p-04 pharmacology

105

J Sex Med 2007;4(suppl 2):105–127

PODIUM SESSION ABSTRACTS

tice in order to prevent somatization of psychosexual problems and toimprove patient compliance.Methods: One-hundred-sixteen heterosexual married couples (agerange: 30–48 years; range of stable marriage: 3–15 years) were con-secutively recruited. Fifty-eight (50%) patients had suffered from PEfor at least 2 years and 58 (50%) patients complained of ED for at least2 years. Patients were comprehensively evaluated and completed thefollowing questionnaires in this order: IIEF, Hamilton DepressionEvaluation Scale (HAM-D). Patients’ partners completed the follow-ing indexes: Female Sexual Function Index (FSFI), Brief Male SexualInventory (BMSI), Measuring Marital Satisfaction (MMS-3G), SexualSatisfaction Scale (SSS), The Conflict Tastics Scales (CTS). Afterwardsthere was both an individual (also using the Operationalizing Prema-ture Ejaculation, G. Grenier et al., University of New Brunswick,1997, Canada) and a couple interview.Results: The large proportion of women (35%) and men (10–25%)patients had traumatic sexual experiences in the past; 18% patientsreported either negative or traumatic experiences due to urogenitaldisorders, and 23% patients with urological, sexological and/or psy-chiatric co-morbidities. Moreover, 8% patients reported both sexualand gastrointestinal complaints.Conclusion: During the evaluation for a sexual dysfunction it is nec-essary to realize that regardless of the cause of the (erectile and ejac-ulatory) disorder there is always a secondary psychological reactionsthat may aggravate the sexual dysfunction and/or influence coping,sexual relationships and therapeutic compliance.

P-01-003

Factors that contribute to sexual satisfactionFernandez Lozano, A.1; Sotolongo Vergo, I.2; Ruiz Castañe, E.1

1Fundacio Puigvert, Andrology, Sabadell/Barcelona, Spain; 2ICUN,Urology, Sabadell/Barcelona, Spain

Objective: Sexual satisfaction is frequently linked to quality of life.Screening for sexual dysfunction is important, but do we really knowwhat factors are most important to our patients in assessing a satisfac-tory sexual relation?Methods: 206 men (mean age 42, range 18–71 years) and 187 women(mean age 38, range 19–66 years), with a regular sexual activity (>1 a month), with stable partner (112/206 men and 131/187 women), and a good educational level a 64% had finished high school (259/393).Subjects were chosen randomly among the family members of patients who consult at an urology open clinic, and were asked which10 factors from a questionnaire are the most important at the time of having sexual intercourse, and rating them on a scale from 1 to 10.Results: 21/206 men, and 8/187 women reported homosexual activ-ity and were excluded. Men who answered (185) rated experiencingpleasure as the most important factor (8.9), fulfil partner’s needs (8.2),achieve orgasm (8.1), maintain a good erection (8.0), having foreplay(6.9), experience sexual desire (6.1), satisfaction after sex (5.6), delayearly orgasm (4.7), have romantic relation (3.9) and lastly, not feelanxious before intercourse a (3.4). Women rated having foreplay as themain factor (8.7), together with a romantic relation (8.5) and to expe-rience pleasure (8.1), fulfil partner’s needs (7.3), experience sexualdesire (7.0), achieve orgasm (6.7), satisfaction after sex (5.7), ex-perience intercourse of desired length (4.6), and to maintain a goodlubrication (4.3).Conclusion: There are important differences in perception of factorsthat contribute to sexual satisfaction depending on age, gender, cul-tural and economic backgrounds. Clinicians should not lose this per-spective when facing sexual and couple dysfunctions.

Monday, 4 December 200610.00–11.30 ZeremoniensaalP-01 Hormones and SexualityChairpersonsJ. Buvat, FranceE. Waldkirch, Germany

P-01-001

Assessment of the relational factor in male patientsconsulting for sexual dysfunction: The concept ofcouple sexual dysfunctionCorona, G.1; Petrone, L.1; Mannucci, E.2; Magini, A.2; Lotti, F.1; Ricca, V.3;Chiarini, V.4; Forti, G.1; Maggi, M.1

1Andrology Unit, University of Florence, Italy; 2Diabetes Section GeriatricUnit, University of Florence, Italy; 3Psychiatry Unit, University of Florence,Italy; 4Endocrinology Unit, Maggiore-Bellaria Hospital, Florence, Italy

Objective: To date it is not clear to which extent a clinical, or a sub-clinical, sexual dysfunction in the female partner might associate witherectile dysfunction (ED) in the male partner. The present study isaimed at the assessment of clinical features of ED associated with rela-tional disturbances.Methods: In a consecutive series of 1140 male subjects reporting astable couple relationship we evaluated the impact of relational factors,as assessed by SIEDY Scale 2 (exploring, as reported by the patient,menopausal symptoms, partner’s medical illness interfering with sexualactivity and reduced partner desire and climax). SIEDY is an easy toadminister instrument for the first screening of ED patient, providingscores for the relational component besides those to quantity theorganic and intrapsychic components. Several hormonal, biochemicaland instrumental parameters were also studied, along with psy-chopathology scores (Middlesex Hospital Questionnaire modified;MHQ).Results: We found that SIEDY Scale 2 is significantly and independ-ently from other factors (as the organic ones) associated with ED,delayed ejaculation, hypoactive sexual desire and decreased number ofintercourses. In particular, the chance of being affected by severe EDincreased by 10 [1–10] % for each increment of SIEDY Scale 2 score(p < 0.05). SIEDY Scale 2 scores are associated with an advanced ageof the partner and a long couple relationship (>10 years), independ-ently from patient’s age. In addition, an increased relational factor sig-nificantly (p < 0.0001) correlates with increased extra-marital affairs (r= 0.111), conflicts in the couple (r = 0.279), alcohol abuse (r = 0.155)and presence of depressive symptoms (r = 0.182), as assessed by MHQ.Conclusion: Our result should encourage the andrologist to considerthe context in which the sexual symptom develops, analysing the rela-tionship and partner’s behaviour and diseases. Resolving, or amelio-rating, the relational background and the sexual framework might helpin treating male sexual dysfunction.Policy of full disclosure: This paper was supported from uncondi-tioned grant from Bayer, Milan, Italy.

P-01-002

The role of the sexologist in sexual medicineLonghi, E.1; Salonia, A.1; Colombo, R.1; Zanni, G.1; Lania, C.1; Briganti, A.1; Rigatti, P.1; Montorsi, F.1

1IRCCS San Raffaele, Dept. of Urology, Milano, Italy

Objective: The aim of this study was to evaluate the cooperationbetween the physicians and the sexologist in daily andrological prac-

106 Podium Session Abstracts

J Sex Med 2007;4(suppl 2):105–127

P-01-004

Community pharmacists’ views on sexual dysfunctionPapaharitou, S.1; Nakopoulou, E.1; Katsohi, E.1; Kouvelas, D.1; Hatzichristou, D.11Aristotle University of Thessaloniki, Center for Sexual and Reproduction,Thessaloniki, Greece

Objective: Patients are often hesitant to discuss sexual problems withhealth care professionals. Community pharmacists (CP) can play a roleon counseling them on this issue. The present study was an initialattempt to describe CP views on dealing with sexual dysfunction (SD).Methods: The study recruited a convenience sample of CP attendinga tutorial on ED management hosted by their professional association.A 20-item questionnaire was constructed and randomly distributed,comprised demographics, and items regarding CP’s i.comfort level inaddressing their clients’ sexual concerns and ii.familiarisation with ED treatment. Paired samples t-test and correlation analysis were conducted.Results: A total of 202 CP were approached (69 males, 133 females)and all returned fully completed questionnaires. Respondents had amean age of 45.68 (+10.04) yrs and average of 18.63 (+9.81) yrs of pro-fessional experience. As they reported, both sexes seek advice for theirSD (men: 42.1%, women: 32.7%). Clients seeking advice mostly arebetween 45–65 yrs old (n = 96, 47.5%). CP feel more comfortabletalking to, and are trusted on sexual issues, by same sex clients (p <0.001). CP’s increased age related with male clients’ increased tendencyto discuss their sexual concerns (r = 0.232, p < 0.01). Six out of 10 CPfavoured PDE5 distribution without a prescription (58% female, 42%male CP). About half of the participants reported to be quite informedabout sexual function issues, appropriate treatments and referrals (n =100, 49.5%; n = 102, 50.5%; n = 129, 63.9% respectively).Conclusion: CP’s personal characteristics appeared to influence boththeirs and their clients’ willingness to talk about sexual problems. Itwas also shown that they lack information on sexual health and EDtreatment. Since CP are easily accessed and constitute credible sourcesof information, education focusing on SD and their treatment, shouldbe promoted.

P-01-005

Testosterone regulates rhoa/rho-kinase signalling intwo distinct animal models of chemical diabetesVignozzi, L.1; Morelli, A.1; Filippi, S.2; Mancina, R.1; Luconi, M.1;Ambrosini, S.3; Vannelli, G. B.3; Forti, G.1; Maggi, M.1

1University of Florence, Clinical Physiopathology, Italy; 2University of Flo-rence, Pharmacology, Italy; 3University of Florence, Anatomy, Histology andForensi, Italy

Objective: The RhoA/Rho-kinase (ROK) signalling pathway is up-regulated in erectile tissue of diabetes animal models and contributesto diabetes-related erectile dysfunction (ED). We previously demon-strated that testosterone (T) restores diabetes-induced ED by influ-encing the NO/cGMP/PDE5 pathway. We investigated the effect ofT on RhoA/ROK signalling in diabetes.Methods: Two distinct animal models of chemical diabetes: alloxan-induced in the rabbit and streptozotocin-induced in the rat were used.Results: In diabetic animals, hypogonadism was observed, character-ized by reduced T and atrophy of androgen-dependent accessoryglands. Diabetic animals showed a significant increase in responsive-ness to increasing concentrations of Y27632, a highly selective ROKinhibitor, as evaluated either by “in vitro” contractility study (rabbit)and “in vivo” as erectile response elicited by electrical stimulation ofcavernous nerve (rats). T-substitution (30 mg/kg, weekly) completelyreverted hypogonadism and diabetes-induced penile hypersensitivityto Y27632. To test whether this effect was due to a T-dependent reg-ulation of RhoA/ROK gene expression, we measured RhoA/ROKmRNA. Both isoforms of ROK (ROK1 and ROK2) were analyzed byqRT-PCR in penile samples of each rat group. We found that ROK1

mRNA was significant increased (p < 0.05) in penile tissues from dia-betic animals and restored to the control values by T, also confirmedin rabbit by RT-PCR. Conversely, expression of RhoA and ROK2mRNAs was not influenced neither by diabetic condition and by Tadministration. Accordingly, ROK1 protein expression (western blotand immunohistochemistry), resulted increased in penile samples fromdiabetic animals and normalized by T.Conclusion: Our data support the hypothesis that RhoA/ROK sig-nalling activation contributes to diabetes-related ED. Moreover, treat-ing hypogonadism in course of diabetes, may restore erectile functionby maintaining a correct balance between pro-erectile NO/cGMP andanti-erectile RhoA/ROK pathways.

P-01-006

Estrogens regulate epididymal contractility throughrhoa/rho-kinase signallingFilippi, S.1; Morelli, A.2; Vignozzi, L.2; Mancina, R.2; Forti, G.2; Maggi, M.2

1University of Florence, Pharmacology, Italy; 2University of Florence, Clinical Physiopathology, Italy

Objective: Epididymis is a sex steroid-sensitive duct and its contrac-tility is crucial for ejaculation. We demonstrated that human epi-didymis expresses an high abundance of mRNA for ER-alpha andER-beta. We also demonstrated that estrogens up-regulate either OTresponsiveness, acting at the receptor level, and responsiveness toendothelin-1 (ET-1), another stimulator of epididymal motility.However, we did not find any significant change either at gene orprotein level in ET-1 and its cognate receptors. Hence, other molec-ular effectors should mediate the increased sensitivity to ET-1. In par-ticular we hypothesized that estrogens up-regulate some contractileeffectors, such as RhoA/Rho-kinase pathway, downstream to the ET-1 receptors.Methods: We induced hypogonadism (hypo) in rabbits with a singleadministration of 2.9 mg/kg of a long-acting GnRH analog, triptore-lin, and we replaced weekly hypo rabbits with different sex steroids(Testosterone, T or estradiol valerate, E2).Results: After 8 weeks from GnRH analog administration, T plasmalevels were decreased and the relaxant effect of the Rho-kinaseinhibitor, Y27632 on ET-1 pre-contracted epididymal strips, was sig-nificantly decreased. T administration restored T plasma levels, butnot Y27632 sensitivity in the epididymal strips. E2 not only completelyrestored Y27632 responsiveness but even amplified it, indicating thatthe RhoA/Rho-kinase pathway is up-regulated by E2. Accordingly,RT-PCR studies indicate that Rho kinase gene was strongly inducedby E2 but not by T. To verify whether endogenous estradiol is involvedin the regulation of Y27632 responsiveness, we treated intact rabbitswith an aromatase inhibitor, letrozole (1.25 mg/day) for 21 days.Blocking aromatase activity abolished Y27632 responsiveness in rabbitepididymis.Conclusion: E2 are involved in the ejaculation process by increasingRhoA/Rho-kinase signalling and therefore the ET-1/OT-induced epi-didymal motility.

