Wehave used p value to establish statistical significance.Results: We analysed for each group of age the desire, the arousal, thelubrication, the orgasm, the satisfaction of sexual life and the painduring intercourse. 78% of them were from urban communities, 35% were smokers, 64% had regular periods and 37% were using contraception methods. 84% had the same partner in the last year. Full scale score and the satisfaction domain score (15, 16)was alteredfor the patients with cystitis, urinary incontinence and malignanttumours.Conclusion: In our study the recurrent cystitis, incontinence andmalignant tumours have the biggest impact on female sexual life.Policy of full disclosure: None

PP-09-274

Spontaneous orgasm associated with yawning: Anunusual side effect of antidepressant medicationGyovai, G.1; Huszka, C.1

1University Hospital Szentes, Department of Gynaecology, Hungary

Objective: The aim of this study was to demonstrate 2 seldomly rec-ognized side effects of SSRI therapy in patients with major depressionthat is associated with abnormal female sexual functioning.Methods: We have pooled 3 patients from our outpatient databasewith the diagnosis of major depression and a subsequent therapy withSSRI, who met the following criteria: female, repeatedly experiencedabnormal yawning and orgasm with or without clitoral enlargementafter medication ingestion without signs of sexual arousal, at least 5events per week. Only patients with at least one year follow-up periodand a minimum of 6 interviews per year have been selected. Follow-up charts and records served as a basis of analysis.Results: All patients experienced a rapid onset of yawning withoutsensation of drowsiness and orgasm without any sexual thoughts orsexual stimulation. These symptoms were preceded in 2 cases by atransient non-painful clitoral engorgement associated with the sensa-tion of spontaneous sexual arousal. Both the yawning and orgasmsappeared approximately one hour following SSRI ingestion, continuedfor several hours and disappeared. The symptoms caused measurabledistress as well as feeling of shame reducing the effectiveness of anti-depressive therapy and also interfered with the patients’ regular sexualactivity.Conclusion: All patients receiving SSRI treatment should routinelybe queried about their experiences with orgasm in order to establish a more clear relationship between the treatment and these side effects and reduce stress and unnecessary discomfort due to feelings ofshame as well as to improve the patients’ sexual life. A better under-standing of serotonergic agents, yawning, and sexual stimulation andtheir possible relevance in the pathophysiology of depression is

necessary in order to fine-tune and maximize treatment of depressivedisorders.Policy of full disclosure: None

PP-09-275

Sexual counseling in the elderly coupleBitzer, J.1; Alder, J.1

1University Hospital Basel, Gyn. Psychosomatics, Switzerland

Objective: Sexuality in the elderly couple is an underinvestigated issueand sexual counselling in this age group a relatively rare activity. Withthe upcoming of new pharmacological treatment options it seemsmandatory to develop a age and gender sensitive approach regardingsexualityMethods: 1. Evaluation of the empirical literature regarding the influ-ence of age on sexuality. 2. Evaluation of the theoretical framework(perspectives) of sexuality in the elderly. 3. Development of a coun-selling concept and algorithm for this age group based on the combi-nation of a biopsychosocial and a systemic concept.Results: Empirical studies show that the aging process is accompaniedby specific changes in sexuality: A decline in sexual activity, an increasein sexual dysfunction, a relative discrepancy between dysfunctions anddistress (less personal distress with age) and a low demand for profes-sional help. To respond to the complexity of sexuality of the elderlycouple, an integrative model is necessary: The male axis with sexualfunction conditioned by biological, psychological and social factorsand the female axis with the same items; the interactional axis describ-ing the patterns of communication of wishes, needs and objectives,negative and positive feedback, conflict management and develop-mental crisis.Conclusion: Many elderly couples suffer from sexual problems, whichthey may be ashamed of and reluctant to talk about. To enable coun-selling, physicians should take a comprehensive perspective includingthe biopsychosocial changes influencing the individual male andfemale sexuality and the typical patterns of sexual interaction hinder-ing or enhancing the quality of their sex life.Policy of full disclosure: None

PP-09-276

Profiles of patients seeking treatment for non-consummation of marriage at a sexual concerns clinicin Singapore and their response to treatmentNg, B.-Y.11Singapore General Hospital, Dept. of Psychiatry, Singapore

Objective: This study describes the profiles of 20 Chinese males whosought treatment for non- consummation of marriage at a Sexual Con-cerns Clinic at a general hospital in Singapore. Their response to treat-ment was also studied.Methods: The data were collected prospectively. The profiles ofpatients were studied and their response to treatment monitored.Their reasons for default were elicited by interviews over the phone.Results: All 20 are Chinese males aged 28–45 who are well- educatedprofessionals and executives. The delay in visiting the clinic rangedfrom 6 months to 3 years after marriage. All of them have the sameproblem of not being able to penetrate their wives or have a success-ful intercourse on at least one occasion following their marriage.Fifteen of them have erectile dysfunction, and five of them have pre-mature ejaculation. 80% of those with erectile dysfunction have faileda course of PDE5 agent (sildenafil, vardenafil, tadalafil). All of havebeen assessed by the urologist. In five cases, their wives also come forevaluation, and out of the five women, two were found to have vagin-ismus. These twenty patients sought treatment primarily because theywere under pressure to have children. Most of the men were found tobe highly driven and competitive individuals who work long hours.They were found to have high level of performance anxiety. Tenpatients (50%) stopped treatment after the initial session. The reasonsgiven for default include: no time because of work pressures (6 cases);prefer a quick fix (3 cases); does not believe that sex therapy will work


J Sex Med 2008;5(suppl 2):94–145

(1 case). For those 10 cases who remained in therapy, treatment con-sisted of: stress management strategies; getting the couple to accordsome priority to intimacy; sensate focus; psychoeducation; communi-cation training; use of PDE5 inhibitors; sex therapy. Nine out of the10 were able to consummate their marriages eventually. The durationof treatment ranges from 4 to 12 months. In 1 case, treatments failedas his stress level remains high and he was not able to find time fortherapy or to carry out the assignments in between sessions.Conclusion: This study finds a high drop-out rate of 50% after theinitial session when the men came for evlauation of non-consumma-tion of marriage. They have a good response to sex therapy if theyremain in treatment. The main factor affecting outcome of therapy isthe willingness of couples to continue with treatments. Therapistsneed to devise more effective means of engaging this group of men intreatments.Policy of full disclosure: None

PP-09-277

“Innovative” sexual practices in patients with mentalillnessNita, G.1; Petrisor, G.1; Gheorghe, N.1; Razvan, M.1; Bogdan, G.1

1Saint John Clinical Hospital, Dept. of Urology, Bucharest, Romania

Objective: In patients with mental illnesses, urological pathology maybe sometimes produced by “innovative” sexual practices using a widevariety of foreign bodies. This study aimed to present our experiencein treating such cases.Methods: Between January 1995 and April 2007, 49 patients (16females and 33 males) with psychiatric documented mental pathologywere admitted into our clinical department for self inflicted urinary orgenital lesions: 19 patients with urethral or intravesical foreign bodies(group I), 14 patients with penile constriction with various objects(glass or plastic bottles, bearings, etc.)—(group II) and 16 patients withinjection/insertion of foreign bodies/substances into the penile skin(group III).Results: 18 patients of group I were managed using endoscopic tech-niques (grasping forceps extraction associated or not with lithotripsyand fragmentation of the foreign body). Only 1 patient required opensurgical procedure. All patients from group II were managed conser-vatively, by cassation, sometimes requiring innovative procedures(especially when hard objects were used for constriction). 11 patientsof group III, with foreign bodies inserted into the penile skin weretreated by excision of the fragments (10 cases) or circumcision (1 case).Six patients with liquid lip gloss injected into the penile shaft under-went excision of the infiltrated skin followed by dermal grafting.Conclusion: A wide variety of self-inflicted urological lesions may beassociated with abnormal sexual activity in patients with mental ill-nesses. Most of these cases may be managed in a minimally invasivemanner, nevertheless raising technical challenges for the urologist.Policy of full disclosure: None

PP-10 Sexual diversity

PP-10-278

Effect of NuvaRing on women sexual health conditionGorpynchenko, I.1; Romashchenko, O.1; Melnikov, S.1; Bilogolovskaya, V.1;Yaschenko, L.11Insitute of Urology, Andrology and Sexology, Kyiv, Ukraine

Objective: Sexual health estimation of women using the NuvaRingvaginal ring for contraception objectives.Methods: A gynecological, sexology and psychological examination ofthirty sexually active women aged 22 to 36 with non-disordered men-strual and reproductive functions taking the innovative contraceptiveNuvaRing (a vaginal ring containing 2.7 mg ethinylestradiol and 11.7mg etonogestrel, intended to be used during one menstrual cycle) hasbeen conducted. Examination of their sexual partners was carried outat the same time. Before assigning the contraceptive, the patients werepointed out that inserting a NuvaRing enables to study sexuality andit was a prerequisite for new positive feelings. The survey was con-ducted by means of interviewing. It was recommended to keep sexualexperience and feelings diary. Estimation of sexual health values withaccount of vascular disorders was conducted using ultrasound investi-gation with duplex Doppler scanning on the XARIA TOSHIBAdevice, as well as pH-measuring of vaginal mucous membrane indynamics. Prior to the examination and 6 months after its termination,the evaluation of erogenic zones map coincidence by the partners wasfulfilled.Results: When using NuvaRing, 30.0% of women and 53.1% of theirsexual partners were observed to have sexual contacts initiationincreased. Libido and orgasm vividness decrease was indicated among2 multi-orgastic women. 5 female patients were indicated to havelibido and orgasm vividness and sexual excitiment grown. 63.3% ofwomen using NuvaRing were observed to have clitoris vessels volu-metric blood flow rate increased (to 7.0–8.0 cm/s) which is indicativeof vasocongestion improvement and lubrication increase of suchpatients.Conclusion: We can suppose that increase of sexual contacts initia-tion, libido and orgasm intensity among the majority of women andtheir partners when using NuvaRing is associated with sexual interestincrease due to unusual contraceptive usage. A feeling of the ringtouching vagina paries can be an extra sexual excitor of first-order ero-genic zones both for women and men. A positive emotional dominantwhen using the NuvaRing contributed to creation of intime trustful-ness and sexual comfort for majority of partners.Policy of full disclosure: None

PP-10-279

Prolonged androgen application safety evaluation inpatients with female transsexualismVertkin, A.1; Rudenko, L.2; Kalinchenko, S.2; Uryadnova, M.2;Ramazanova, Y.2; Polupanova, Y.2; Naumov, A.2

1MSMSU, Clinical Pharmacology, Moscow, Russia; 2MSMSU, clinicalpharmacology, Moscow, Russia

Objective: To determine the safety of lengthy androgen therapy in thepatients with female transsexualism.Methods: To evaluate the treatment adequacy the content of TT, thequantity of erythrocytes, the level of hemoglobin, hematocrit and fib-rinolysis factors as well as total cholesterol, triglycerides, HDL, LDL,glucoses, and immune reactive insulin were determined in the bloodserum of the patients. To evaluate the liver function the hepaticenzymes were studied in the patients who also underwent ultrasoundexamination. The cardiovascular system was studied by the 24 hourECG-monitoring, echocardiography, the dynamics of the 24 hourarterial pressure. In order to evaluate the effect of androgens on themineral density of the osseous tissue the X-ray two-photon absorp-tiometry in the distal part of the forearm was carried out in 44 patients.Results: No cumulation, sensorialyzation and tolerance to testos-terone preparations develop as a result of prolonged androgen therapy.


J Sex Med 2008;5(suppl 2):94–145

No considerable effect of the prolonged androgen therapy on lipid andcarbohydrate metabolism and hemostasis was revealed in the patientswith female transsexualism. A number of laboratory indices (hemo-globin, erythrocytes, hematocrit, triglyceride) in case of female trans-sexualism are close to the indices of healthy males, while others(glucose)—are close to the indices of healthy women, but according tothe level of hepatic enzymes these patients occupy the intermediateposition between males and females. No considerable effect of theandrogen therapy on the electrophysiological and hemodynamicparameters of the cardio-vascular system was found in the patients withfemale transsexualism; a tendency to tachycardia was noticed in com-parison with healthy males. No effect of the androgens on the struc-ture and functional condition of the liver was revealed. Against thebackground of a prolonged androgen therapy in the patients withfemale transsexualism a significant decrease of osseous tissue mineraldensity was marked in comparison with healthy males and females.Conclusion: It should be a special screening group for patients withfemale transsexualism with the health passport. Forced androgentherapy should be spent under the control of hemogram indicators (atleast once a year), lipid exchange (especially important control oftriglycerides) and osseous tissue mineral density.Policy of full disclosure: None

PP-10-280

Fournier’s gangrene of genitalia: Our experienceBitelli, M.1; Pietrantuono, M.2; Ranieri, M.2; Maraone, A.2; Pietrantuono,F.3; Zucchi, A.4; Ranieri, G.5; Virgili, G.3; Finazzi Agro, E.3; Vespasiani,G.3

1Rome, Italy; 2U.O.C. of Urology, Urology, Cassino, Italy; 3Tor Vergata University, Urology, Rome, Italy; 4University of Perugia, Urology, Italy;5University of L’Aquila, Urology, Italy

Objective: Fournier’s gangrene is a rare infection characterized withfast-progressing myonecrosis, that affect regions of perineum, geni-talia and perianal area. Although the incidence is relatively lowFoumier ‘s gangrene represents an important surgical problem, it isfor the elevated rate mortality that involves, is for the difficult man-agement of the patients, forced to extended antibiotic therapies andlong periods of stay in hospital In this work we show our managementof 4 cases.Methods: In our Unit we treated four cases of Fournier’s gangrenefrom July 2002 to April 2007. All patients were male, ranging in agefrom 50–78 years old, admitted to our hospital complaining of per-ineal pain, scrotal swelling and high fever. The FG severity index(FGSIS) was used to predict outcome.Results: All the patients were subordinates to antibiotic, medicaltherapy and surgical debridement. In one case Hyperbaric oxygentherapy was used. 1/4 pts died in day 15 postoperative. 3/4 pts are cur-rently in good physical conditions. The mean Fournier’s gangreneseverity index score (FGSIS) for survivors was 4.0 ± 1.8 compared with11 for nonsurvivor.Conclusion: Fournier’s gangrene, although during the last few yearsthe antibiotic use to wide phantom has reduced the mortality rate,remains always one pathology of extreme gravity. The antibiotictherapy alone he is not sufficient in the treatment of the disease, butof fundamental importance it turns out to be surgical debridement andhyperbaric therapy where possible. Patients’ metabolic status and theextent of disease at presentation is an important factor in the progno-sis of Fournier’s gangrene. We suggest the clinical use of FGSIS, whichis simple and objective when evaluating therapeutic options and pre-dicting outcome.Policy of full disclosure: None

PP-10-281

Day surgery management of varicocele: Subinguinalmicrosurgical varicocelectomyBitelli, M.1; Forte, F.2; Parisi, I. A.2; Valitutti, M.3; Pagliarella, G.2; Zucchi, A.4; Vespasiani, G.5; Virgili, G.5

1Rome, Italy; 2Ospedale Israelitico, Urology, Rome, Italy; 3Aurelia Hospital,Urology, Rome, Italy; 4University of Perugia, Urology, Italy; 5Tor VergataUniversity, Urology, Rome, Italy

Objective: The varicocele is a pathology of frequent reply in urolo-gist practice and the surgical techniques are turned to minimal inva-sivity, minor the time of stay in hospital and a satisfactory clinicalresult. Objective of our study has been to estimate the validity of Sub-inguinal microsurgical varicocelectomy sec. Marmar in regimen ofDay Surgery in patients affected from left varicocele.Methods: From September 2003 to September 2006 have beenenrolled 71 patients affected from symptomatic left varicocele of vari-able clinical degree (2°–3°) previously assessed through clinical fea-tures (testicular pain or scrotal sensation), physical examination andDoppler ultrasound. After to have carried out the blood examinationsof routine and semen analysis the patients have been subordinates tosubinguinal microsurgical varicocelectomy sec. Marmar. After localanesthesia on the spermatic cord using 20 cc of Carbocaine + 10 ccNaropine 10% (mean 21.4 cc) it is proceeded to 3 cm subinguinalrecording and successive exposure of spermatic cord with fastening andthe section of the dilated spermatic veins, without exposure of theentire testis, and the eventual accessory veins collaterals. To the termof the procedure we submitted to the patients VAS (Visual AnalogicalScore) questionnaire for the quantitative determination of the intra-operative pain.Results: All operations were performed on an outpatient basis (post-operative stay: 4–7 hours) and the operating time was 43.2 minutesmean. Follow-up was performed by physical examination, dopplerultrasound and semen analysis. Immediate and long-term complica-tions were: 4 (5.6 %) mild pain, 2 (2.8%) wound infections, 2 (2.8%)transient hydroceles (no one permanent hydroceles), 1 (1.4%) long-term recurrence, 0 testicular atrophy. VAS showed a rate of 3.175(range 2–6).Conclusion: Microsurgical treatment of varicocele in Day Surgery bysubinguinal approach is a safe and reliable procedure.Policy of full disclosure: None

PP-10-282

Cancer and sexual problems: Awareness and skillsamong health professionals of general hospital:Preliminary resultsBondil, P.1; Habold, d.1


Objective: In case of cancer, preservation of sexual life is an impor-tant parameter for the quality of life. A specific consultation of onco-sexology has been created in our hospital because this demandpotentially concerns one out five adults (patient / partner). But, if bothdemand and expectations of patients are relatively well known, the atti-tudes of health professionals still remain imprecise. Objective: Analyzeand evaluate: a) their awareness concerning these dimensions, b) theirskills for listening and treating this problem of quality of lifeMethods: We used the specific FSP questionnaire (frequency, seri-ousness and problem quoted 0, 1 or 2) for identifying the needs of bothinformation and training. The survey (n = 112) has been done amongvarious health professionals (physicians, nurse, psychologists . . .).Results: a) frequency: the sexual complaint in oncology appears asusual (mean: 1.4) particularly among the no physicians. But, almost allhealth professionals hesitate to have a proactive attitude (mean: 0.5).They are more reactive in case of patient demand (mean: 1.2), b) seri-ousness: to be listening to the sexual complaint appears like veryimportant (mean: 1.9) for all, c) problems: to know where and how toorientate appears as very important (mean: 1.8) because both techni-cal and theoretical knowledges (know-how, know-be) are considered


J Sex Med 2008;5(suppl 2):94–145

as insufficient among the physicians (mean: 0.5) and nearly absentamong the other health professionals (mean: 0.1). However, the rela-tional skills bother fairly the most experiment physicians in oncology(mean: 1.2) and the no physicians (mean: 1).Conclusion: The large majority of health professionals of our hospi-tal approve the opening of this specific oncosexology centre becausethey agree with the importance of this particular field for quality oflife. The rarity of the double skill (oncology and sexology) logicallyexplains the strong demand for a better: a) information for all, b) train-ing for the most concerned and motivated, c) readability of this par-ticular health care offer.Policy of full disclosure: None

PP-10-283

Intrafascial nerve sparing technique improves the rateof erectile function recovery after retropubic radicalprostatectomy, compared to standard techniqueBriganti, A.1; Gallina, A.1; Salonia, A.1; Deho, F.1; Zanni, G.1; Pellucchi,f.1; Camerota, T.1; Petralia, G.1; Sacca, A.1; Rigatti, P.1; Montorsi, F.1