P-01-007

Androtest: A structured interview for the screening ofhypogonadism in patients with sexual dysfunctionCorona, G.1; Petrone, L.1; Mannucci, E.2; Fisher, A. D.1; Balercia, G.3;Chiarini, V.4; Forti, G.1; Maggi, M.1

1Andrology Unit, University of Florence, Italy; 2Diabetes Section GeriatricUnit, University of Florence, Italy; 3Endocrinology Unit, Polytechnic Uni-versity of Marc, Ancona, Italy; 4Endocrinology Unit, Maggiore-Bellaria Hos-pital, Bologna, Italy

Objective: At present, three different inventories have been developedfor screening of hypogonadism in aging male. All these instrumentsdemonstrated a good sensitivity but low specificity. No inventories areavailable for the screening of hypogonadism in patients with sexual

Podium Session Abstracts 107

J Sex Med 2007;4(suppl 2):105–127

dysfunction. We wished to set up a brief structured interview provid-ing scores useful for detecting hypogonadism defined as low total T(<10.4 nmol/L, 300 ng/dL) in a symptomatic population (sexual dysfunction).Methods: A minimum set of items was identified within a larger struc-tured interview through iterative ROC curve analysis, with assessmentof sensitivity and specificity for hypogonadism in a sample of 215patients. Sensitivity and specificity were verified in a further sample of664 patients. Correlation of test scores with PSA, testis volume, andothers clinical and psychological parameters, was assessed for concur-rent validity.Results: In the validation sample, the final 12-item version of theinterview (ANDROTEST) had a sensitivity and specificity of 68% and65% with an accuracy of 0.700+/−0.03 (p < 0.0001), in detecting lowtotal testosterone (<10.4 nmol/l) and of 71% and 65% with an accu-racy of 0.716 +/−0.03 (p < 0.0001), in the screening for low free testos-terone (<37 pmol/l). Furthermore, patients with pathological test (i.escore >8) showed higher prevalence of hypogonadism related signs,such as lower testis volume and higher depressive symptoms. Finally,when younger patients only (<54 years, which represents the medianage of the sample), were considered, Log10 [PSA] levels were signifi-cantly lower in those with ANDROTEST score >8.Conclusion: ANDROTEST is a quick, and easy-to-administer inter-view that provides scores for the screening of male hypogonadism inpatients with sexual dysfunction.

P-01-008

Positive impact of a new educational program tooptimize treatment with sildenafilBrock, G.1; Carrier, S.2; Casey, R.3; Tarride, J.-E.4; D’Angelo, P.5; Elliott, S.6; Dugre, H.7; Rousseau, C.8; Defoy, I.9

1Canada; 2McGill University, Department of Urology, Montreal, Canada;3The Male Health Centres, The Male Health Centres, Oakville, Canada;4McMaster University, St. Joseph Hospital, Hamilton, Canada; 5PfizerCanada Inc, Medical Division, Kirkland, Canada; 6Vancouver General Hos-pital, Centre for Sexual Medicine, Canada; 7Centre Hospitalier de l’Univer,Hopital St-Luc, Montreal, Canada; 8Pfizer Canada Inc, Outcomes Research,Kirkland, Canada; 9Kirkland, Canada

Objective: To evaluate the impact of a new educational program forthe management of erectile dysfunction (ED) treatment with sildenafilin men with ED who were sildenafil naïve.Methods: In this Canadian study, sites were randomized to eitherreceive the treatment optimization program (TOP) tool at visit 1(TOP sites) or not (non-TOP sites). The TOP tool (a tear-off sheet,a brochure, and a video) described ways to optimize treatment withsildenafil. Treatment satisfaction was evaluated with the EDITS. Self-reported questionnaires were used to assess patients’ and physicians’satisfaction with the TOP tool. To account for clusters (sites), a nestedANCOVA was used, adjusting for possible predictors.Results: The ITT population included 2573 patients from 231primary care sites. After 3 months of treatment, patients were highlysatisfied with their sildenafil treatment (EDITS index), and this satis-faction level was similar in both groups (LS means: 78 for TOP sitesvs. 79 for non-TOP sites; p = 0.1722). Patients receiving the TOP toolat baseline were more likely to renew their prescription for sildenafil(p < 0.0001). More than 85% of patients were “satisfied” or “very sat-isfied” with the TOP tool. According to the patients, the partners’ satisfaction with the TOP tool, when involved, was also very high.Physicians’ satisfaction with the TOP tool was 83%. A very large pro-

portion of physicians (84%) would use the TOP tool in their currentpractice. 73% of the physicians found that the TOP tool saved themtime, with an estimated 30% (average) of their time saved with theTOP tool.Conclusion: High satisfaction rates with sildenafil was found in bothgroups, with the TOP tool providing important benefits to newly diag-nosed ED patients. Patients, partners and physicians were very satis-fied with this educational program which reduced physician time andyielded optimized sildenafil treatment results.Policy of full disclosure: G. Brock: Investigator and advisory boardmember of: Pfizer Canada, Bayer Canada, Eli Lilly Canada, Janssen-Ortho Canada, Solvay Canada, Organon Canada.

P-01-009

Safety and tolerability of transdermal testosteronepatch (TTP) in surgically menopausal womenreceiving oral or transdermal estrogen over 36 monthsof therapyNachtigall, L.1; Casson, P.2; Lucas, J.3; Melson, C.3; Schofield, V.31New York University, School of Medicine, USA; 2University of Vermont,College of Medicine, Burlington, USA; 3P&G Pharmaceuticals, Cincinnati,Ohio, USA

Objective: Evaluate the safety and tolerability of investigational 300 µg/day TTP in surgically menopausal women with HypoactiveSexual Desire Disorder receiving concomitant estrogen therapy.Methods: 1094 women were enrolled in two 6 month multi-centerrandomized double-blind trials and received placebo or 300 µg/dayTTP. After 6 months, patients could roll into open-label extensionsreceiving 300 µg/day TTP. Data were analyzed in 6 month incrementsusing time to first event for adverse events (AEs) and change frombaseline for labs.Results: Of the women enrolled, 59% completed year 1, 21% year 2and 12% year 3. There was no increase over time in occurrence orseverity of AEs, serious AEs (SAEs) or withdrawals due to AEs (table1). The three most common AEs were application site reaction, upperrespiratory infection and hirsutism. Over 3 years of exposure, therewere no clinically relevant increases in risk of any specific AE includ-ing androgenic AEs. Lab analyses including liver function, hematol-ogy, carbohydrate metabolism, lipids and clotting parameters showedno clinically relevant changes through 3 years exposure. Over 3 years,patients experienced a small weight gain of 1.7 kg (p < 0.05) and a smallincrease (<2 mmHg) in blood pressure (p > 0.05). Consistent with ageappropriate expected rates (SEER), 3 cases of invasive breast cancerwere observed. The absence of a parallel placebo treated control grouplimits our ability to draw definitive conclusions from these data.Conclusion: These data from 36 months exposure demonstratedinvestigational TTP has a favorable safety profile and was well toler-ated. No clinically relevant safety concerns were detected.Policy of full disclosure: L Nachtigall and P Casson are recipientsof a research grant from Procter & Gamble Pharmaceuticals. J Lucas,C Melson and V Schofield are employees of Procter & Gamble Phar-maceuticals.


J Sex Med 2007;4(suppl 2):105–127

P-01-010

Comparison of men and women of the BDSMcommunity in Portugal: An Internet-based studyPascoal, P.1; Rui Henriques, R.2; Monteiro Pereira, N.2

1Hospital Julio de Matos, Servico de P C, Lisboa, Portugal; 2UniversidadeLusofona, Lisboa, Portugal

Objective: Our objective was to compare a sample of men and womenbelonging to BDSM Internet based community in Portugal.Methods: We compared 46 men with 22 women respondents to an Internet based study on the BDSM community in Portugal. Theauthors visited different BDSM parties and events and contacted theorganization of these parties, of different newsgroups, of discussionforums, of Internet journals and magazines in order to present theirgeneral objective and make a connection with the community. Thequery was set up in a website especially devoted to the study of humansexuality through on-line data collection. The General Questionnaireincluded questions on sex, gender, education, marital status, residence,cohabitation, sexual orientation, and perception of sexual dysfunction.The news groups and forum moderators previously contacted sent thelink and a presentation letter to the users by e-mail. The study was on-line for 1 month. The data were submitted quantitative analysis.Results: There were significant differences between the two groups(>0.005). Women were younger (p > 0.001), more frequently bissex-ual; had less arousal difficulties; had more orgasmic difficulties; weremore frequently involved in an on-going relationship with the personwith whom they had regular BDSM practices. Women had startedtheir practices more recently.Conclusion: The results point out the differences in terms of sexual-ity of men and women involved in BDSM practices have different rela-tionship and sexual profiles. The similarity in socio-demographicalvariable, except for age, might indicate that BDSM might have a dif-ferent meaning and implications for both genders.

Monday, 4 December 200613.30–15.00 ForumP-02 Pathophysiology of Sexual DysfunctionsChairpersonsJ. Angulo, SpainA. Jungwirth, Austria

P-02-011

Isolated hypertriglyceridaemia and erectiledysfunction: Is there a significant correlation?Chitale, S.1; Irving, S.1

1Norflok & Norwich University Hospital, Urology, United Kingdom

Objective: A full assessment of lipid profile forms an integral part ofinvestigations of patients with erectile dysfunction (ED) in addition tochecking random blood sugar and total plasma testosterone levels.However, on many occasions, measurement of all components of thelipid profile is not performed which we believe may lead to subopti-mal management of these patients.Methods: Data was collected prospectively from 160 new casesreferred to the ED clinic (age range: 37–76 yrs.) over a period of 12months. Results of biochemical investigations performed by the GPsin primary care as well as the ones requested from the ED clinic inthis study population were recorded.Results: 106 (66.25%) patients had some biochemical investigationsperformed whereas 54 (33.75%) had none. A full lipid profile (on a 16hrs fasting sample) was available for 69/106 (65%) while 37/106 (35%)patients had random cholesterol, random blood sugar or randomtestosterone levels done in various combinations but not triglycerides.Thus, 69/160 (43%) were adequately investigated but 91/160 (57%)were not. 32/69 (46.4%) patients with ED had isolated hypertriglyc-eridaemia (HTG), 1/69 (1.5%) had hypercholesterolemia and hyper-triglyceridaemia and 36/69 (52.1%) had a normal lipid profile inc.triglycerides. Of those with isolated HTG, 2 had sub normal (≤9)testosterone levels, 17 were at lower limit of normal (10–15) i.e. 19/31(59.4%) had low testosterone, 4 (12.5%) had normal levels, andunavailable in 9 (28.1%).Conclusion: Incidence of isolated hypertriglyceridaemia (HTG) hasbeen a significant finding amongst patients with ED. It is likely to beunder diagnosed due to inappropriate levels of investigations in thesepatients. Its causal relation to ED and possible association with lowtestosterone levels remains unanswered and should be addressed bylarger clinical trial.Policy of full disclosure: None.