1Vita Salute University, Urology, Milan, Italy

Objective: To test the role of pre-operative erectile function (EF) onthe recovery of urinary continence (UC) after bilateral nerve sparingradical retropubic prostatectomy (BNSRRP).Methods: From January 2004 to December 2006, 257 fully potentpatients treated with BNSRRP for clinically localized prostate cancerwere prospectively included in the study. Complete pre-op data,including age, International Index of Erectile Function (IIEF) Charl-son comorbidity index (CCI), body mass index (BMI) and smokingstatus were available for 142 patients. All patients were assessed every3 months by the attending urologist and all information regarding UCwere recorded using the International Consultation on Incontinencequestionnaire (ICI-Q). The UC recovery was defined as ICI-Q≤6.Univariable (UVA) and multivariable (MVA)Cox regression modelsseparately analyzed the time to UC recovery after BNSRRP. Predic-tors consisted of age, BMI, CCI, smoking status and pre-op IIEF-EF(dichotomized as no / mild-to-moderate ED vs. moderate / severeED).Results: Mean (median) age was 60.1 (60.0) yrs. The pre-op IIEF-EFwas 1–10 in 22.1%, 11–16 in 6.8%, 17–21 in 2.6%, 22–25 in 17.4 %and ≥26 in 51.1%. Mean (median) post-op follow-up was 12.2 (11.0)months. In Kaplan Maier analyses, pre-op IIEF-EF was a significantpredictor of UC (log rank p = 0.02). In MVA, pre-op IIEF was an inde-pendent predictor of UC recovery (p = 0.028; OR 1.66), after adjust-ing for age, BMI, CCI and smoking status.Conclusion: In our cohort of patients treated with BNSRRP, pre-op IIEF was an independent predictor of the time to continencerecovery.Policy of full disclosure: None

PP-10-284

Obesity and comorbidities do not affect erectilefunction recovery after bilateral nerve sparing radical prostatectomyBriganti, A.1; Gallina, A.1; Salonia, A.1; Deho, F.1; Zanni, G.1; Capitanio,U.1; Bianchi, M.1; Maccagnano, C.1; Sacca, A.1; Rigatti, P.1; Montorsi, F.1

1Vita Salute University, Urology, Milan, Italy

Objective: To test the role of body mass index (BMI) and comorbidi-ties on the recovery of erectile function (EF) after bilateral nervesparing radical retropubic prostatectomy (BNSRRP).Methods: From January 2004 to December 2006, 257 fully potentpatients treated with BNSRRP for clinically localized prostate cancerwere prospectively included in the study. Complete pre-op data,including age, International Index of Erectile Function (IIEF), BMI,Charlson Comorbidity Index (CCI) and smoking status were availablefor 142 patients. All patients were assessed every 3 months by theattending urologist and all information regarding EF and urinary con-

tinence (UC) were recorded. Post-op EF was evaluated using the erec-tile domain of IIEF (IIEF-EF). The EF recovery was defined as IIEF-EF≥17, while UC recovery was defined as ICI-Q≤6. Univariable(UVA) and multivariable (MVA)Cox regression models analyzed thetime to EF recovery after BNSRRP. Predictors consisted of age, pre-op IIEF-EF, BMI, CCI and smoking status.Results: Mean (median) age was 60.3 (60.0) yrs. The pre-op IIEF-EFwas 1–10 in 23.2%, 11–16 in 6.3%, 17–21 in 2.1%, 22–25 in 18.3%and ≥26 in 50.1%. Mean (median) post-op follow-up was 12.3 (11.0)months. In UVA, age (p = 0.01) and pre-op IIEF (p < 0.001) were sig-nificant predictor of EF recovery. In MVA age (p = 0.046) and pre-opIIEF-EF (0.001) achieved independent predictor status. Both in UVAand MVA, BMI, CCI and smoking status did not achieve statistical sig-nificance (all p≥0.6)Conclusion: In cohort of patients treated with BNSRRP, BMI andCCI are not affecting post-op EF recovery. Conversely, pre-op EF andage at surgery are independent predictor of post-op EF recovery.

Univariable Multivariable O.R. O.R. Predictors p value p value

Age 0.95 0.01 0.96 0.046IIEF-EF 2.26 <0.001 2.199 0.001BMI — 0.6 — 0.925–30 vs. < 25 kg/m2 1.27 0.3 1.08 0.8>30 vs. < 25 kg/m2 1.05 0.9 0.95 0.9 CCI — 0.8 — 0.8 1 vs. 0 0.84 0.5 0.82 0.52 vs. 0 0.8 0.7 0.88 0.8smoking 1.06 0.8 1.16 0.7

Policy of full disclosure: None

PP-10-285

Physical impairment and gender—a desmasculinizingeffectCardoso, J.11Hospital Julio de Matos, Clinic of Sexology, Lisbon, Portugal

Objective: This work aims to briefly reflect upon the way men withacquired physical disability face a social reality marked by the body’sobjectification and by androcentrism, both of which originate exclu-sion mechanisms that cover numerous fields.Results: In today’s Western society, the social representation of thebody is permeated by the myth of bodily perfection. The evolution ofcorporality has emancipated to a point where the body becomes thecore of personal identity, modifying individuals’ relation with them-selves and with others. The social valorization of the body externalizesit, as a kind of “public property”, potentiating a series of beliefs whichhave impact on the most inner self, in the sense that external appear-ance equates with the individual’s essence. Disability raises a dimen-sion of alterity, both in terms of bodily integrity and bodily expression,which defies the control of several socially produced attributes. If weconjugate disability with masculinity, countless socially imposed con-tradictions emerge. The construction of masculinity, through adichotomic process which implies opposition to or even rejection offemininity, is inextricably associated with invulnerability, physicalstrength, emotional control, manhood and sexual performance, amongothers. Due to its consequences, namely regarding body image and theability to play roles connotated with masculinity, disability maythreaten one’s gender identity, thus requiring a less gender-polarizedreformulation.Policy of full disclosure: None

PP-10-286

Management of ischemic penile gangrene: the role of prompt partial penectomy and other treatment optionsChiang, I.1; Chang, S.1; Hsieh, J.1

1Taiwan University Hospital, Urology, Taipei, Taiwan


J Sex Med 2008;5(suppl 2):94–145

Objective: Penile gangrene is a rare disease. It can be a troublesomeproblem. But the treatment was equivocal. We described our experi-ence in treating 5 patients with ischemic penile gangrene, discussedtheir underlying disease, management, and reviewed the literatures.Methods: Between 1996 to 2006, we have treated 5 patients withpenile gangrene. The medical records were reviewed retrospectivelyfor patients’ age, initial presentation, co morbidity, renal status, othervascular disease, coagulation profile, treatment course, and outcome.Results: All of the 5 patients finally received partial penectomy. Onepatient received partial penectomy immediately. Four of the 5 patientsreceived delayed partial penectomy because of progressive distal penilegangrene change.Conclusion: Penile dry gangrene change was an irreversible process.Early partial penectomy and correcting underlying disease would avoidwound liquefaction, preserve more penile length and improve lifequality.Policy of full disclosure: None

problems are answered in a correct way by the majority of generalpractitioners. Also the treatment options for the different sexual dys-functions are very well known.Conclusion: This study shows that Belgian general practitioners arealready very familiar with sexual problems nowadays.Policy of full disclosure: This study was supported by a grant ofBayer HealthCare, Brussels, Belgium.

PP-10-288

Myths and sexuality in late pregnancyConde, P.1; Queiros, A.2; Ambrosio, P.2

1Maternidade Alfredo da Costa, Lisbon, Portugal; 2Maternidade Alfredo daCosta, Maternal and Fetal Medicine, Lisbon, Portugal

Objective: Throughout ages and cultures, sexual life during preg-nancy has been ruled by beliefs and myths. Sexual activity is harmlessto most pregnancies, tightening marital bond and mutual relationship.However, many of these myths have survived until our century,restraining couple’s sexuality.Objective: To investigate sexual beliefs and myths in the thirdtrimester of pregnancy.Methods: Cross-sectional study in a tertiary care obstetric hospital.One hundred pregnant women, who were not restricted in their sexualactivities by their physicians. Women anonymously completed self-administered questionnaires regarding sexual activity and beliefsduring pregnancy. Responses were summarised using descriptive sta-tistics, and comparisons were made between social-economic groupsand reproductive variables.Results: Culture, inadequate knowledge, and excessive anxiety arelikely the important factors for the marked reduction in sexuality.Conclusion: Health staff should take a proactive role in providingmore information about sexual issues during pregnancy.Policy of full disclosure: None

PP-10-289

The effect of PDE5 inhibitors on penile rigidityparameters in the period without sexual stimulationEkmekcioglu, O.1; Halis, F.1; Demirtas, A.1; Karacagil, M.1; Gokce, A.1

1Erciyes University, Urology, Kayseri, Turkey

Objective: To evaluate the effects of PDE5 inhibitors in males, wihouterectile dysfunction but with premature ejaculation, on penile rigidityin the period without sexual stimulation.Methods: Eighty males, 20 in each group, received placebo, vardenafil(10 mg), sildenafil (50 mg) or tadalafil (20 mg) in a double blind studydesign. All males were immediately monitorized with Rigiscan ®device for one and half an hour. In this period there was no sexual stim-ulation. Times to first measured and total durations of base and tiprigidities and also, total and per minute rigidity qualities were evalu-ated. Statistical evaluations were made with one way ANOVA test.Results: The findings were shown in table 1. Base and/or tip rigidi-ties were recorded in 40% (8/20), 70,6% (12/17), 47,4% (9/19) and70% (14/20) of the subjects who took placebo, sildenafil, tadalafil andvardenafil, respectively (p = 0,126). The ratio of males who couldobtain at least 60% base and/or tip rigidities were 10% (2/20), 41,2%(7/17), 26,3% (5/19) and 55% (11/20) in plecebo, sildenafil, tadalafiland vardenafil groups, respectiverly (p < 0,05).Policy of full disclosure: None