P-02-012

The metabolic syndrome and associated sexualdysfunction: Psychobiological correlatesCorona, G.1; Mannucci, E.2; Petrone, L.1; Mansani, R.1; Schulman, C.3;Balercia, G.4; Chiarini, V.5; Forti, G.1; Maggi, M.1

1Andrology Unit, University of Florence, Italy; 2Diabetes Section GeriatricUnit, University of Florence, Italy; 3University Clinics of Brussels, ErasmeHospital, Bruselles, Belgium; 4Endocrinology Unit, Polytechnic University ofMarc, Ancona, Italy; 5Endocrinology Unit, Maggiore-Bellaria Hospital,Bologna, Italy

Objective: The aim of present study is to determine psychobiologicalcharacteristics of sexual dysfunction (SD) associated with metabolicsyndrome (MS; defined by National Cholesterol Education Program’sAdult Treatment Panel III criteria) in a consecutive series of 803 maleout-patients.Methods: Several hormonal, biochemical and instrumental (peniledoppler ultrasound, PDU) parameters were studied, along with psy-chopathology scores (Middlesex Hospital Questionnaire modified;MHQ). The Structured Interview on Erectile DYsfunction (SIEDY),was also applied.Results: Among subjects studied, 236 patients (29.4%) were diagnosedas having a MS. Among them 96.5% reported ED, 39.6% hypoactive


J Sex Med 2007;4(suppl 2):105–127

sexual desire (HSD), 22.7% premature and 4.8% delayed ejaculation.Patients with MS were characterized by greater subjective (as assessedby SIEDY) and objective (as assessed by PDU) ED and by greatersomatizated anxiety than the rest of the sample. The prevalence ofhypogonadism (total testosterone, TT < 8 nM) was significantly higherin patients with MS. Circulating TT decreased as the number of MScomponents increased (B = −1.35+/−0.182 nmol/l; p < 0.0001, afteradjustment for age). Accordingly, the relative risk for hypogonadismwas significantly higher in patients reporting 3 or more risk factors forMS. Among MS components, waist circumference and hyperglycaemiawere the best predictors of hypogonadism. Among patients with MS,hypogonadism was present in 11.9% and 3.8% in the rest of the sample(p < 0.0001) and it was associated with typical hypogonadism-relatedsymptoms, such as HSD, low frequency of sexual intercourses anddepressive symptoms.Conclusion: Our data suggest that MS is associated with a moresevere ED and induces somatization. Furthermore, MS is associatedwith a higher prevalence of hypogonadism in patients with SD. Thepresence of hypogonadism can further exacerbate the MS-associatedsexual dysfunction, adding the typical hypogonadism-related symp-toms (including HSD, 66.7%).

P-02-013

Erectile dysfunction is related to arterial stiffness and markers of systemic vascular inflammation and endothelial function in patients with metabolic syndromeRokkas, K.1; Vlachopoulos, C.1; Ioakeimidis, N.1; Aznaouridis, K.1; Vasili-adou, C.1; Tsekoura, D.1; Baou, K.1; Askitis, A.1; Stefanadis, C.11Hippokration Hospital, 1st Department of Cardiology, Athens, Greece

Objective: Erectile dysfunction (ED) may be considered a clinicalmanifestation of a generalized arterial disease. Aortic stiffness may bean early marker for vascular changes associated with metabolic syn-drome (MetS). We evaluated associations between erectile function,aortic stiffness and markers of systemic vascular inflammation andendothelial function in patients with MetS.Methods: Two groups of subjects (mean age: 58 yrs) with MetS wereinvestigated: 39 men with ED and 30 men with normal erectile func-tion. Aortic stiffness was evaluated with carotid-femoral pulse wavevelocity (PWV) using high-fidelity pulse wave analysis. Plasma levelsof interleukin 1β (IL-1β), tumor necrosis factor-α (TNF-α) andsoluble vascular cell and intercellular adhesion molecules (sVCAM-1,sICAM-1) were measured with ELISA.Results: The mean erectile function score (SHIM-5) was 13 [6–20] inmen with MetS and ED and 23 [22–25] in men with MetS and normalerectile function. ED patients had increased carotid-femoral PWVcompared to patients with normal erectile function (8.9 ± 1.6 vs 8.3 ±1.2 m/s, p < 0.05). Compared with men without ED, ED patients hadsignificantly higher levels of IL-1β (0.7 ± 0.4 vs 0.5 ± 0.3 pg/ml, p =0.01), TNF-α (1.8 ± 0.5 vs 1.5 ± 0.4 pg/ml, p < 0.01), sVCAM-1 (611± 174 vs 535 ± 139 ng/ml) and sICAM-1 (267 ± 67 vs 232 ± 38 ng/ml)(p < 0.05 for both). SHIM-5 score was negatively associated withcarotid-femoral PWV (r = −0.30, p = 0.01), IL-1β (r = −0.25, p < 0.05),TNF-α (r = −0.32, p < 0.01), sVCAM-1 (r = −0.24, p < 0.05) andsICAM-1 (r = −0.40, p < 0.001).Conclusion: ED and aortic stiffness are related in men with MetS andmay contribute to their raised cardiovascular risk through impairedendothelial function associated with enhanced vascular inflammatorystate.

P-02-014

Prothrombotic markers predict the presence oferectile dysfunctionVlachopoulos, C.1; Aznaouridis, K.1; Vasiliadou, C.1; Rokkas, K.1;Ioakeimidis, N.1; Dima, I.1; Askitis, A.1; Stefanadis, C.11Hippokration Hospital, 1st Department of Cardiology, Athens, Greece

Objective: Recent studies have shown that erectile dysfunction (ED)is associated with atherosclerosis. Aim of the present study was to eval-uate the prothrombotic (fibrinogen and von Willebrand Factor [vWF])and inflammatory (high-sensitivity C-reactive protein [hsCRP]) statein men with ED and to investigate whether such markers are predic-tive of the presence of impaired sexual performance.Methods: Erectile function was evaluated in 121 consecutive men(mean age 58.6 years). ED was diagnosed with medical and sexualhistory, and a score of the 5-item Sexual Health Inventory for Men<21. Levels of the above mentioned markers were measured in venousblood.Results: All markers were significantly increased in patients with ED(n = 71) compared to subjects without ED (n = 50), after adjusting forage, systolic BP and risk factors (fibrinogen: 317 vs 242 mg/dL; vWF:91.7 vs 70.1%; hsCRP: 1.51 vs 1.05 mg/L; all P < 0.01). ROC curveanalysis for the prediction of the presence of ED showed that areasunder the curve (AUCs) for fibrinogen, vWF and hsCRP level were79% (95% CI: 71 to 87%), 75% (66 to 84%) and 67% (57 to 76%)respectively. AUC for fibrinogen was significantly greater than AUCfor hsCRP (difference between AUCs 12.2%, 95% CI: 2.2 to 22.2%,P < 0.05, Figure). A fibrinogen value >255 mg/dL combined with vWF>77% was the best predictor of ED (63% sensitivity, 82% specificity,and 83% positive predictive value).Conclusion: Erectile dysfunction is associated with increased levels ofprothrombotic and inflammatory markers, but the former are betterpredictors of impaired sexual performance. These findings underscorethe pathophysiological involvement of endothelial prothrombotic acti-vation in ED and have implications for increased cardiovascular riskin these patients.

P-02-015

Risk of severe erectile dysfunction is higher in older,overweight menCarrier, S.1; Morales, A.2; Defoy, I.3

1McGill University, Department of Urology, Montreal, Canada; 2QueensUniversity, Centre for Advanced Urological, Kingston, Canada; 3PfizerCanada Inc, Medical Affairs, Kirkland, Canada

Objective: To determine the impact of different variables on theextent of response to sildenafil and to determine if there is a correla-tion between BMI and baseline erectile dysfunction (ED) severity.Methods: Men eligible for this retrospective analysis had completedthe series of open-label extension studies leading to 3 years of use ofsildenafil on a prn basis. Efficacy of sildenafil was assessed using event-log diaries, the IIEF, the GAQ, and the Erectile Distress Scale. Datawere stratified based on the following baseline variables: ED severity,BMI, age, bother of ED, duration of disease, ED aetiology andsmoking status.Results: A total of 225 men were eligible for this sub-analysis. At base-line, 49% had severe ED, mean age was 59 years, and mean BMI was27.2. All efficacy parameters were significantly improved betweenbaseline and month 3 (p < 0.0001), and between baseline and month36 (p < 0.0001). When stratified by baseline ED severity and by base-


J Sex Med 2007;4(suppl 2):105–127

line IIEF-OS domain, scores of the IIEF-EF domain and the propor-tion of successful attempts were numerically increased, but not neces-sarily statistically significant. Years since, bother, age, aetiology, BMIand smoking status did not impact the extent of response to sildenafil.Although BMI did not influence the response to sildenafil, a strongcorrelation between ED severity at baseline and BMI was found in thispatient population: men with a BMI >25 at baseline were much morelikely to have severe ED (odds ratio: 2.67) as opposed to a lesser degreeof ED severity. This odds ratio was further increased in men >65 years.Conclusion: This retrospective analysis shows that several variables,including age and years since diagnosis, did not affect the extent ofresponse to sildenafil. However, men with a BMI >25 were more likelyto have severe ED at study entry.Policy of full disclosure: S. Carrier: Investigator and advisory boardmember for Pfizer Canada, Eli Lilly Canada, Bayer Canada, Janssen-Ortho Canada.

P-02-016

Prevalence of neuropathic disturbances and their predictive value for erectile dysfunction in diabetic menKamenov, Z.1; Christov, V.1; Yankova, T.11Clinic of Endocrinology, Medical University, Sofia, Bulgaria

Objective: Diabetic erectile dysfunction (DED) is of complex originand diabetic neuropathy (DN) plays most important role in its devel-opment. The aim of this study was to evaluate the prevalence of neu-ropathy disturbances, determined with some neurologic tests, and theirprognostic value for DED.Methods: 150 consecutive men with mean age ± SD 53.0 ± 12.5 years,DM1/2 = 39/111 and diabetes duration of 4.9 ± 3.8 years were includedin this study. ED was diagnosed with a questionnaire, about havingerectile problems. For determination of somatic DN the ModifiedNeuropathy Disability Score (NDS): vibration (VP), thermal (TP) andtactile (MF) perceptions and Achilles reflexes (AR) were used. Thepresence of autonomic DN was evaluated with a new test for sudo-motor dysfunction—Neuropad.Results: Positive (>0) results for DN by different tests demonstratedfor Neuropad −117 of all men(78.0%), VP-115(76.7%), TP-76(50.7%), MF-62(41.3%), AR-13(87.3%) and NDS-139(92.7%). EDwas present in 44.7% of men (ED+). Compared to men without ED(ED−) the ED+ group had higher prevalence of abnormal results forVP (p < 0.001), TP (p < 0.01), MF (p < 0.01), Achilles reflexes (p <0.001), NDS ≥ 6 points (p < 0.001), NDS ≥ 1 p. (p < 0.001) and Neu-ropad (p < 0.01). All these tests (but MF) were predictors (OR) for ED.After adjustment for age remained VP ≥ 6/8 [OR(CI;p)] −3.350(1.193–9.410;p < 0.05) and NDS ≥ 6p. −2.957(1.348–6.485;p <0.01). ED had prognostic power for abnormal neurological tests andfor presence of DN respectively.Conclusion: Presence of DN is a strong predictor for ED and viceversa. Simple neuropathy tests like NDS and Neuropad, used in thegeneral practice for diagnosing DN are indirect indicators for ED.

P-02-017

In vivo electrophysiology in the paraventricularnucleus: Correlations with erectile activityAllers, K.1; Richards, N.1; Wayman, C.1

1Pfizer Global R&D, Discovery Biology, Sandwich, United Kingdom

Objective: The paraventricular nucleus of the hypothalamus (PVN)plays an important role in the control of male sexual function. However,

PVN neuronal firing has not been demonstrated to change in responseto sexual arousal inducing stimuli. The aim of this study was to recordPVN neuronal activity in rats while measuring genital endpointsindicative of sexual arousal. Apomorphine, a non-selective dopamineagonist, was used in this study as a sexual arousal inducing stimuli.Methods: All experiments were conducted in compliance with UKlegislation. Under terminal anaesthesia, a glass electrode is placed intothe PVN of the hypothalamus and lowered until a single unit is iso-lated. Pressure measurements are made from the corpus spongiosumof the penis, which indicates rising pressure within the penis duringan erectile response. A metal recording electrode is then placed withinthe bulbospongiosum (BS) muscle. The BS muscle is involved inseminal emission and ejaculation; hence this measure provides an indi-cation of muscular contractions involved in these processes.Results: PVN neurones showed both increases (n = 10, mean 1394%of baseline values at 100 ug/kg) and decreases (n = 8, mean 54% ofbaseline values at 100 ug/kg) in firing rate. Animals simultaneouslyshowed increases in ICP, and seminal emissions. Neuronal firing andICP demonstrated dose-responsiveness in a range of 1.0 200 ug/kgapomorphine administered as an intravenous bolus. PVN local fieldpotential recordings demonstrated a decrease in delta range activityand an increase in theta range activity during apomorphine inducedpenile erection, which was not present under the influence of apo-morphine without penile erection.Conclusion: These data demonstrate correlated activity (positive andnegative) between PVN neurones and erectile activity and synchro-nous network activity during erection. These data support the involve-ment of the PVN of the hypothalamus in male sexual function and indopamine receptor agonist induced sexual arousal.

P-02-018

Sexual quality of life of 10,161 subjects over 40 yearsold: Partial resultsAbdo, C.1; Abdo, J. A.2; Caetano, M. E.3

1University of Sao Paulo, Medical School, Brazil; 2Santa Cruz Hospital,Urology, Sao Paulo, Brazil; 3Schering Brazil, Andrology, Sao Paulo, Brazil

Objective: Evaluate sexual quality of life of 10,161 subjects sample and iden-tify elements suggesting Androgen Deficiency in the Aging Male (ADAM).Methods: A self-administered and anonymous questionnaire with 71questions on several aspects of sexual health was applied to 10,161 sub-jects (men and women), 40 years old and above, in 20 Brazilian states.Questions on general and sexual health, sexual relationships, life habitsand the Aging Male’s Symptoms (AMS) questionnaire were answeredin this survey. The data was analysed with chi-square tests (p ≤ 0.05was considered statistically significant).Results: 1853 subjects from Sao Paulo/Brazil (57.1% men and 42.9%women) were the first ones analyzed and here presented. 20.6% of menand 22.2% of women have sedentary life; 18.5% of the sample referstress; 6.1% have smoking habits. Women have in average 6.0 inter-courses/month, and men, 7.9. 95.4% of men and 94.6% of womenconsidered sex important/very important to the couple harmony.Orgasm is not reached by 26.0% of women. 48.1% of men refer somelevel of erectile dysfunction (2.0% complete; 10.0% moderate; 36.1%mild). AMS men’s scores point to: no symptoms (46.7%); mild(34.9%); moderate (15.7%) and severe (2.7%).Conclusion: 18.5% of the male subjects refer moderate/severe scoreto AMS. Unhealthy life habits contribute to high levels of not satisfac-tory sexual health of 40 years old and above men and women from SaoPaulo city. Sex is significantly important to the couple harmony, and thefrequency of sexual intercourses vary from 1.5 to 2 times by week.Policy of full disclosure: This research was sponsored by ScheringBrazil.


J Sex Med 2007;4(suppl 2):105–127

Tuesday, 5 December 200610.00–11.30 ZeremoniensaalP-03 Female Sexual HealthChairpersonsY. Vardi, IsraelC. Damsted Pedersen, Denmark

P-03-019

Sexual distress in Danish women with type I and typeII diabetesGiraldi, A.1; Kristensen, E.1; Vibe-Petersen, J.1; Behrend, L.2; Hommel, E.1;Eplov, L. F.11Rigshospitalet, Sexological Clinic, Copenhagen, Denmark; 2Rigshospitalet,Department of Psychiatry, Copenhagen, Denmark

Objective: Knowledge on sexual dysfunction and distress in womenwith diabetes is sparse. The aim was to investigate the prevalence ofsexual dysfunction and distress in a cohort of Danish women with diabetes.Methods: 1380 women (age of 18–60 yrs) were invited to participatein the study; 469 with diabetes (DM) and 911 without diabetes (con-trols). The women completed a questionnaire including the FemaleSexual Function Index (FSFI) and the Derogatis Distress Scale (FSD).Statistical analysis: 2 and two-sites T-test.Results: 1136 women (82%) returned the questionnaire; 367 DM(78%) and 769 controls (84%). Of the DM, 316 had type I diabetes(mean age 39.4 ± 8.7 yrs) and 51 type II (mean age 47.0 ± 8.2 yrs).Mean age of controls were 39.5 ± 8.7 and 46.8 ± 7.9 yrs. respectively.734 controls were included, as 1 DM was matched to 2 controls forstatistical analysis. Significantly more DM (36%) reported sexual dis-tress than controls (29%, p = 0.03). Among type I, 36% reported dis-tress (controls 29%, p = 0.03), but no difference in level of distress wasseen in type II compared to controls (35% vs 31%, p = 0.71). Overall,women with diabetes reported a significantly lower level of sexualdesire compared to controls (p = 0.02), using the FSFI domains fordesire, but no difference in total FSFI scores were observed. Whenseparating into diabetes type; type II reported significantly lower desirethan their controls (p < 0.05), but no difference was found in type Icompared to controls.Conclusion: In our study DM women express more sexual distressthan women without diabetes due to women with type I were more distressed. Overall DM women report lower sexual desire than non-diabetics, because of low desire in women with type II diabetes.Policy of full disclosure: The study was supported by the Pfizer A/S,Eli Lilly and the Danish Diabetes Foundation.

P-03-020

Female sexual function after surgery for stress urinaryincontinence: Transobturator suburethral tape (TOT) versus tension-free vaginal tape obturator(TVT-O)Elzevier, H. W.1; Putter, H.2; Pelger, R. C. M.1; Lycklama a Nijeholt, G. A. B.11Leiden University Medical Center, Urology, Netherlands; 2Leiden Univer-sity Medical Center, Medical Statistics and Bioinfo, Netherlands

Objective: Sexual function after TVT replacement has been studiedbefore. The aim of the present study was to assess the influence ofTOT or TVT-O for the surgical treatment of stress urinary inconti-nence (SUI) on female sexual function.Methods: In a retrospective study we evaluated 77 sexual activepatients with partner and 3 without partner after TOT (n = 43) andTVT-O (n = 34 + 3) placement for SUI based on responses to a mailedquestionnaire 3 months after operation. Frequency, reduction ofincontinence during intercourse, improvement of sexual function andalso clitoral function was evaluated.

Results: TOT (n = 43, mean age 52.2 yr): No difference in frequencyof sexual intercourse and improvement of continence during inter-course from 20 patients (46.5%) before, to 39 patients (90.7%) afteroperation was seen. Appreciation of sexual intercourse was improvedin 8 patients (18.2%) and worsened in 6 patients (13.6%). TVT-O (n= 34, mean age 53.4): No difference in frequency of sexual intercourseand improvement of continence during intercourse from 12 patients(35.5%) before, to 28 patients (82.4%) after operation. Appreciationof sexual intercourse was improved in 7 patients (20.7%) and worsenedin 2 patients (5.9%). Postoprative TOT (n = 43) vs TVT-O (n = 34 +3): Lost of lubrication 7 patients [17.5%] vs 5 patients [13.5%] (p =0.630). Clitoral tumescence reduction 7 patients [17.1%] vs 2 patients[5.4%] (p = 0.159). Clitoral sensibility reduction 7 patients [16.3%] vs3 patients [8.1%] (p = 0.326). Pain because of vaginal narrowing 8patients [19,5%] vs 1 patient [2.8%] (p = 0.032).Conclusion: Overall, in this study the technique of TOT (outside-in)rise to more sexual dysfunction than TVT-O (inside-out). However,because of the successful outcome on incontinence, overall in bothprocedures it has a positive effect on sexual function.Policy of full disclosure: This study was initiated by the Pelvic Floor& Sexuality Research group Leiden supported by an unrestricted grantfrom Pfizer and Stichting Amsterdam 98.

P-03-021

Review of potential role of bremelanotide (PT-141) inthe treatment of female sexual dysfunctionPerelman, M. A.11Weill Medical College Cornell, Human Sexuality Program, New York, NY,USA

Objective: Bremelanotide is a synthetic peptide analog of α-melanocyte stimulating hormone and is an agonist at melanocortinreceptors MC3R and MC4R. This review examines research to dateregarding the potential use of bremelanotide for the treatment offemale sexual dysfunction (FSD).Methods: Findings from six distinct research paths are summarized.Results: 1) Clinical trials have demonstrated induction of significanterectile activity in healthy male volunteers and ED patients, support-ing the hypothesis that bremelanotide is a central initiator of sexualarousal in men. Anatomical similarities between genders suggestsimilar benefits may accrue to women. 2) Preclinical research demon-strated effects of bremelanotide on proceptive sexual behaviors inovariectomized female rats. Appetitive behavior in female rats mayhave a human analog in sexual interest, desire, or arousal. 3) Thirty-two healthy women were treated with either placebo or subcutaneousbremelanotide. Bremelanotide was safe and well tolerated. 4) An in-clinic, double-blind, placebo-controlled, crossover study of two con-current doses of 10 mg intranasal bremelanotide in 18 premenopausalpatients with female sexual arousal disorder found that more womenreported moderate or high sexual desire after bremelanotide thanplacebo and there was a correlation between positive desire responsesand increased genital arousal. 5) A similar study enrolling post-menopausal women with FSD was recently completed and resultscomparable to the premenopausal data were suggested. 6) An at-home,multi-site clinical trial enrolling both premenopausal and post-menopausal women with FSD is underway.Conclusion: Collectively, these preclinical and clinical data evoke acautious optimism and strong recommendation for continued assess-ment of bremelanotide for the treatment of FSD. Additionally, con-textual sensitivity of female sexual response may require combinationtreatment, where sexual pharmaceuticals and sex coaching is integratedmore frequently for women than it has been for men.Policy of full disclosure: Research studies were sponsored by PalatinTechnologies, Inc.


J Sex Med 2007;4(suppl 2):105–127

P-03-022

Nasally applied testosterone rapidly increases theamygdala response to emotional stimuli in middle-aged womenvan Wingen, G.1; Zylicz, S.1; Pieters, S.1; Petersson, K. M.1; Mattern, C.2;Verkes, R. J.3; Fernandez, G.11Radboud University Nijmegen, F.C. Donders Centre, Netherlands;2Mattern Research AG, Mattern Research AG, Stans, Switzerland;3Radboud University Nijmegen Me, Department of Psychiatry, Netherlands

Objective: To investigate whether nasally applied testosterone canrapidly increase the amygdala response in healthy, middle-agedwomen.Methods: Twenty healthy women (43 years; range 37–50 years) whodid not take hormonal contraception participated in this double-blind,placebo-controlled, cross-over study in two different menstrual cyclesduring their follicular phase. They received an intranasal gel contain-ing 0.9 mg testosterone (Noseafix®) or placebo 40 minutes beforescanning with functional MRI. During scanning, the subjects viewedthree simultaneously presented faces that expressed anger or fear, andhad to indicate which faces expressed the same emotion. In addition,serum concentrations and subjective effects were measured beforeadministration (0 min), and before (30 min) and after the scanningsession (150 min).Results: The intranasal testosterone gel increased the serum concen-tration of testosterone from baseline at 30 and 150 minutes afteradministration. Importantly, the fMRI data show that testosteroneincreased the amygdala response to angry and fearful faces already 40minutes after administration. In contrast to younger women (24 years;range 19–30) that participated in a previous drug study, the resultsshowed no significant activation of the amygdala in the placebo sessionof the present age group. We therefore compared the placebo sessionsof the young and middle-aged women, and found that the amygdalaresponse was significantly lower in middle-aged than young women.Conclusion: These results show that nasally applied testosterone canrapidly increase amygdala activity in middle-aged women, which isreduced in comparison to young women. These results therefore show,for the first time in humans, a neural mechanism by which testosteronecould increase emotional arousal. Nasally applied testosterone might therefore be beneficial for the treatment of Female Sexual Dysfunction.