PP-10-287

The state of knowledge and the approach of sexualdysfunctions by general practitioners in BelgiumClaes, H.1; Roumegere, T.2; Schulman, C.2; Hendrik, Van Poppel, H.1

1UZ Gasthuisberg, Urology, Leuven, Belgium; 2UC Erasme, Urology, Brus-sels, Belgium

Objective: To evaluate the attitude and the familiarity of the generalpractitioners in Belgium concerning sexual problems.Methods: This study was a prospective, observational, multicentric,non-interventional study in Belgium. General practitioners were askedto complete a questionnaire in order to collect data on patient char-acteristics concerning sexual dysfunctions and the discussion of thiskind of problems with the patient.Results: 416 general practitioners filled in the questionnaire. A largemajority of them is also the general practitioner of the partner (77%)and we observe rather seldom new patients who consult for sexual dys-functions (15,5%). Most patients consult for sexual problems in astable relationship (75%). Nevertheless, in case of erectile dysfunction,up to 45% do so in a new relationship. The discussion on sexual dys-functions is only initiated by the general practitioner in a minority ofcases: (erection: 30%; ejaculation: 20%; libido: 26%; orgasm: 20%).However, when risk factors are present, a majority of general practi-tioners (74%) will strike up a conversation, especially about erectiledysfunction. For erectile dysfunctions patients are only referred to aspecialist after failure of a first treatment (61%) and in case of rela-tionship problems (19%). For relationship problems the patient willbe referred to a psychiatrist (6%) or more frequently to a sexologist(13%). Also for ejaculation (28%) and certainly for libido problems(74%), they refer to a psychiatrist or sexologist. In all other case, thelarge majority will be send to the urologist (93%). Questions about thepossible causes of erectile dysfunction, ejaculation, libido and orgasm


J Sex Med 2008;5(suppl 2):94–145

PP-10-290

Lower urinary tract symptoms affect continence butnot erectile function recovery after bilateral nervesparing radical prostatectomyBriganti, A.1; Gallina, A.2; Salonia, A.1; Deho, F.1; Zanni, G.1; Sozzi, F.1;Camerota, T.1; Strada, E.1; Suardi, N.1; Rigatti, P.1; Montorsi, F.1

1Vita Salute University, Urology, Milan, Italy; 2Reparto di Urologia,Ospedale San Raffaele, Milano, Italy

Objective: To test the role of pre-operative lower urinary tract symp-toms (LUTS) on the recovery of erectile function (EF) and urinarycontinence (UC) after bilateral nerve sparing radical retropubic prosta-tectomy (BNSRRP).Methods: From January 2004 to December 2006, 257 fully potentpatients treated with BNSRRP for clinically localized prostate cancerwere prospectively included in the study. Complete pre-op data,including age, International Index of Erectile Function (IIEF) andInternational Prostate Symptom Score (IPSS) were available for 194patients. All patients were assessed every 3 months by the attendingurologist and all information regarding EF and UC were recorded.Post-op EF was evaluated using the erectile domain of IIEF (IIEF-EF). The EF recovery was defined as IIEF-EF≥17, while UC recov-ery was defined as ICI-Q ≤ 6. Univariable (UVA) and multivariable(MVA)Cox regression models separately analyzed the time to EF andUC recovery after BNSRRP. Predictors consisted of age, pre-op IIEF-EF and pre-op IPSS (dichotomized as no symptoms / mild symptomsvs. moderate / severe symptoms).Results: Mean (median) age was 60.1 (60.0) yrs. The pre-op IIEF-EFwas 1–10 in 22.1%, 11–16 in 6.8%, 17–21 in 2.6%, 22–25 in 17.4 %and ≥26 in 51.1%. Mean (median) post-op follow-up was 12.2 (11.0)months. In Kaplan Maier analyses, pre-op IPSS was a significant pre-dictor of UC (log rank p = 0.03) but not of EF recovery (log rank p =0.6). In MVA, pre-op IPSS was an independent predictor of UC recov-ery (p = 0.048; OR 0.72), after adjusting for age and pre-op IIEF. Con-versely, in MVA predicting EF recovery pre-op IPSS did not achievestatistical significance (p = 0.7).Conclusion: In our cohort of patients treated with BNSRRP, pre-opLUTS are an independent predictor of the time to continence recov-ery. Conversely, pre-op LUTS do not affect erectile function aftersurgery.Policy of full disclosure: None

PP-10-291

Phase II prospective study to test the “efficacy” andtolerability of a penile extender device in thetreatment of “short penis”Gontero, P.1; di Marco, M.2; Giubilei, G.3; Pappagallo, G.4; Tizzani, A.5;Mondaini, N.6

1Novara, Italy; 2Casa di Cura Silicato, Urology, Roma, Italy; 3Clinica Uro-logica, Urology, Firenze, Italy; 4Ospedale Noale, Oncology, Italy; 5Universityof Torino, Urology, Italy; 6Ospedale Ponte Anniccheri, Urology, Firenze, Italy

Objective: Penile extender devices have been on the market for awhile but little scientific evidence supports their potential clinicalutility in the treatment of patients complaining of inadequate penilesize. In the current study we assessed a marketed brand of penile exten-der, the Andro-Penis ® device, in a phase II single arm study that waspowered to detect significant changes in penile size.Methods: Fifteen patients were required to test the efficacy of thedevice assuming an effect size of >0.8. Eligible patients were coun-selled on the use of the penile extender for at least 4 hours per day for6 months. Penile measurements were carried out at baseline, at 1, 3,6 and 12 months (end of study). The EF domain of the IIEF wasadministered at baseline and at end of study. Treatment satisfactionwas assessed at end of study using an institutional 5 item questionnaire.Results: At 6 months the mean gain in length was significant, meetingthe goals of the effect size: 2.3 cm and 1.7 cm for the flaccid and thestretched penis respectively. No significant changes in penile girthwere detected. IIEF EF domain improved significantly at the end of

study. Treatment satisfaction scores were consistent with acceptable togood improvement in all items except for the penile girth where thescore was comprised between no changes and mild improvements.Conclusion: Penile extender should be regarded as a minimally inva-sive and effective treatment options to elongate the shaft in patientsseeking treatment for short penis.Policy of full disclosure: None


J Sex Med 2008;5(suppl 2):94–145

PP-11 General issues

PP-11-292

Comparison of KTP laser photoselective prostatevaporization vs. TUR-P on erectile functionAkkus, E.1; Hattat, H.1; Erol, A.2

1Cerrahpasa School of Medicine, Urology-Andrology, Istanbul, Turkey;2Duzce School of Medicine, Urology, Turkey

Objective: To compare the impact of KTP 532 photoselective vapor-ization PVP (Greenlight) and TUR-P with regards to erectile func-tion.Methods: 112 PVP and 81 TUR-P cases were evaluated pre and post-operative 3–6 months. IPSS and IIEF 5 item scores and erectiongrades (0–2) were recorded in each group. Patients with diabetes mellitus,severe hypertension,chronic prostatitis and history of pre-operative ED were excluded. Statistycal anakysis pf paired andunpaires t and chi-square tests were used. KTP 532 with 80 watts wasgenerated by Greenlight device (Lasescope,CA).Results: Both operations revealed significant improvement in IPSSand IIEF scores. There were no significant statistical differencesbetween both groups with regards to IPSS and IIEF scores. Thenumber of patients with good erections increased in both groups againwithout any significant statistical difference. The percentage of retro-grade ejaculation cases were less in PVP cases however without anystatistical difference(56 % vs 64 %).Conclusion: PVP is an alternative to TUR-P in the surgical treatmentof BPH. Post-operative morbidity rates are almost similar in both procedures.Policy of full disclosure: None

PP-11-293

From Dick to John Thomas: Cross-culturalnomenclature for the penisEdwards, D.1

1White House Surgery, Oxfordshire, United Kingdom

Objective: Working with patients of many ages, classes and culturesin the UK I was aware of many names for the penis, more so thanother anatomical parts. Cross-cultural variation was explored.Methods: Standard medical methodology techniques were used; focusgroups, one-to-one semi-structured and unstructured interviews usingkey informants. Respondents were asked whether local penile termshad additional meanings that could translate into English. Etymolog-ical research was undertaken to determine the origins of Englishnames.Results: There were hundreds of examples, majority can be groupedtogether; many old e.g. prick (16thC English). Maternal expressionsbased on small wriggly creatures: L’asticot maggot (French), winkle(20thC English), meeya mouse (Sinhalese) mentioned by femaleinformants, conveniently forgotten by men. Friendly and personalqualities: Chotta bhai (Hindi/Gujrati), malli (Sinhalese) both meanlittle brother. John Thomas (D. H. Lawrence’s Lady Chatterley’slover). Popol (French) Paul Old friend. Onkel Fröhlich (German)Uncle Happy.) Strength and power: tool, ramrod (English), Le BiteShip’s bollard (French),Scabbard (St. Helena). Birdlike: Latin/Italianuse bird and sparrow, cock (English), hamama pigeon (Egypt) petitoiseau little bird (French).Conclusion:• Some languages have a large number of penile names, whilst others

only a few especially those where sexual discussions were culturallytaboo.

• Penile terms group into several distinct but similar categories cross-culturally, across a wide language spectrum.