P-03-023

The effect of a testosterone transdermal patch onhypoactive sexual desire disorder in postmenopausalwomen not receiving systemic estrogen therapy, The APHRODITE studyStudd, J.1; Bouchard, C.2; Kroll, R.3; Koch, H.4; von Schoultz, B.5; Davis, S.6

1Lister Hospital, London, United Kingdom; 2Clinique RSF Inc, Quebec,Canada; 3Women’s Clinical Research Cent, Seattle, USA; 4P&G Pharma-ceuticals, Schwalbach, Germany; 5Karolinska Institute, Stockholm, Sweden;6Monash Medical School, Melbourne, Australia

Objective: To evaluate the safety and efficacy of the transdermaltestosterone patch (TTP) in menopausal women with HypoactiveSexual Desire Disorder (HSDD) not receiving systemic estrogentherapy.Methods: 814 postmenopausal women enrolled in a 1 yr randomized,doubleblind, multinational study. They received TTP 150 µg or 300 µg/day, or placebo (PL) patch twice weekly. Efficacy was assessedover 24 wks; endpoints were—frequency of total satisfying sexualactivity assessed by the Sexual Activity Log©, sexual desire domain ofthe Profile of Female Sexual Function©, distress from the PersonalDistress Scale©. Hormones, adverse events (AEs) and clinical labswere evaluated over 1 yr.Results: The 24 wk efficacy analysis included 771 participants. The300 µg/day TTP significantly improved 4 wk frequency of total satis-

fying sexual activity (p < 0.0001), sexual desire (p < 0.0001), the 6 otherdomains of the PFSF, and decreased distress (p < 0.0001) versus PL.Significance was also seen in the subgroup of naturally menopausalwomen (p </= 0.0003 vs. PL). Despite the small number of surgicallymenopausal women (n = 199), significance was achieved for desire anddistress (p < 0.04). A dose response was observed with the 150 µg/dayTTP reaching significance for some endpoints. Mean and median freeT levels observed at 6 months with the 300 µg/day TTP were respec-tively 7.14 and 6.40 pg/ml, within the reference range for normal premenopausal women (0.9–7.3 pg/ml). There were no clinically significant changes in lab parameters measured over 24 wks. OverallAEs and AE withdrawals were similar in the PL and TTP groups. Anincrease of the frequency of unwanted hair in the 300 µg/day groupversus PL was observed, however, 99% were mild to moderate inseverity.Conclusion: In this study, the 300 µg/day TTP showed significantimprovements and was a well-tolerated treatment for HSDD inmenopausal women not receiving systemic estrogen +/− progestogentherapy.Policy of full disclosure: J Studd, C Bouchard, R Kroll, B vonSchoultz and S Davis are recipients of a Research Grant from Procter& Gamble Pharmaceuticals. H Koch is an Employee of Procter &Gamble Pharmaceuticals.

P-03-024

Sexual problems in the transition to menopauseAlder, J.1; Leiser, E.1; Marti, J.1; Bitzer, J.1

1Universitäts-Frauenklinik Basel, Gyn. Psychosomatic, Basel, Switzerland

Objective: To determine the impact of menopausal status, HRT, well-being, body image and sense of coherence on self-reported sexual difficulties.Methods: Healthy peri- and postmenopausal women were contactedto participate in a questionnaire based study. Information on demo-graphic data and information on menopause, depression and anxiety(HADS), sense of coherence (SOC), body image (composite score) andsexuality (composite score and scales 7 and 9 from MRS) were anony-mously assessed once by questionnaires which the participants sendback to the study team. From a total of 250 questionnaire sets, 144(57.6%) were sent back. Linear regression analysis with backwardelimination was used to determine the impact of HRT, enhanced levelsof depression and anxiety, satisfaction with body image and sense ofcoherence on sexual difficulties for the whole sample and for peri- andpostmenopausal women separately.Results: 25–40% of the respondents reported to be bothered by lesssexual drive, painful intercourse or loss of lubrication. Negative bodyimage and depressive mood were predictive for sexual problems in theentire group. For perimenopausal women negative body image waspredictive for a composite score of sexual problems (p < 0.05) and,together with not being on HRT for vaginal dryness (p < 0.01 and p< 0.05). For postmenopausal women depressive mood was predictivefor higher scores in the MRS-sexuality-scale (p < 0.01) and for vaginaldryness (p < 0.01).Conclusion: Sexual difficulties are reported by a quarter of this group.While for women who according to their bleeding patterns were stillperimenopausal dissatisfaction with body image seems to be moreimportant for the explanation of sexual problems, postmenopausalwomen’s sexuality is more impaired by depressive mood. Assessingmood and problems with body image therefore should be standard incounselling women in their transition to menopause.


J Sex Med 2007;4(suppl 2):105–127

P-03-025

Epidemiology of dyspareunia in sexually active pre-menopausal women: Relationship to contraceptivesGoldstein, I.1; Fugl-Meyer, K.2; Fugl-Meyer, A.3

1The Journal of Sexual Medicine, Milton, MA, USA; 2Karolinska Univer-sity Hospital, Andrology and Sexual Medicine, Stockhol, Sweden; 3UppsalaUniversity, Neuroscience, Sweden

Objective: To examine, for the first time in pre-menopausal sexuallyactive women, prevalence, severity and correlates of dyspareunia, espe-cially associations to contraceptive usage.Methods: The epidemiologic investigation “Sex in Sweden” was uti-lized. Contraceptive use, including condoms, intra-uterine devices andoral contraceptives, was reported at last intercourse. Dyspareunia wasassessed by: “It happens that the woman has periods of pain in the gen-itals during intercourse. Has this happened in your sexual life duringthe last 12 months?” Severity was characterized by manifest dyspare-unia (all the time, rather often), mild dyspareunia (rather rare, hardlyever) or never.Results: Of 851 women (mean age 34 ± 10.0 years) who met inclu-sion/exclusion criteria, 5% reported manifest, 36% mild and 59% nodyspareunia during the past 12 months. Of those who reported man-ifest dyspareunia, 70% had manifest and 23% mild personal dyspare-unic distress. Among 497 sexually active pre-menopausal women usinga contraceptive at their last intercourse, 199 (40%) used oral contra-ceptives. No significant differences in dyspareunia were found betweenusers of condoms and intrauterine devices; in contrast, oral contra-ceptive-users reported dyspareunia significantly more commonly (p <0.01). Manifest and mild dyspareunia were about 2.5 and 1.5 timesmore likely to occur for oral contraceptive-users than non-users,respectively. Among oral contraceptive-users, women with manifestdyspareunia were significantly less sexually satisfied. In oral contra-ceptive-users, lubricative dysfunction was not age-dependent. Dys-pareunia was significantly more common in women with lower BMI.Younger subjects age 18–34 years had less BMI, more penetrativeintercourse episodes/month (7.8 versus 6.4) and more dyspareuniathan women >34 years. Those on oral contraceptives had a higherprevalence of chlamydia infections than non-users.Conclusion: Since oral contraceptive-associated dyspareunia is com-mon, clinically relevant and iatrogenic, warnings should be providedto users.

P-03-026

The prevalence of female sexual dysfunction inpartners of men with premature ejaculationHobbs, K.1; Symonds, T.2; Abrahams, L.2; May, K.3; Morris, M.4

1Deal, United Kingdom; 2Pfizer Inc, Outcomes Research, Sandwich, UnitedKingdom; 3Pfizer Inc, Clinical Development, Sandwich, United Kingdom;4Pfizer Inc, Statistics, Sandwich, United Kingdom

Objective: To investigate the prevalence of Female sexual dysfunction(FSD) in a sample of female partners of men with premature ejacula-tion (PE) and to compare this with levels of FSD in partners of sexu-ally functional (‘normal’) men.Methods: Partners of men with PE (n = 139) and female partners ofmen without a diagnosis of PE (n = 89) were screened by telephoneand sent an abbreviated version of the Sexual Function Questionnaire(Quirk et al, 2002). The men with PE had been either clinician diag-nosed or they had an intravaginal ejaculatory latency time of less thantwo minutes. All of the partners, both PE and normals, had to be: • Currently sexually active, • With partner for at least six months • >18 years of age.Results: Overall, 77.7% of PE partners had at least one sexual dys-function, compared with 42.7% of normal partners (p =< 0.001). Theprevalence of specific types of FSD seen in the PE partner sample vs.the normal partner sample was also statistically significantly differentfor each sub-type. Additionally, 48.2% of PE partners had two or morediagnoses, compared with only 22.4% in the normal partner group.Conclusion: These results demonstrate that PE partners are morelikely to have be sexually dysfunctional than those with a normal

partner (overall with an odds ratio of 4.7 times more likelihood). Theserates are comparable with those found by Greenstein et al (2006) inpartners of men with erectile dysfunction. Therefore, it is likely thata sexual dysfunction in one partner can cause sexual dysfunction in theother. What is additionally notable here is that the PE partners prob-lems are often multiple.Policy of full disclosure: All authors are employees of, or associatedwith, Pfizer Inc.

P-03-027

Endorsement of models of female sexual response andcorrelation with FSFI scores in a sample of registerednurses: The Nurses Sexuality StudySand, M.1

1Duesseldorf, Germany

Objective: To assess, in a sample of American Registered Nurses,women’s endorsement of commonly accepted models of female sexualresponse (Masters and Johnson; Kaplan; Basson).Methods: A random sample of 580 registered nurses was mailed a 58-item questionnaire in which the Female Sexual Function Index wasembedded. One item addressed women’s perception of fit of their ownexperience with widely accepted models of sexual response.Results: 133 women returned responses, of whom 111 had a currentmale partner. The proportion of women who endorsed each model asbest representing their sexual response varied significantly across thesample and between those women with FSFI scores above and belowthe scale cutoff score of 26.55 (Table 1). FSFI scores differed signifi-cantly as a function of model endorsement, with women endorsing theBasson model having significantly lower domain scores than womenwho endorsed either Masters and Johnson or Kaplan (Table 2).Conclusion: These are the first data to assess and compare the pro-portion of a community sample of women who endorse widelyaccepted models of female sexual response. Women in this samplediffer widely in endorsement these models, with the Basson model lessfrequently endorsed than earlier models. Endorsement of the modelswas also correlated with FSFI scores and suggest that the model(Basson) currently advanced by the Second International Consultationon Sexual Medicine (Basson R et al 2004) may best reflect women withsexual concerns (eg. FSFI < 26.55), rather than a healthy sexualresponse pattern.Policy of full disclosure: I am an employee of Bayer HealthCare AG.


J Sex Med 2007;4(suppl 2):105–127

P-03-028

Hypothalamic neuropeptides have functionalreceptors in the rat spinal cord (l4-s1) which maymodulate female sexual functionWilson, L.1; Wayman, C.1; Jackson, M.1

1Pfizer, Discovery Biology, Kent, United Kingdom

Objective: Neuropeptides such as alpha stimulating hormione(αMSH) and oxytocin have been shown supraspinally to facilitate lor-dosis, whereas corticotrophin releasing factor (CRF) and the mu opiateDAMGO inhibit female receptivity (Cragnolini et al., 2000; Caldwellet al., 1986; Sirinathsinghji, 1986; Acosta-Martinez et al., 2002). Oftenoverlooked is the fact that lordosis is believed to be a spinal reflex. Therole of neuropeptides within the spinal cord reflex that controls lor-dosis remains to be elucidated. A hemisected spinal cord preparationwas used to investigate the effects of neuropeptides in the lumbrasacralregion associated with sexual function. The aim was to determine howαMSH, CRF, oxytocin and DAMGO modulate glutamate release fromstretch Ia fibres underlying the H-Reflex predicting orgasm (Landry,2004), touch sensation Aβ fibres and Aδ/c pain fibres.Methods: Spinal cords were removed from Sprague-Dawley rats(10–14 days) anaesthetised with urethane in compliance with UKHome Office guidelines. Hemisected preparations were superfusedwith aCSF at 23oC. A suction electrode was used to electrically stim-ulate the dorsal root (L4–S1) at 0.02 Hz. A biphasic reflex responsewas recorded from the ventral root consisting of a monosynaptic (Ia)and a polysynaptic (Aβ, Aδ and C) component.Results: αMSH, CRF, oxytocin and DAMGO all potently decreasedelectrically-evoked glutamate release but had different effects on affer-ent fibre subtypes (see table).Conclusion: αMSH, oxytocin, CRF and DAMGO have functionallyexpressed receptors in the lumbosacral spinal cord. In contrast to theirdiffering effects on lordosis all inhibited glutamate release within thespinal reflex. αMSH, oxytocin, CRF and DAMGO have the ability tomodulate orgasm whereas oxytocin, CRF and DAMGO could increasethe pain threshold during sexual intercourse. Oxytocin and CRF maydampen touch sensation.Policy of full disclosure: Pfizer Global Research and Development.

Tuesday, 5 December 200613.30–15.00 ZeremoniensaalP-04 PharmacologyChairpersonsD. Hatzichristou, GreeceE. Wespes, Belgium

P-04-029

Safety and efficacy of orally inhaled apomorphine(VR004) in the treatment of erectile dysfunctionRiley, A.1; Morgan, F.2; Main, M.2; Newton, M.2; Kirkpatrick, J.31University of Central Lancashi, Carmarthenshire, United Kingdom;2Vectura Group plc, UK, Chippenham, United Kingdom; 3Insight Statisti-cal, Consulting LTD, Huntingdon, United Kingdom

Objective: This Phase IIb double-blind, randomised, placebo-controlled, dose ranging, parallel-group study evaluated the safety andefficacy of VR004 (orally inhaled apomorphine) delivered using theAspirair® inhaler, in men with mild, moderate and severe erectile dysfunction (ED).Methods: After a 4-week no-treatment run in period, patients, agedup to 65 years, were randomized to placebo or one of three VR004fine particle dose levels (150 µg, 250 µg or 300 µg). Each patient’s firststudy dose was administered in-clinic and immediately followed by anorthostatic challenge. Following successful completion of this proce-dure patients were allowed home to use study treatment for amaximum of 12 weeks. Erectile function was assessed via the SexualEncounter Profile (SEP) questions 2 and 3.Results: A total of 138 patients aged 23 to 66 (median 58) years completed the study per protocol. ED severity at baseline (IIEF EDdomain scores) was mild, 17%; moderate, 62% and severe 21%. Thepercentage of positive SEP 2 and SEP 3 answers in last 4 weeks oftreatment and change from baseline to the last 4 weeks are: see image.Apart from symptomatic postural hypotension reported by 4 patientsduring the stringent orthostatic challenge, no safety concerns arosewhich would preclude further clinical evaluation. 54% of patientsreported the onset of erection within 5 minutes and 83% within 10minutes.Conclusion: This study confirmed the safety and efficacy of VR004and demonstrated a very rapid onset of action.

P-04-030

Increased erection hardness in men treated withflexible-dose Viagra® (Sildenafil Citrate) in a double-blind, placebo-controlled multinational trial withopen-label extensionKadioglu, A.1; Grohmann, W.2; Depko, A.3; Levinson, I.4; Sun, F.4; Collins, S.4

1Istanbul Universitesi, Dept. of Urology, Capa, Istanbul, Turkey; 2Praxis,Munich, Germany; 3Polish Society for Sexual Medicine, Warszawa, Poland;4Pfizer Inc, Pfizer Inc, New York, USA

Objective: Erectile dysfunction (ED) impacts the ability to achievequality erections that are hard enough for successful and satisfactoryintercourse. We assessed change in erection hardness in men treatedwith Viagra (sildenafil citrate) for ED.


J Sex Med 2007;4(suppl 2):105–127

Methods: At 25 European Union and South America centers, menwith ED, documented by a score of ≤25 on the Erectile Functiondomain of the International Index of Erectile Function, received flexible-dose Viagra (25, 50, or 100 mg, PRN) for 6 weeks in a ran-domized, double-blind, placebo-controlled (DBPC) trial, followed by6 weeks of open-label (OL) treatment. Erection hardness was gradedby the patient at the occasion of sexual stimulation using the ErectionHardness Grading Scale (grade 1, increase in size but not hard; grade2, hard but not hard enough for penetration; grade 3, hard enough forpenetration but not completely hard; or grade 4, completely hard) andwas assessed as the percentage of occasions that grade 3 or 4 erectionswere achieved. During treatment, the denominator was limited tooccasions of medication use.Results: Mean (range) age was 45 (18–55) years and ED duration was2 (<1–21) years. Grade 3 or 4 erections were achieved on 46% and45% of occasions in men subsequently randomized to placebo (n =153) and Viagra (n = 154), respectively, at baseline. This increased to57 ± 3% and 85 ± 3%, respectively, during DBPC treatment (P <0.0001 between groups, estimated as least squares means ± SE froman analysis of covariance model), and to 93% and 92%, respectively,following the OL Viagra treatment phase. Mean values for grade 4erections were 5% in each group prerandomization, 15% and 57%,respectively, during DBPC, and 61% and 67%, respectively at the endof OL.Conclusion: Erection hardness increases in men treated with Viagrafor ED, with completely hard erections being achieved on most occasions.Policy of full disclosure: Pfizer, Inc Investigator.

P-04-031

Daily tadalafil improves endothelial and erectilefunction in men with systemic sclerosisAversa, A.1; Proietti, M.2; Bruzziches, R.3; Rossi, C.2; Greco, E. A.3; Letizia, C.4; Salsano, F.2; Spera, G.3

1Rome, Italy; 2University of Rome ’La Sapienz, Clinical Medicine, Italy;3University of Rome ’La Sapienz, Medical Pathophysiology, Italy; 4Univer-sity of Rome ’La Sapienz, Clinical Sciences, Italy

Objective: Men with Systemic Sclerosis (SSc) frequently report erec-tile dysfunction (ED) due to endothelial and vascular damage. Weassessed the potential effects of tadalafil on endothelial and erectilefunction in men with SSc and refractory ED.Methods: 45 SSc pts of both sexes were assigned to receive: group A(n = 15; F = 13 M = 2) N-Acetylcysteine (5 gr/every 15 days i.v.) in thepresence of lung fibrosis; group B (n = 15 M) Tadalafil (TAD) 10 mg/daily (n = 15; M) in the presence of ED; group C (n = 15; F =11 M = 4) Bosentan (BOS) 250 mg/daily, in the presence of pulmonaryhypertension. Primary endpoint: variation from baseline of plasmaEndothelin1-ET1, Adrenomedullin-AM, peak systolic velocities atdynamic duplex ultrasound and IIEF5 scores. Secondary endpoint:Q13-SIEDY score variation from baseline.Results: Baseline ET1 and AM values were higher in all pts as com-pared to age-matched healthy controls (p < 0.05). After respectivetreatments group B, but not other groups, showed net reduction ofcirculating ET1 (24.2 +/− 15.7 pg/ml vs. 9.9 +/− 7.5 pg/ml p < 0.05)and AM (18 +/− 12.1 pg/ml vs. 9.6 +/− 6.1 pg/ml p < 0.05) levels. Asignificant improvement of arterial inflow to cavernous arteries (20.2+/− 5.5 cm/s vs. 30.5 +/− 4.1, p < 0.05) and of IIEF5 scores (12.0 +/−2.7 vs. 20.0 +/− 1.1, p < 0.05) were found. Most pts under TAD (N =12, 85%) reported improvement of morning erections (2.5 +/− 0.7 vs.0.4 +/− 0.1, p < 0.01).Conclusion: Daily tadalafil may convert ED unresponsive to on-demand TAD in men with SSc through improvements of markers ofendothelial function, of penile vascularization and of morning erec-tions, all of which may determine better penile oxygenation.Policy of full disclosure: A.A. and G.S. have been occasional Con-sultants for Eli-Lilly Italia.

P-04-032

Daily treatment with sildenafil reverses endothelialdysfunction and oxidative stress in an animal model ofmetabolic syndromeBehr-Roussel, D.1; Oudot, A.1; Caisey, S.1; Le Coz, O.1; Gorny, D.1; Bernabé, J.1; Wayman, C.2; Alexandre, L.1; Giuliano, F.31Pelvipharm, Gif sur Yvette, France; 2Pfizer Global Research and Dev,Sexual Health, Sandwich, United Kingdom; 3AP-HP, Raymond PoincaréHospit, Dept. of Physical Medicine and, Garches, France

Objective: Patients with metabolic syndrome exhibit generalizedendothelial dysfunction. We postulated that chronic sildenafil treat-ment could upregulate the NOS/cGMP pathway and improveendothelial function in fructose-fed rats.Methods: Wistar rats (n = 10–14 per group) were fed a standard chow(CONT) or a fructose-enriched diet for 9 weeks (FFR) while receiv-ing sildenafil twice a day (sc, 20 mg/kg, FFR+SIL) from week 6through 8, and then observing a 1-week wash-out period from sildenafil. Concentration-response curves (CRC) to endothelium-dependent (ACh and A23 187) and -independent (SNP) relaxants in presence of indomethacin were performed on isolated aortic and superior mesenteric arterial (SMA) rings. Vascular cGMP con-tent, urinary excretion of nitrates and nitrites (NOx) and 8-isoprostanes (IPT), and plasma levels of IL-6 and TNF-alpha were alsoevaluated.Results: Relaxations to ACh were reduced in aortas of FFR while onlyslightly affected in SMA rings. Relaxations to A23 187 were signifi-cantly reduced both in aortic and SMA rings of FFR. In aortas, silde-nafil restored normal endothelium-dependent relaxations to ACh. InSMA rings, a leftward shift of the CRC to ACh could be detected.Relaxations to A23 187 were also restored by sildenafil in both aorticand SMA rings of FFR. Enhanced compensatory endothelium-independent relaxations to SNP in FFR were not modified by sildenafil. Neither IL-6, TNF-alpha, vascular cGMP nor urinary NOx levels were modified by the fructose or sildenafil treatment.Urinary IPT levels was enhanced in FFR and normalized by chronicsildenafil.Conclusion: Endothelial dysfunction and oxidative stress associatedwith the metabolic syndrome can be reversed in FFR by a chronictreatment with sildenafil, even 7 days after treatment has ceased. Thissustained improvement in endothelial function suggests that chronicadministration of sildenafil may lead to structural and molecularchanges within the vascular wall.Policy of full disclosure: This work was supported by a restrictedgrant from PFIZER. Chris Wayman is an employee of Pfizer.

P-04-033

Differential effects of 2-week treatment withatorvastatin or elocalcitol, rhoa/rho-kinase signallingmodulators, on erectile function and sildenafilresponsiveness in spontaneously hypertensive ratsMorelli, A.1; Zhang, X.-H.1; Filippi, S.2; Vignozzi, L.1; Mungai, S.1;Adorini, L.3; Maggi, M.1

1University of Florence, Clinical Physiopathology, Italy; 2University of Flo-rence, Pharmacology, Italy; 3Bioxell, Bioxell, Milan, Italy

Objective: Increased RhoA/Rho-kinase (ROK) signalling impairserectile function. Since spontaneously hypertensive rats (SHR) over-express penile RhoA and are unresponsive to phosphodiesterase 5(PDE5) inhibition, we tested treatments known to inhibit RhoA onerectile function and sildenafil responsiveness in SHR.Methods: A two-weeks treatment with atorvastatin (5 and 30 mg/kg/day), or with elocalcitol (30 microg/Kg/day), a non-hypercalcemicvitamin D receptor (VDR) agonist was performed in SHR and nor-motensive controls Wistar Kyoto (WKY). Frequency-dependentintracavernous pressure/mean arterial pressure (ICP/MAP) ratio afterelectrical stimulation (ES) of the cavernous nerve was measured.


J Sex Med 2007;4(suppl 2):105–127

Results: Neither atorvastatin affected cholesterol, nor elocalcitolaffected calcaemia in both SHR and WKY rats. In WKY, sildenafil (25 mg/kg) increased ICP/MAP ratio after cavernous nerve ES, whilein SHR, both basal and sildenafil-stimulated ICP/MAP ratio weredepressed. Atorvastatin did not affect basal ICP/MAP at any concen-tration tested. However, it dose-dependently increased sildenafil effecton ES-induced erection, significantly potentiated by 30 mg/Kg dosing.At this dose, atorvastatin normalized the RhoA mRNA over-expres-sion in SHR (qRT-PCR), without affecting other genes (ROK1,ROK2, PDE5, nNOS, and eNOS). Conversely, elocalcitol, at a doseknown to ameliorate bladder overactivity by inhibiting RhoA activa-tion, failed to restore ICP/MAP ratio, sildenafil responsiveness andRhoA overexpression in SHR. SHR expressed elevated levels of VDRmRNA in the bladder (5-fold increase over WKY), but not in thepenis.Conclusion: Our data confirm that an increased RhoA signallingimpairs erectile function and sildenafil responsiveness in SHR. Ator-vastatin ameliorates sildenafil effectiveness and down-regulates RhoAexpression. Conversely, elocalcitol, w/o sildenafil, was ineffective inrestoring erectile function in SHR. The VDR differential quantitativeexpression in bladder and penis suggests a tissue-specific effect of elo-calcitol on RhoA/ROK pathway.