• Some can be traced back many centuries others are recent.• The penis is something ‘very close’ to its owner but somewhat

detached.• Many names reflect the penis’s power and machine like qualities.• Important consultation considerations:

1. Reflect language used by the patient.2. Explore colloquial nomenclature utilised by patients of differing

ethnic origin.3. It is difficult for a patient to admit to a doctor that his ‘tool’ is

malfunctioning when he is trying to be ‘warriorlike’.Policy of full disclosure: None

PP-11-294

Patient preference of provider’s gender in obstetricsand gynaecology in United KingdomMallappa Saroja, C. S.1; Makam, A.2; Edwards, G.11Royal Gwent Hospital, Obstetrics and Gynaecology, Newport, UnitedKingdom; 2Royal Gwent Hospital, Newport, United Kingdom

Objective: To determine patient’s preference of care provider’s genderin obstetrics and gynaecology and factors determining them.Methods: Patients attending antenatal and gynaecology clinic wereasked to complete a simple quesionnaire regarding their preference formale or female doctor or whether they had no preference. Other dataincluding demographics and the reasons for their preference were alsocollected.Results: 51.7 % of the patients did not have any preference. 44.6%patients preferred female gynaecologists. 3.7% of the patients pre-ferred male gynaecologists. Patient who preferred female doctors sitetheir reason for their prefernce as that the female doctors underetoodtheir problem better, personal modesty and religious beliefs.Conclusion: Majority of patients expressed no preference for thegender of the care provider in obstetrics and gynaecology. Patients whopreferred female doctors mainly did so because of personal modesty,religious beliefs or because they felt that female gynaecologsits under-stood their problem well.Policy of full disclosure: None

PP-11-295

Teenagers about themselves: A study on informationabout sexuality in teenagersZbranca, E.1; Mogos, V.2; Moldovan, C.1; Gotca, I.3

1Universitate de Medicina Gr.T., Endocrinologie, Lasi, Romania; 2Univer-sitatea de Medicina Gr.T, Lasi, Romania; 3Mental Health Center, Dr. Ghel,Psyhology, Lasi, Romania

Objective: A study was performed, on the basis of multiple-choicequestionnaires applied to a lot of 96 pupils in forms 9 to 11 at a high-school in the city of Suceava.Methods: The questionnaires of 96 de respondents were analysed—42 de teenage boys (13 from the rural environment, 29 from the urbanenvironment) and 54 de teenage girls (19 from the rural environmentand 35 from the urban environment).). The objectives of the questionswere: clarifying the relationships between the teenager and the socialand family environment, affiliation to the reference group, knowledgeand attitudes concerning the various aspects of sex life: the affectivecomponent, the start of sexual activity, notions about contraceptionand STD-s, the teenagers’ attitude concerning the introduction of sexeducation in school.Results: ost of the teenagers have an optimistic projection on thesociety’s permissive mentality concerning them and they enjoy afavourable family climate. Affiliation to the peer group, as a referencegroup, is based on fundamentally positive criteria and moral values andless based on professional interests. Love is perceived in an idealmanner, especially by teenage girls. The optimal age for becoming sex-ually active is declared as being 16–18 by most of the boys and as being19–21 by most of the girls. The notions about contraception have ageneral character, and their practical application is more frequent withthe boys than with the girls.Conclusion: MThe notions about sexually transmitted diseases, riskand prevention, are slightly better in the boys than in the girls. Themain sources of information the teenagers have about their own sex-uality are the media, more than the family and the educators. Althoughmost of the teenagers agree with the need to have sex education in


J Sex Med 2008;5(suppl 2):94–145

school, they could not offer solutions on the practical ways of deliver-ing this education.Policy of full disclosure: None

PP-11-296

Anxiety performance in male sexual life: ContributingfactorsNakopoulou, E.1; Salpiggidis, G.2; Kapoteli, P.2; Ferenidou, F.2; Papaharitou, S.21Greece; 2Aristotle University, Center Sex. and Reprod. Health, Thessaloniki,Greece

Objective: Anxiety performance (AP) contributes significantly to thedevelopment and/or maintenance of sexual dysfunction (SD). Thepresent study aimed to investigate factors associated with AP asreported by men calling to a help-line for their sexual problems.Methods: The study included all telephone calls between 9/2004 and4/2007 made to the help-line of the Greek Centre for Sexual andReproductive Health by men. During the call, the counsellor com-pletes a caller-sheet addressing a series of questions. For the purposesof the present study the following information was used: demograph-ics, type of SD, previous doctor consultation, anxiety performance,general and occupational stress. Independent samples t-test and logis-tic regression analysis were conducted in order to detect age differ-ences and associations between categorical variables.Results: A total of 2,928 men called for their own sexual concerns.Analysis was based on 285 calls (mean age = 47.97, SD = 14.96) thathad complete data on all three sources of stress. The majority of menreported having AP (82.1%) with more than half expressing generaland occupational stress (63.9% and 50.5% respectively). Men experi-encing AP were significantly younger compared to those who did notfeel anxious (45.69 vs 58.43, p < 0.01). No such difference was obtainedfor SD duration (p > 0.05). Men having general and occupational stresswere significantly more likely to report AP (OR 3.53, p < 0.01 and OR2.73, p < 0.05 respectively) whereas lowest odds ratio was obtained inmarried men (OR 0.20, p < 0.01). No significant association was foundbetween AP, type of SD, occupation and help-seeking behaviour (p >0.05).Conclusion: Physicians treating men with SD should bear in mindthat marital status, age, and especially occupational and general stressmight influence sexual anxiety performance. In such cases doctorscould strive after optimal treatment outcomes through the collabora-tion with mental health professionals.Policy of full disclosure: None

PP-11-297

The effect of alpha blocker therapy in patients withlower urinary tract symptoms who have erectiledysfunction or notOzdemir, I.1; Bozkurt, O.1; Demir, O.1; Aslan, G.1; Esen, A.11Dokuz Eylul University, Urology, Izmir, Turkey

Objective: In this study we evaluated the response of patients withLUTS to alpha blocker therapy who have erectile dysfunction or not.Methods: A total of 64 patients who applied to our clinic with LUTS(IPSS score >7, maximum flow rate <15 ml/sec, post-voiding residualurine volume <200 ml and PSA < 4 ng/dl). The patients erectile func-tions were asked and IIEF scoring was performed before the initiationof the treatment. All patients were prescribed doxazosin 4 mg once aday and invited for the evaluation of the treatment 6 weeks later. IPSSwas used for the evaluation of LUTS and IIEF for sexual functions.The patients were divided into two groups according to their selfreported erectile status; group-I who had erectile dysfunction andgroup-II who did not have erectile dysfunction.Results: The mean age was 64 ± 7.6 years for group-I and 56 ± 7.7years for group-II, respectively. The mean decrease in IPSS score afterthe treatment period was 6.9 ± 6.4 in group-I (p < 0.001) and 8.2 ± 5.8in group-II (p < 0.001). The average decrease for the QoL scores ofpatients in group-I was 0.95 ± 1.8 (p < 0.05) whereas this value was 1.9

± 1.1 for group-II (p < 0.001). Qmax values in the uroflowmetric exam-ination demonstrated an average rise of 2.3 ± 3.3 ml/sec in group-I (p< 0.05) and 3.7 ± 5.3 ml/sec in group-II (p < 0.001). The mean IIEF-EF (Erectile function domain) scores determined before the treatmentperiod was 9.6 ± 7.7 in group I and 22.3 ± 7.3 in group-II. The increaseof IIEF-EF scores after the treatment period was statistically signifi-cant in group-I.Conclusion: The effect of alpha blocker therapy for BPH with LUTSwas better by means of symptomatic relief for patients who did nothave ED complaint when compared with patients who have ED.However, significant improvement in erectile functions was observedwith alpha blocker therapy for ED accompanying LUTS.Policy of full disclosure: None

PP-11-298

The efficacy of tadalafil once daily for chronicprostatitis/chronic pelvic pain syndrome in young andmiddle aged patientsPark, H.1; Park, N.1; Chon, W.1; Lee, C.1; Yoon, C.1

1Pusan National Univ. Hospital, Urology, Busan, Republic of Korea

Objective: It has been speculated that PDE5 inhibitors may have aneffect on chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).The aim of this study was to investigate the efficacy of tadalafil oncedaily in young and middle aged patients with CP/CPPS.Methods: Seventy-eight men with CP/CPPS were randomized, in asingle-blind fashion, to receive either levofloxacin (500mg/d)(group 1;40 patients) or levofloxacin (500mg/d) and tadalafil (10mg/d)(group 2;38 patients) for 4 weeks. The International Prostate Symptom Score(IPSS), NIH chronic prostatitis symptom index (NIH-CPSI) andInternational Index of Erectile Function-5(IIEF-5) were used to gradethe symptoms and the quality of life (QoL) at the baseline and 4 weeksinto the study.Results: The mean ages of the two groups were 41.2 ± 6.7 and 43.3± 7.1 years, respectively. There was no significant difference betweengroup 1 and 2 with regard to age, duration and scores of IPSS, NIH-CPSI and IIEF-5 at the baseline. Tadalafil significantly improved themean change from baseline in the IPSS at 4 weeks (group 1; −1.0 vs.group 2; −2.6, p < 0.05). Significant improvements were also seen inthe IPSS obstructive domains (group 1; −0.6 vs. group 2; −2.4, p <0.05). Larger changes from the baseline in the NIH-CPSI at 4 weekswere observed in group 2 (group 1; −1.2 vs. group 2; −2.7, p < 0.05).Significant improvements were also seen in the NIH-CPSI urinarydomains (group 1; −0.46 vs. group 2; −0.8, p < 0.05) and the QoLdomains (group 1; −0.4 vs. group 2; −1.4, p < 0.05). Group 2 showeda significantly greater increase in the IIEF-5 total score (group 1; +0.2vs. group 2; +3.7, p < 0.05). Commonly reported (1 case or greater)treatment adverse events in group 2 were frequent erections, dyspep-sia, back pain, and headache (for each, 2 cases or less); however, nopatient discontinued the treatment due to adverse events.Conclusion: Tadalafil once daily was well tolerated and showed sig-nificant symptomatic improvement in young and middle aged patientswith CP/CPPS.Policy of full disclosure: None