P-04-034

A comparison of vardenafil and sildenafil: Preferenceamong men with erectile dysfunction andcardiovascular risk factorsPorst, H.1; Rubio-Aurioles, E.2; Eardley, I.3; Goldstein, I.4

1Private Urological Practice, Hamburg, Germany; 2Asociacion Mexicanapara la Sa, Clinical Research, Tlalpan, Mexico; 3St. James University Hos-pital, Pyra Department of Urology, Leeds, United Kingdom; 4Private Prac-tice, Urology, Milton, USA

Objective: This analysis was performed to compare the number ofmen with erectile dysfunction (ED) expressing a preference for varde-nafil versus sildenafil.Methods: This was a pooled analysis of two randomised, double-blind crossover studies, one performed in the USA and one inEurope/Mexico. Patients were men aged ≥18 years with ED for >6months according to NIH criteria and risk factors for cardiovasculardisease (diabetes mellitus, hypertension and/or hyperlipidaemia).Another requirement was a stable, heterosexual relationship for morethan the last 6 months. Patients underwent 4-weeks’ treatment withvardenafil 20 mg or sildenafil 100 mg, followed by 1 week of washoutthen 4 weeks’ treatment with the other study medication. Preferencequestions were asked at week 9, after completion of both treatmentperiods.Results: A total of 1,057 men were randomised to treatment. Overallpreference for vardenafil was expressed by 38.9% of men, comparedwith 34.5% for sildenafil; 26.6% indicated no preference. Men pre-ferred vardenafil regardless of the order in which the two medicationswere received (the proportion of patients preferring vardenafil was37.8% among those who received vardenafil then sildenafil, and 40.0%among those who received sildenafil then vardenafil). Preference wasanalysed in 18 subgroups, based on age, body mass index, smokingstatus, baseline IIEF-EF score, ED aetiology, ED duration, previoussildenafil use, or presence of diabetes mellitus status. In 16/18 of thesesubgroups, vardenafil was preferred by more men than sildenafil.Conclusion: Among men with ED and cardiovascular risk factors,vardenafil was preferred by greater numbers than sildenafil across allsubgroups based on age, body mass index, smoking status and diabetesmellitus status, as well as subgroups based on baseline IIEF-EF score,ED aetiology and ED duration.Policy of full disclosure: Dr. Rubio-Aurioles is a speaker and con-sultant for Bayer Healthcare, Lilly ICOS LLC, and Johnson &Johnson/Janssen-Cilag and receives grant support from Bayer Health-care, Lilly ICOS, and Johnson & Johnson. Mr. Eardley and Prof. Porstare both speakers and consultants for Bayer Healthcare, Pfizer, andLilly ICOS. Dr. Goldstein is a lecturer and consultant for Bayer, Pfizer,Lilly ICOS, Auxillium, Mentor, and Surface Logix.

P-04-035

Consistent benefits with vardenafil regardless of age,prior pde-5 use or geographical location in men witherectile dysfunction and their partners: theCOUPLES-projectRosen, R.1; Fisher, W.2; Beneke, M.3; Homering, M.4; Evers, T.51New England Research Institute, Clinical Research, Watertown, USA;2University of Western Ontario, Department of Psychology, Ontario,Canada; 3Bayer Vital GmbH, Biometry, Leverkusen, Germany; 4BayerHealthCare AG, Biometry, Wuppertal, Germany; 5Bayer HealthCare AG,Pharma—Research and Developm, Wuppertal, Germany

Objective: To assess treatment satisfaction with vardenafil in sub-groups of men with erectile dysfunction (ED) and their female partners.Methods: This was a pooled analysis of three randomised, double-blind, placebo-controlled, 12-week studies of flexible-dose vardenafilversus placebo, in men with ED ≥6 months duration (n = 788) andtheir female partners. The main efficacy measure was the TreatmentSatisfaction Scale (TSS). Vardenafil was compared with placebo byprofiling differences between vardenafil and placebo for the six TSSdomains (ease with erection, erectile function satisfaction, pleasurefrom sexual activity, satisfaction with orgasm, confidence to completesexual activity and satisfaction with medication). Results for patients,partners, and patient subgroups based on age, previous PDE-5 treat-ment and geographical location were analysed.Results: After 12 weeks’ treatment, vardenafil significantly improvedthe LS mean score for all domains compared to placebo, among bothpatients and their partners (p < 0.0001, last observation carried forward[LOCF] analysis). Absolute improvement with vardenafil, versusplacebo, in domain scores for patients (vardenafil minus placebo) were37.4 (medication satisfaction), 36.7 (erectile function satisfaction), 28.2(confidence), 27.6 (orgasm satisfaction), 23.4 (ease) and 23.0 (pleasure).A similar overall pattern was observed in the different subgroups, andin the partners of men with ED. In all of the subgroups, the greatestbenefit with vardenafil treatment was seen in the erectile dysfunctiondomain, with medication satisfaction second. Significant benefits withvardenafil versus placebo were also evident in secondary parameterssuch as the International Index of Erectile Function, Erectile Functiondomain (IIEF-EF).Conclusion: Significant benefits with vardenafil versus placebo wereconfirmed in all TSS domains (nominal significance). Treatment sat-isfaction with vardenafil was consistently superior to that with placeboacross different subgroups of men with ED (based on age, previousPDE-5 treatment and geographical location) and their partners.Policy of full disclosure: Dr Rosen and Dr Fisher are both speakersand consultants for Bayer Healthcare, Pfizer, and Lilly ICOS. DrBeneke, Dr Homering and Dr Evers are all employees of Bayer.

P-04-036

Tadalafil administered once a day is efficacious andwell tolerated for treating erectile dysfunction in menwith diabetes mellitusBrock, G.1; Buvat, J.2; Gambla, M.3; Hatzichristou, D.4; Lording, D.5; Rose, L.6; Aurioles, E. R.7; Spera, G.8; Liang, S.-Y.9; Frumkin, L.10

1Canada; 2Centre d’Etude Traite. Path. l’A, Le Grand Hunier, Lille, France;3Urology Surgeons, Inc., Columbus, OH, USA; 4Papageorgiou GeneralHosp. of Thessaloniki, Dept. Urology, Thessaloniki, Greece; 5MelbourneAndrology Centre, Cabrini Medical Centre, Suite, Malvern, Victoria, Aus-tralia; 6Gemeinschaftspraxis, Muenster, Germany; 7Asoc. Mexicana para LaSalud S, Tlalpan, Mexico; 8Dipartimento de Fisiopatologia, Universita deRoma “La Sap, Italy; 9ICOS Corporation, Biometrics, Bothell, WA, USA;10ICOS Corporation, Clinical Research, Bothell, WA, USA

Objective: Tadalafil, an inhibitor of phosphodiesterase 5 (PDE5), isan established treatment for erectile dysfunction (ED). Tadalafil has amean half-life of 17.5 hours and improves erectile function up to 36hours postdosing. The pharmacokinetic characteristics of tadalafilsuggest the feasibility of once-a-day dosing, an alternative to on


J Sex Med 2007;4(suppl 2):105–127

demand, for patients with ED. In this study, the efficacy and tolera-bility of tadalafil administered once a day for treating ED were assessedin men with diabetes mellitus and ED.Methods: This was a randomized, placebo-controlled, double-blind,parallel-design, multicenter study. Following a 4-week treatment-freerun-in period, patients were treated for 12 weeks with tadalafil 2.5 mg,5 mg, or placebo once a day. Efficacy was measured using InternationalIndex of Erectile Function (IIEF) questionnaire and responses toSexual Encounter Profile (SEP) diary questions.Results: Tadalafil improved erectile function, compared with placebo(P ≤ 0.005), from baseline to endpoint, in IIEF erectile function (EF)domain score and mean per-patient percentage of “yes” responses toSEP questions 2 (successful penetration) and 3 (successful intercoursecompletion). The most common treatment-emergent adverse events(incidence ≥5%) were headache (2%, tadalafil 2.5 mg and 9.2%,tadalafil 5 mg vs. 7%, placebo), back pain (3% and 5.1% vs. 0%), dys-pepsia (3% and 5.1% vs. 1%), flushing (0% and 5.1% vs. 1%) andcough (5% and 2% vs. 1%). The percentage of patients discontinuingdue to adverse events was low (4%, tadalafil 2.5 mg; 3.1%, tadalafil 5 mg; 4%, placebo).Conclusion: Tadalafil 2.5 mg and 5 mg administered once a dayimproved erectile function, compared with placebo, and was well tol-erated. Once-a-day dosing with tadalafil may be a useful treatmentstrategy for ED in patients with diabetes mellitus.Policy of full disclosure: G. Brock is an advisor for Lilly ICOS LLC,Pfizer, Bayer, and Johnson & Johnson, and a shareholder in Eli Lilly.

consummatory and refractory sexual behavior were assessed by theAcute Sexual Experience Scale (ASES).Results: OT plasma levels were significantly elevated after intranasalOT-administration throughout the whole experiment (>60 min). Inaddition, OT-treatment induced significant increases in epinephrine,norepinephrine and dopamine plasma levels during the period ofsexual arousal and orgasm without affecting cortisol or prolactin levels.In contrast, OT treatment did not alter appetitive, consummatory andrefractory sexual behavior on the ASES. However, when asked aboutthe subjective perception of whether OT or placebo had been applied,8 out of 10 OT-treated but blinded subjects correctly indicated OTdue to an increased sexual arousability.Conclusion: In conclusion, intranasally administered OT leads toincreased plasma levels of OT and increased sympathetic nervoussystem activity when subjects are engaged in sexual activity in a labo-ratory setting. As the effects of OT on sexual behavior were equivo-cal, future studies will reassess possible facilitatory propertiesincorporating males, females and couples in a field setting taking intoaccount that OT exerts the most prominent behavioral effects in socialinteractions.

P-04-038

Randomized, double-blind, placebo-controlled, at-home study of intranasal bremelanotide (PT-141)in men with erectile dysfunction with and withoutdiabetes mellitusHellstrom, W.1; Gittelman, M.2; Zinner, N.3; Hallam, T.4; Harning, R.5;Dworaczyk, D.6; Rolleri, R.7

1Tulane U Health Sciences Ctr, Dept of Urology, New Orleans, LA, USA;2South Florida Medical Research, Executive Director, Aventura, FL, USA;3Western Clinical Research, Inc, Medical Director, Torrance, CA, USA;4Palatin Technologies, Inc, Research and Development, Cranbury, NJ, USA;5Palatin Technologies, Inc, Clinical Affairs, Cranbury, NJ, USA; 6KingPharmaceuticals, Inc, Clinical Development, Cary, NC, USA; 7King Phar-maceuticals, Inc, Clinical Research, Cary, NC, USA

Objective: Bremelanotide, a synthetic analog of α-melanocyte stimu-lating hormone, is under investigation for male erectile dysfunction(ED) and female sexual dysfunction. Two randomized, double-blind,placebo-controlled trials were conducted to evaluate efficacy, safety,and tolerability of intranasal (IN) bremelanotide under conditions ofhome use by men with ED with and without diabetes mellitus.Methods: In the first study, ∼725 males, 21 to 70 years old, with EDwere randomized to placebo or one of the following IN doses ofbremelanotide: 5 mg, 7.5 mg, 10 mg, 12.5 mg, or 15 mg. In the secondstudy, ∼300 males, 21 to 70 years old, with ED and a diagnosis of con-trolled type 1 or type 2 diabetes mellitus were randomized to placebo,10 mg IN bremelanotide or 12.5 mg IN bremelanotide. Subjectsreceived one in-clinic dose of study medication prior to 12 weeks ofat-home treatment. Subjects visited the clinic after weeks 4, 8, and 12to return Sexual Encounter Profile questionnaires completed within 1hour of each attempt of vaginal intercourse and to complete the fol-lowing questionnaires on site: the International Index of ErectileFunction (IIEF), the Global Assessment Questionnaire, and the Self-Esteem and Relationship questionnaire. In addition, safety evaluations(vital signs, clinical laboratory tests, resting 12-lead ECG) were con-ducted at baseline and week 12. The primary efficacy outcome was thechange in IIEF erectile function domain score from baseline to week12.Results: As of August 2006, all data were collected and statisticalanalysis was underway. Final results will be reported including changesin IIEF scores from baseline to end of study, changes in other efficacyassessment scores, and outcomes related to safety and tolerability.Conclusion: These results will provide valuable evidence about thepotential use of bremelanotide as a future treatment for ED.Policy of full disclosure: This research was funded by Palatin Tech-nologies, Inc., Cranbury, NJ, USA.