PP-11-299

Portuguese validation of female sexual function indexPechorro, P.1; Diniz, A.2; Almeida, S.3; Vieira, R.3

1Faculty of Medicine of Lisbon, Portugal; 2ISPA, Sexology, Lisboa, Portugal;3Faculty of Medicine of Lisbon, Sexology, Lisboa, Portugal

Objective: The aim of the present investigation was to translate andvalidate the Female Sexual Function Index (FSFI et al., 2000) to thePortuguese population using a sample of Portuguese women.Methods: FSFI is a 19-item scale and has been developed as a brief,multidimensional self-rate instrument to asses key domains of femalesexual function namely: desire (2 items), arousal (4 items), lubrication(4 items), orgasm (3 items), sexual satisfaction (3 items), and pain (3items). For individual domaine scores, one must add the scores of the


J Sex Med 2008;5(suppl 2):94–145

individual item that comprise the domain and multiply the sum by thepredetermined factor (domain score will vary between 2 and 36). Thetotal sample of 187 participants were divided into three groups: 152women of the general population (community sample; mean age 41,DP = 12) and 37 women (clinical sample; mean age 58, DP = 5) of theSexology Clinical Department- Hospital Santa Maria. SPSS 14 wasused for statistics procedures.Results: FSFI have shown good psychometric properties at level ofconfirmatory factorial analysis, convergent validity, known-groupsvalidity, concurrent validity, internal consistency (Cronbach alpha),and homogeneity test.Conclusion: Portuguese health clinicians and researchers have now areliable psychometric instrument to evaluate key dimensions of femalesexual function.Policy of full disclosure: None

PP-11-300

Sexual satisfaction: Relation with sexual satisfactionand with sexual behavioursPechorro, P.1; Vieira, R.2; Diniz, A.31Faculty of Medicine of Lisbon, Portugal; 2Faculty of Medicine of Lisbon, Sex-ology, Lisboa, Portugal; 3ISPA, Sexology, Lisboa, Portugal

Objective: The aim of this study was to evaluate the relationship b/wsexual satisfaction and sexual function and also b/w sexual satisfactionand sexual behaviour in women.Methods: The measures used were:Index of Sexual Satisfaction (ISS;Hudson, Harrison & Crosscup, 1981) and Female Sexual FunctionIndex (FSFI; Rosen et al., 2000). Our sample was composed by 152women of the general population, mostly urban and white, (range26–70 years; M = 41 years), divided into three age groups: group 1, n= 66 (range 26–35 years; M = 29 years); group 2, n = 44 (range 40–49years; M = 43 years); group 3, n = 42 (range 54–70 years; M = 58 years).The statistical analysis was performed using SPSS for Windows,version 14. Statistical significance was predefined as p < .005.Results: No statistically significant association were found b/w sexualsatisfaction and the phases of sexual response cycle e. g. desire, arousal,orgasm. However, a statistically significant ralationship (p < .01) was found b/w sexual satisfaction and sexual behaviour: kissing andcaressing.Conclusion: The results of this small study is consistent with findingsof the literature and highlight the role that sexplay activities have infemale sexual satisfaction.Policy of full disclosure: None

PP-11-301

Pregnancy and phimosisPetrisor, G.1; Nita, G.2; Razvan, M.2; Bogdan, G.2

1Saint John Clinical Hospital, Bucharest, Romania; 2Saint John ClinicalHospital, Dept. of Urology, Bucharest, Romania

Objective: Phimosis may have a significant emotional and familialimpact, especially when it occurs in adult patients. This study aimedto evaluate a rare cause of presentation to urologists by these patients:inability to father children.Methods: Between January 1991 and June 2007, 259 patients weretreated in our department for phimosis. In 9 of these cases, the reasonfor presentation to urologist was infertility. The investigative protocolincluded assessment of patient’s history, clinical examination, usualblood tests and dermatological examination. Circumcision followed byhystopathological examination of the removed specimen was per-formed in all patients.Results: Mean patients’ age was 42 years (ranging from 22 to 50 yearsold). All 9 patients presented grade III or IV phimosis (Meuli scale).All patients were sexually active. Two patients had normal sexual activ-ity while 7 patients reported various degrees of pain and/or bleedingduring sexual intercourse. Diabetus mellitus was diagnosed in 3 cases,balanitis in 3 cases, prostatitis in 1 case, balanitis xerotica obliterans in1 case and squamous penile cancer located on the glans in 1 case. All

8 patients with benign pathology fathered children during the first yearafter circumcision.Conclusion: Infertility may be a rare cause for presentation to urolo-gist by adult males with phimosis. This fact underlines the potentialsocial impact of a condition considered as a simple pathology. Cir-cumcision associated with the treatment of associated pathologyproved to be sufficient in achieving fertility in these cases.Policy of full disclosure: None

PP-11-302

Penile fracture: Diagnosis, management and outcomeat two urological centersPinto, R.1; Oliveira, M.2; Oliveira, R.1; Ribeiro, J.2; Tomada, N.1; Vendeira,P.1; Santos, A.2; Cruz, F.11Hospital de Sao Joao, Urology, Porto, Portugal; 2Hospital de São Marcos,Urology, Braga, Portugal

Objective: Penile fracture (PF) is the most commonly described bluntinjury to the penis. Predominantly affecting young men, may pro-foundly influence health-related quality of life. Diagnosis is clinical,but cavernosography, cavernous doppler ultrasound or magnetic resso-nance imaging may be useful to confirm absence of penile fracture.The goal of the present study is to report our experience in the man-agement of this urological problem.Methods: We reviewed 39 patients treated for presumed PF fromJanuary, 1992 until August, 2007 (clinical data—pre and after treat-ment; outcome).Results: Thirty nine patients (15–57 years old, mean—24) wereadmitted 7,5 hours after presumed PF (mean time). Thirty four hadtypical clinical presentation and the main causes were: sexual inter-course (20, 51%), forced manipulation (9, 23%) and masturbation (5,13%). Twenty nine patients had grade II penile injuries (AmericanAssociation for the Surgery of Trauma) and 10 had grade I. Twentythree patients presented ultrasound confirmation of diagnosis and in12 the cavernosography was performed. Surgical exploration wascarried out by subcoronal incision, degloving and corporarraphy. Sixpatients had concomitant rupture of corpus cavernosum and spongio-sum and 3 patients had bilateral rupture. All patients resumed sexualactivity in 4–12 weeks after treatment. Thirty eight reported full stiff-ness painless erections, 7 of them a minor penile deviation and 5 aslight reduction of penis lenght.Conclusion: The clinical presentation of PF is usually diagnostic.Doppler ultrasound is a precious tool for differential diagnosis of othervascular lesions. In our series surgical management, first option oftreatment, had good functional and aesthetic results.Policy of full disclosure: None

PP-11-303

Difference in sexual history obtaining among doctorsReda, M.1

1Cairo, Egypt

Objective: Determine Ain Shams residents’ attitude regarding obtain-ing sexual history from their patients.Methods: A special questionnaire was designed in 3 parts, part I: cov-ering sexual dysfunction history obtaining in general and in detail, partII: reasons for not obtaining sexual history, part III: determine knowl-edge about effect of illness and medication on sexual function. 100questionnaire sheets were randomly distributed among residents ofAin Shams university in different departments.Results: Response rate 49%, Within the medicine group 24.5% werein the dermatology department, 16.3% in the general medicine depart-ment, 4.1% in cardiology, 8.1 % in neuropsychiatry; whereas withinthe surgery group 22.4% were in gynecology, 16.3% in generalsurgery, plastic, vascular and orthopedic surgery and 6.1% in uro-surgery department. 51% obtained detailed sexual history beinghighest in dermatology & endocrinology 100%, followed by urology& urosurgery 100% then gynecology & obstetrics 54.5%. Askingabout use of sexually enhancing drugs in urology & urosurgery 100%


J Sex Med 2008;5(suppl 2):94–145

dermatology & endocrinology 92.3% followed by gynecology &obstetrics 36.4%. Female sexual history (pubertal and contraceptive),showed highest level of acceptance by residents, gynecology & obstet-rics, followed by neuropychiatrists. Reasons for not obtaining sexualdysfunction history not included patient data sheet, finding this topicunimportant.Conclusion: Discrepancy in the attitude of Ain-Shams Universityhospital residence towards obtaining sexual dysfunction history reflectsthe need for a curriculum change to high light the importance of sexualhistory from patients and care should be pied toward managing reasonsfor not engaging in providing the patient with needed data concern-ing their sexual life.Policy of full disclosure: None

PP-11-304

Sexual functions after renal transplantation in malesSahin, A.1; Cihan, A.2; Akgul, K.3; Demir, O.2; Gurkan, A.4; Celik, A.5;Can, E.3; Esen, A.21Tepecik Training Hospital, Turkey; 2Dokuz Eylul University, Urology,Izmir, Turkey; 3Tepecik Training Hospital, Urology, Izmir, Turkey; 4TepecikTraining Hospital, Nephrology, Izmir, Turkey; 5Dokuz Eylul University,Nephrology, Izmir, Turkey

Objective: Patients with end-stage renal disease (ESRD) experiencedisturbances in erectile function related to organic factors including asuremia, hypertension, endocrine, and nonorganic factors like depres-sion. In this study, we aimed to evaluate the sexual functions after renaltransplantation in male patients with end stage renal diseases.Methods: Forty six male patients admitted for renal transplant inTepecik Teaching and Dokuz Eylül University Medicine School Hos-pitals included in the study. Data of demographic, clinic examination,renal transplantation and sexual functions collected with question-naire. All patient fill out the IIEF for evaluated the sexual functions.Also, sexual functions and quality of erection before and after trans-plantation compared with additional one each questions.Results: The mean age was 42.6 ± 1.2 years. The mean duration ofhemodialysis before transplantation was 16.7 ± 2.9 months and meanduration after transplantation was 58.1 ± 9.6 months. Live donor usedin 61% transplant. Self reported ED was 34.8% and premature ejac-ulation was 54.3%. Also 8.7% of patients reported decreased and17.4% increased libido. According to mean IIEF-EF domain score47.8% of patients had ED. The mean hemodialysis duration of patientwith and without ED was 13.7 ± 2.6 and 19.9 ± 5.5 months, respec-tively (p < 0.05). ED was diagnosed in 42.9% of live donor transplantpatients and in 55.6% of cadaver donor transplant patients. This wasnot statistically significant. There was no relation determined betweenED and data of physical examination and laboratory findings.Conclusion: Sexual functions were improved after renal transplanta-tion. A relation observed with duration of hemodialysis before trans-plantation and incidence of ED after transplantation. Earlytransplantation in CRF patients will be improving the ED occurring.Policy of full disclosure: None

PP-11-305

Repeated end-to-end urethroplastyScheplev, P.1; Gvasaliya, B.2; Garin, N.31Moscow, Russia; 2RMAPE, Moscow, Russia; 3RMAPE, Endourology,Moscow, Russia

Objective: End-to-end urethroplasty remains the optimal method oftreatment of proximal urethral strictures because of the best postop-erative outcomes. Recurrent strictures after primary end-to-end anas-tomosis often associated with performance of operation by not skilledsurgeons and in the unspecialized centers.Methods: Between 2004 and 2005, 19 patients were operated forrecurrent posttraumatic posterior urethral stricture. All patients 1–3years before have undergone end-to end urethroplasty for post-trau-matic complete urethral rupture. In our clinic, in all cases, the area offibrosis was excised, the corpus spongiosum was mobilized, and a

tension-free, spatulated end-to-end anastomosis was achieved by split-ting the corporeal bodies in 16(84%) cases, by an additional perineallyperformed inferior pubectomy in 3 (16%) cases and by supracrural ure-thral rerouting in 1(5%) case.Results: The mean follow-up was 29 months. The mean stricturelength was 2.9 cm (range, 2.4 to 3.7 cm). Urethrography performed 1month postoperatively demonstrated a widely patent anastomosis in allcases. Only one patient developed an anastomotic stricture 5 monthsafter surgery that was treated successfully by internal urethrotomy.Conclusion: Even in patients with failed previous urethroplasty, exci-sion and primary anastomosis provides good surgical results in post-traumatic posterior urethral strictures In most cases the splitting ofcorporeal bodies is quite sufficient for achievement of a tension-freeanastomosis.Policy of full disclosure: None

PP-11-306

History of andrology and sexual medicine in Russia:Role of professional societiesScheplev, P.1; Garin, N.2; Gvasaliya, B.2

1Moscow, Russia; 2RMAPE, Urology, Moscow, Russia

Objective: Andrology and sexual medicine in Russia have a reachhystory. Russian czar Peter the 1st paid much attention to the urologyand andrology: he suffered from postgonorrheal urethral strictures. Hedilated his own urethra and died from urosepsis. Fedor Sinicin(1835–1907) was a founder of andrological school in Russia. Hefounded the first Russian clinic for urogenital disorders in 1866. Healso founded the Moscow Surgical Society and was the chairman of it.He tried to make andrology an independent speciality. He was the firstin Russia to suggest to treat the prostate cancer with castration. Nick-olay Bogoraz (1874–1952). Russian pioneer of phalloplasty and penileimplant surgery He used the patient’s rib cartilage to reconstruct afunctional neophallus and to put an implant into the reconstructedpenile body (1936) as the final step to facilitate an erection. The aminproblems of andrology in Russia are: uncertainty of the legal status ofandrology, diagnostics and treatment of nonexistent urogenital infec-tions, using of excessive diagnostic and medical procedures. In this sit-uation there is a very important role of professional societies. Theactivity of Professional association of andrologists of Russia includes:the journal “Andrology and genital surgery” is a scientific journal pub-lished by PAAR. It was found in 2000. Working with its members indelivering the last information in different fields of andrology. Orga-nization of Congresses and Conferences. Publishing the journal andtexbooks. Collaboration with the Russian and International scientificsocieties. Developing the national guidelines and standarts in androl-ogy. Unification of the educational process in andrology in Russia andEurope. Public relations, government relations, working in separatingthe andrology as a specialty, scientific work.Policy of full disclosure: None

PP-11-307

Strangulation of the penis by a cone bearning as aresult of male sexual competitivenessSutory, M.1; Sramkova, T.2; Dolezel, J.2

1Brno, Czech Republic; 2Medical Faculty of Masaryk Un, TramatologicalHospital—Trau, Brno, Czech Republic

Objective: Putting a ring over the root of penis is usually motivatedby an attempt at achieving a better quality and longer-lasting erection.Disproportionate size of the ring to erectile response can be the causeof penile strangulation. Release of the strangulation is often difficult.Authors describe an unusual motive of the patient, unusual strangu-lating object, and an original method of removal.Methods: Case report: A fifty-four-year-old truck driver was doingrepairs in the garage with his colleagues. They started competing atwho can carry the heaviest weight on his penis, using a big conebearing for this purpose. Our patient was able to carry it, however,there was immediately a great escalation of erection followed by stran-


J Sex Med 2008;5(suppl 2):94–145

gulation. Method: The inner ring of the cone bearing is very resistantto destruction. That is why we used our experience with ring removalin injuries of upper extremities. We began by coiling a strong silonethread around a finger from the ring periferally to the distance of about1 cm from the ring. We passed the proximal end under the ring andgradually uncoiled the fibre. The ring then periferally slid along thecoils. This procedure was repeated until the ring came off completely.In our case we used analogical approach. Instead of silone thread, weused a thin tube made of silicone rubber.Results: Erectile function: Fourteen days after the incident the patientreported no erectile dysfunction (ED)—International Index of Erec-tile Function-5 (IIEF-5) = 25 One year later the patient reported ED—IIEF-5 = 16.Conclusion: Conclusions: Male competitiveness can at times be thecause of senseless strangulation of the penis. Experience with remov-ing rings can be used to remove a strangulating ring from the penis.Strangulation of the penis plays a role in the development of ED.Policy of full disclosure: None

PP-11-308

Superselective embolization therapy of dominant sidefor arterial priapism due to bilaterale cavernous artery lacerationTahmaz, M. L.1; Üstünsöz, B.2; Yildirim, I.1; Dayanc, M.1

1Gülhane Military Medical Acade, Urology, Ankara, Turkey; 2Gülhane Mil-itary Medical Acade, Radiology, Ankara, Turkey

Objective: Superselective arterial angiography and embolization forpost-traumatic priapism is an established procedure for the control ofpriapism refractory to conservative measures and medication. We eval-uated the longterm results of superselective embolization at dominantfistula of bilaterale arterio-cavernous fistulae in three patients.Methods: Between 1995 and 2005, three patients were treated due toarterial priapism. Following trauma, each patient had priapism anddoppler showed us bilaterale fistulae on each cavernosal artery. For thefirst patient, we did embolization with PVA for the right arteriocaver-nosal fistula with PVA in 1995. For the second patient, we didembolization with gelfoam at left arteriocavernous fistula in 1998. Atthe third patient, we did embolization with microcoil for the rightdominant fistula.Results: We obtained detumesance for each patient after the therapy.Spontaneous erections continued for 3 days for the first patient, 3weeks for second and 3 months for the third. We followed the otherfistula with doppler ultrasonography after embolization. All three fis-tulae were disappeared without any additional treatment in threemonths. All the patients had full erection now without any problem.IIEF-5 score is normal for each.Conclusion: We determined 13 patients in literature with bilateralepost traumatic arteriocavernous fistulae. We had three patients in tenyears and embolization of dominant fistula solved the problem. It is asafe procedure and gives excellent results for longterm without anyadditional therapy.Policy of full disclosure: None

PP-11-309

Genitourinary Reconstruction After Fornier’sGangreneTahmaz, M. L.1; Irkilata, C.1; Yildirim, I.1; Dayanc, M.1

1Gülhane Military Medical Acade, Urology, Ankara, Turkey

Objective: We evaluated the results of our complicated cases follow-ing Fornier’s gangrene with different methods for genitourinary recon-struction.Methods: For the first case, we used unproceed honey withoutdebridement. After three months, we performed secondary suturingwith newly epitelized skin on the penis (Figures I, II). For the secondcase, we used split thickness graft and hyperbaric oxygen therapy forall penile skin reconstruction (Figures III, IV). For the third patient,after extened debridemant, we performed malleable prostheses for one

cavernous body (the other one was injuried due to gangrene), fullthickness skin graft for suprapubic and perineal region and appendi-covesicostomy (due to destroyed urethra) (Figure V).Results: All patients enjoy living now. They all have aestetic apperance.Conclusion: Different modalities like unproceed honey, hyperbaricoxygen and unilateral prostheses application could be performed forthe genitourinary rehabilitation of difficult cases.Policy of full disclosure: None

PP-11-310

Analysis of the counterfeit erectile dysfunction drug(Levitra) found in PolandTajanko, E.1; Wronka, M.2; Kozlowska-Boszko, B.21Bayer, Warsaw, Poland; 2Bayer, Medical Department, Warsaw, Poland

Objective: According to the recent debate (June 2007) in EuropeanParliament counterfeiting of medicines is becoming a growing concernof EU community. Especially erectile dysfunction (ED) drugs and“life-style” medicines are affected. The study reports the result ofanalysis of counterfeit Levitra cases in Poland. To our knowledge, nodata from Poland concerning counterfeit Levitra tablets compositionhave been published so far.Methods: Counterfeit Levitra tablets were identified by the police anddelivered to the Bayer Medical Department in Poland in 2006. Five of18 tablets were analyzed in Bayer Leverkusen laboratory using bothNear Infrared (NIR) and Raman spectroscopy. A comparative analysisbetween original and counterfeit Levitra tablets and blisters has beenperformed as well.Results: Sildenafil (the active ingredient of Viagra), not vardenafil (theactive ingredient of Levitra), was identified by NIR and Raman spec-troscopy in all analyzed counterfeit Levitra tablets. Although theappearance of tablets and blisters corresponded to the original product,there were no boxes and patient information leaflets attached.Conclusion: Erectile dysfunction drugs need to be used under strictmedical supervision. Usage of imitative copies of drugs is hazardousdue to unknown content of tablets. Physicians and pharmacists shouldbe aware of the growing problem of the ED drugs counterfeiting.Nowadays, physicians should proactively warn patients that medicinespurchased outside of the legal drug distribution chain pose significanthealth risks. Moreover all sources of information (including the Inter-net web pages e.g. http://www.bayerhealthcare.com/scripts/pages/en/company/products/beware_of_counterfeits/index.php) should be usedto increase awareness of the risk in patients. Any unusual reaction orside effect or if a drug appears, tastes or smells abnormal must bereported to the relevant company or authority.Policy of full disclosure: E. Tajanko, M. Wronka and B. Kozlowska-Boszko are employees of Bayer-Poland.

PP-11-311

Sexual medicine in symbolic motives of AnatoliankilimsTaskapu, H.1; Sanli, O.2; Akman, T.2; Kadioglu, A.2

1Karaman State Hospital, Istanbul, Turkey; 2University of Istanbul,Department of Urology, Turkey

http://www.bayerhealthcare.com/scripts/pages/en/


J Sex Med 2008;5(suppl 2):94–145

Objective: To investigate the relationship between symbolic motivesweaved on kilims (flatweaves) and sexual medicine.Methods: We made a comprehensive survey of the field, unravelingcomplex questions surrounding the origins and history of 5 symbolicmotives (hand on belly, ram’s horn, hair band, ear-rings and animalfetter or hobble) that are thought to be related with sexual medicine.Results: According to our survey, “hands on belly” is the symbol offemale sex. It does not only symbolize maternity and the fertility butalso good luck, blessing, fortune, happiness and joy. To our opinion,hands on breast figures of the mother Goddess which were sketchedfrom the Neolithic wall-paintings and clay figurines have beenchanged to “hands on belly” motive due to the cultural change in time.On the other hand, “Ram’s horn” motive, which is the symbol of fer-tility, bravery and masculunity, is such a motive used after the motherGoddess or together with her. “Hair band” was the indication of thedesire of getting married. It symbolizes the birth and fertility. Younggirls who desire to get married cut side-locks and braid their hair inone. The newly married young women braid their hair double. “Earrings” symbolizes sexuality. It is determined to have been worn to indi-cate the desire of a young girl to marry. “Aminal fetter or hobble” isthe name of chain tied to the two front ankles of the horses not lettingthem go away from the pastures. It symbolizes the continuation of thefamily, love and marriage.Conclusion: The interpretation of these symbols in terms of sexualmedicine are as follows: Hand on belly, female sexuality and second-ary sex characters; ram’s horn, phallus cult and erection; hair band andear rings, indicator of libido in women; animal fetter or hobble, expres-sion of copulation and monogamy.Policy of full disclosure: None

PP-11-312

Bilateral congenital absence of the vas deferenscoexisting with bilateral seminal vesicle agenezis andsolitary pelvic kidneyUmul, M.1; Turna, B.2; Altay, B.1; Nazli, O.1

1Ege University Medical Faculty, Urology, Izmir, Turkey; 2Ege UniversityMedical Faculty, Izmir, Turkey

Objective: Seminal vesicle pathologies accompanying bilateral con-genital absence of the vas deferens (CBAVD) and renal agenesis arerare congenital urological anomalies, which results from abnormaldevelopment of the Wolffian ducts and ureteric bud. In this report wepresent a case of CBAVD coexisting with bilateral seminal vesicle age-nesis as well as solitary pelvic kidney.Methods: Case report: A 25-year-old man was referred to our clinicafter incidental diagnosis with CBAVD after initial consultation withthe urologist. The physical examination confirmed bilateral absence ofthe vas deferens. Digital rectal examination revealed normal prostate.Scrotal examination demonstrated multiple bilateral epidymal cysticlesions. The semen analysis showed low volume (0.8 cc) azospermiaand very low level of seminal fructose. Routine biochemical analysis ofthe serum and urine analysis did not demonstrate any abnormal find-ings. Transrectal ultrasonography showed bilateral seminal vesicleagenezis. Abdomino-pelvic computed tomography (CT) revealed apelvic solitary kidney with a unilateral ureter opening to the bladderbase on the right side. Bilateral multiple epididymal cysts ranging from3–4 mm size were detected by scrotal doppler ultrasonography. Serumfollicle-stimulating hormone (FSH), luteinising hormone (LH) andtotal testosterone levels were normal. There was a slight increase inserum prolactin (PRL) level. Genetic evaluation evaluating cysticfibrosis transmembrane regulating (CFTR) gene mutation by reversehybridization (Innogenetics Strip Assay) did not reveal any mutationfor cystic fibrosis.Conclusion: CBAVD is a rare cause of male infertility and is usuallyassociated with low ejaculate volume (<2 mL according to WHO cri-teria), total absence of spermatozoa and an acid ejaculate composed ofprostatic secretions, with low or absent fructose, concurring with theabsence of seminal vesicle (SV). Renal anomalies associated withCBAVD should be considered as supporting maldevelopment as acause, but analysis of CFTR gene mutations in these cases should notbe omitted. Because these patients are at greater risk (%50–60) forcystic fibrosis. Therefore, it is important to evaluate these couples forcystic fibrosis during consultation in the infertility clinics. In our casethere was no sign of CF gene mutation. This supports the hypothesisthat the combination of unilateral renal agenesis and CBAVD may bea result of another genetic defect affecting the Wolffian duct early inembriyogenesis prior to week 7, and not due to CF gene mutations.From our findings we can conclude that infertile men with CBAVD


J Sex Med 2008;5(suppl 2):94–145

should be thourogly investigated for renal anomalies. The geneticcounselling in these patients are particularly important.Policy of full disclosure: None

PP-11-313

Post-operative penile shortening in flaccidityfollowing nerve sparing radical prostatectomy (NSRP)Vlachiotis, J.1; Petsis, D.2; Tsintavis, A.2

1Ekali—Athens, Greece; 2Metaxa Cancer Hospital, Urology, Ekali—Athens,Greece

Objective: 66 men, 50–75 y.o.(mean patient age 65.5), who underwentnerve sparing radical prostatectomy (NSRP) were included in thestudy. The aim of our study was to evaluate the penile shortening inflaccidity post NSRP and the time that it happened.Methods: We measured the penile length in flaccidity (from pubis tocorona sulcus) preoperatively and 18 days postop., 3, 6, 9, 12 monthspostoperatively. All patients underwent NSRP performed by two highvolume surgeons.Results: We noticed a continues penile shortening from 18 days(catheter removed) towards the 12 months. The penile shortening wasbigger after the catheter removal compared to the period of 6–12months.Conclusion: Our data agreed with previous studies that the penilelength is shorter postoperatively after RP. The shortening peaks at thetime of catheter removal and it continues to a lesser degree for a yearpostoperatively. We agree with the hypothesis of Mulhall that themechanism of penile shortening after the operation is organ denerva-tion, sympathetic hyperinnervation and at the end organ fibrosis. Wedo not believe that there is a urethra shortening because the urethrais fixed to the perineum. We have to informed our patients for a pos-sibility of penile shortening after a RP.Policy of full disclosure: None

PP-11-314

Sexual complaints and life satisfaction in men andwomen with multiple sclerosisHulter, B.1

1Neurology, Neuroscience, Uppsala, Sweden

Objective: To register sexual dysfunction, anxiety, depression, and lifesatisfaction in men and women with MS, consulting a clinical sexolo-gist at a University Hospital in Sweden.Methods: Twenty-nine women and 22 men with MS were referred tothe sexologist for counselling. They underwent a comprehensive inter-view, a checklist on life-satisfaction (LiSat 11), and the HospitalAnxiety and Depression Scale (HAD).Results: Women: Median age 39 y (range 22–65) MS—duration 10 y(range 0,6–23) Visits: mean 4.6 (range 1–21) Reduced desire: 55%,Orgasm problem: 48%, Lubrication problem: 48%, Problem livingtogether: 14% Anxiety: mean 10 points (range 0–17).Depression: mean 6 points (range 1–15) Most women were not satis-fied with life as a whole and with ten domains of life. Least satisfac-tion concerned sexual life. Men: Median age 39 y (range 23–61)MS—duration 7 y (range 0–26) Visits: mean 4.6 (range 1–14) Reduceddesire: 50%, Orgasm problem: 50%, Erection problem: 77%, Problemliving together: 18%. Anxiety: mean 7.3 points (range 1–16).Depression: mean 5.6 points (range 0–11) Most men were not satis-fied with life as a whole and with ten domains of life. The men wereeven less satisfied with sexual life than were the women.Conclusion: A comprehensive treatment, aiming to release the heavyburden of a chronic, often progressive illness like MS, should includealso aspects concerning men and women’s sexual life.Policy of full disclosure: None

mp-02 pharmacology, hormones

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