P-04-037

Acute effects of intranasal oxytocin on sexual andendocrine function in malesBurri, A.1; Heinrichs, M.2; Schedlowski, M.3; Krueger, T.3

1Behavioral Sciences, Psychology&Immunobiology, Zurich, Switzerland;2University of Zurich, Clinical Psychology and Psycho, Switzerland; 3ETHZurich, Psychology&Immunobiology, Switzerland

Objective: The actions of the neuropeptide oxytocin (OT) range fromthe modulation of neuroendocrine reflexes to the establishment ofcomplex social and bonding behaviours. Experimental studies inanimals together with case reports in humans suggest that OT affectsdifferent aspects of sexual behaviour with predominantly facilitatoryproperties on sexual appetence and performance.Methods: Using a previously established experimental paradigm ofsexual arousal and masturbation-induced orgasm this study investi-gated the acute effects of intranasal OT-application (24 I.U.) onendocrine parameters and measures of sexual appetence and functionin men (n = 10). In a double-blind, placebo-controlled, balanced cross-over design sexual arousal and orgasm were induced by an erotic filmand masturbation. In addition to continuous neuroendocrine (oxy-tocin, cortisol, prolactin, adrenaline, noradrenaline) and cardiovascu-lar (heart rate) recordings, the quality and intensity of appetetive,


J Sex Med 2007;4(suppl 2):105–127

Tuesday, 5 December 200615.30–17.00 ForumP-05 Ejaculatory DisordersChairpersonsJ. Chen, IsraelS. Arver, Sweden

P-05-039

Dapoxetine acts supraspinally to inhibit ejaculatoryreflex in anaesthetised ratsClement, P.1; Bernabe, J.2; Gengo, P.3; Denys, P.4; Laurin, M.2; Alexandre, L.2; Giuliano, F.51Pelvipharm Laboratories, Gif sur Yvette, France; 2Pelvipharm Laborato-ries, Pharmacology & Physiology, Gif sur Yvette, France; 3Alza Corporation,Research & Development, Mountain view, USA; 4Poincaré Hospital, Neuro-Uro-Andology, Garches, France; 5Hopital de Bicetre, Dept. of Urology CHUde B, Le Kremilin Bicetre, Cedex, France

Objective: Dapoxetine, a short-acting selective serotonin reuptakeinhibitor, has been shown effective in delaying ejaculation in patientscomplaining with premature ejaculation. However, its mechanism ofaction is still not clearly established. The aim of the study was to deter-mine whether dapoxetine acts at the spinal or supraspinal level toinhibit ejaculation.Methods: Analysis of pudendal motoneurone reflex discharges elicitedby electric stimulation of the dorsal nerves of the penis (PMRD) wasused to investigate the effects of dapoxetine on the ejaculatory expul-sion reflex in anaesthetised male rats. A spinal site of action was eval-uated by testing the effects of intrathecal (i.t.) dosing of dapoxetine onPMRD. A supraspinal site of action was evaluated by testing the effectof i.v. administration of dapoxetine on PMRD in rats with chemicalbilateral lesion of the lateral paragigantocellular nucleus (LPGi).Results: As compared to control (NaCl 0.9%, i.t.; n = 5), i.t. injectionof dapoxetine (1 and 80 µg; n = 5) significantly increased amplitude ofPMRD in a similar fashion as serotonin (5-HT; 10 and 100 µg, i.t.; n =5). In rats (n = 12) having received bilaterally NaCl 0.9% into LPGi,i.v. treatment with dapoxetine (3 mg/kg) induced a significant delay inPMRD latency and decrease in PMRD amplitude when compared topre-treatment values. These effects were abolished in rats (n = 8) havingkainic acid bilaterally administered into LPGi one day before test.Conclusion: The present study demonstrated that, in anaesthetisedrats, dapoxetine inhibits ejaculatory expulsion reflex by acting at asupraspinal level with LPGi as a necessary brain structure for thiseffect.Policy of full disclosure: This study was sponsored by Johnson &Johnson.

P-05-040

Vibratory ejaculation and home insemination in 140spinal cord injured men and their partnersSönksen, J.1; Löchner-Ernst, D.2; Ohl, D.3

1Amtssygehuset i Herlev, Dept. of Urology, Denmark; 2BG-UnfallklinikMurnau, Dept. of Urology, Germany; 3University of Michigan, Dept. ofUrology, Ann Arbor, USA

Objective: Ejaculatory dysfunction and impairment of semen qualityare commonly found in men after spinal cord injury (SCI). Each con-dition alone or in combination has the potential to interfere with theability of the individual and their partner to have children. Over thepast several decades, clinical treatments and techniques have beendeveloped allowing SCI men to father children. The purpose of thisstudy is to present the last 20 years’ experience from penile vibratorystimulation (PVS) and vaginal self-insemination at home in SCI menand their partners.Methods: A total of 140 SCI men with anejaculation and their healthypartners seeking treatment for infertility were included in this study.Ejaculation was induced by PVS and basic semen analysis was per-formed. Only men who obtained antegrade ejaculation by PVS and

had motile sperm in the ejaculate were included. The couples werecarefully instructed to perform PVS by themselves at home. The timeof ovulation was identified by monitoring the basal body temperature.The ejaculate was collected into a nonspermicidal container. A 10-mLsyringe was then used to instill the ejaculate intravaginally. The mainoutcome measures were total sperm motility count, time to pregnan-cies, numbers of pregnancies and abortions.Results: The median total motile sperm count was 29 millions (1–92).Overall, 57 of the 140 couples (41%) achieved 82 pregnancies withdelivery of 73 healthy babies (71 singletons and 1 pair of twins). Themedian time to pregnancy was 1.9 years (0.5–8.2). A total of 10 abor-tions in 9 couples were noted. No complications from PVS and homeinsemination procedures were reported.Conclusion: Based on the largest study to date PVS and vaginal self-insemination performed by a couple at home is a viable and inexpen-sive option for men with SCI with adequate semen parameters.Policy of full disclosure: Sönksen, Jens: Shareholder in Multicept A/S.

P-05-041

Dapoxetine for the treatment of prematureejaculation: Low incidence of sexual side effectsShabsigh, R.1; Pryor, J.2; Tesfaye, F.3

1USA; 2University of Minnesota, Department of Urologic Surgery, Min-neapolis, MN, USA; 3J&J Pharmaceutical Researc, Clinical Biostatistics,Raritan, NJ, USA

Objective: Some patients receiving chronic daily dosing of selectiveserotonin reuptake inhibitor (SSRI) antidepressants for the treatmentof premature ejaculation (PE) have reported decreased sexual desireand penile rigidity. The sexual side effect profile of dapoxetine, a short-acting SSRI being developed specifically for the on-demand treatmentof PE, was evaluated in an integrated analysis of two double-blind, ran-domized, placebo-controlled trials of identical design and a long-termextension of those trials.Methods: The double-blind trials enrolled men ≥18 years of age whomet the DSM-IV-TR criteria for PE, had an intravaginal ejaculatorylatency time (IELT) of ≤2 min in ≥75% of intercourse episodes duringa 2-wk baseline period, and had self-reported moderate-to-severe PE.Men with erectile dysfunction were excluded. After 12 wks of treat-ment with placebo, dapoxetine 30 mg, or dapoxetine 60 mg, men wereeligible to enroll in a 9-month, open-label extension phase, duringwhich each received dapoxetine 60 mg. Adverse events were recordedat each visit (baseline and wks 4, 8, and 12 of the double-blind phase;months 1, 2, 3, 6, and 9 of the open-label phase).Results: Men received placebo (n = 870), dapoxetine 30 mg (n = 874),or dapoxetine 60 mg (n = 870) in the double-blind phase; from thesegroups, 615, 607, and 552 enrolled in the open-label phase (dapoxe-tine 60 mg; 194 later reduced to 30 mg). In the double-blind phase,sexual side effects were reported by 1.9% receiving placebo and 4.3%and 5.3% receiving dapoxetine 30 and 60 mg, respectively, but only0.9% led to study discontinuation. In the open-label phase, sexual sideeffects were reported by 2.6%, and 0.9% led to study discontinuation.Most were mild to moderate in severity.Conclusion: The incidence of sexual side effects associated with on-demand dapoxetine is low and appears tolerable.Policy of full disclosure: These studies were funded by Johnson &Johnson Pharmaceutical Research & Development, Raritan, NJ.


J Sex Med 2007;4(suppl 2):105–127

P-05-042

Open pilot studies and a multi-centre, open-label,parallel-group study of the Sexual AssessmentMonitor (SAM) in patients with premature ejaculationDinsmore, W.1; Ralph, D.2; Kell, P.2; Wylie, K.3; Dean, J.4; Novak, C.5;Wyllie, J.5; Wyllie, M.6

1Royal Victoria Hospital, Genito-Urinary Medicine Depart, Belfast, Ireland;2Hospital of St Johns and St El, Urinary Medicine Department, London,United Kingdom; 3Porterbrook Clinic, Urinary Medicine Department,Sheffield, United Kingdom; 4The Salisbury Clinic, Urinary MedicineDepartment, Plymouth, United Kingdom; 5Plethora Solutions, Clinicaldevelopment, London, United Kingdom; 6Plethora Solutions, London, UnitedKingdom

Objective: To determine mean and individual times to erection, andejaculation, and ejaculatory latency times (ELT) using the SexualAssessment Monitor (SAM), a novel diagnostic device designed tocollect electronic data on ELT.Methods: Three clinical studies were conducted in centres across theUK on men aged between 18–75 years. The first and second were openpilot studies in healthy volunteers and men with self-reported PErespectively. The third was a multi-centre, open-label, parallel-groupstudy in healthy volunteers and in patients with PE (defined usingDSM-IV criteria). SAM consists of a control box with two front attach-ments, a vibrator (stimulator) and sensor, which are attached to thepenis. Visual sexual stimulation and vibratory stimulation are startedsimultaneously. Ejaculatory pulses are detected by the sensor andtransmitted to a data recorder, where a computer-generated algorithmidentifies times to erection and ejaculation and ELT.Results: Times to erection and ejaculation and ELT values wereobtained from 53 healthy volunteers and 55 patients with PE. Whenthe data was adjusted for differences between the individual studies thegeometric mean time to erection was similar between the two groups2:23 minutes for healthy volunteers and 1:44 minutes for the PEpatients. As expected the geometric mean time to ejaculation washigher in healthy volunteers compared with PE patients (10:12 vs 4:54minutes, respectively) and was supported by a statistically significanthealthy volunteers to PE patient ratio (2:08: p < 0.0001). ELT valueswere also higher in healthy volunteers compared with PE patients(6:15 vs. 2:11 minutes, respectively) with a statistically significanthealthy volunteers to PE patients ratio (2:87; p < 0.001).Conclusion: SAM can consistently and safely measure times to erec-tion (from vibration start) and ejaculation, and ELT in healthy volun-teers and PE patients.

P-05-043

Retarded ejaculation: A psycho-physiological approachforassessment and management in 22 patientsRub, R.1; Kreizman, M.1; Chen, Y.2; Hegarty, P.3; Nahum, E.1

1Hillel Yaffe Medical Center, Urology, Hadera, Israel; 2Tel-Aviv SouraskyMedical Cent, Urology, Tel Aviv, Israel; 3Institute of Urology, University,Urology, London, United Kingdom

Objective: Retarded ejaculation is the inability to ejaculate within thevagina, despite a firm erection and relatively high levels of sexual stim-ulation. Apart from the reproduction problem, it has a negative effecton the couple’s quality of life. Prevalence ranges from 4% to 10%. Theaim of this study was to evaluate the treatment results of such anuncommon but difficult sexual dysfunction problem.Methods: Between the years 1999–2006 we treated 22 heterosexualmen with a mean age of 27 years (range 19–35), diagnosed withretarded ejaculation. All had not reached vaginal ejaculation for at leastsix months prior to treatment. None had libido or erectile dysfunctionproblems. All men underwent physical examination, medical and

sexual history was taken and IIEF questionnaire was completed.Therapy consisted of treatment by sex therapy, instructed masturba-tion, adapted sex position techniques and couple therapy.Results: Mean treatment period was 5 months (range 2–10). Follow-up was 6 months (mean 4–18). Successful treatment was defined as theability to achieve intravaginal ejaculation within an acceptable lengthof time. At the end of the treatment, three patients (13.6%) were ableto ejaculate. One was not able to ejaculate even by masturbation andneeded electro-stimulation to produce sperm. All three preserved theirejaculatory ability at follow-up at 18 months.Conclusion: Disorders of the ejaculatory threshold, such as lifelongretarded ejaculation, are fairly uncommon and can have a great impacton quality of life. The treatment we offered to our selected patientgroup was multidisciplinary. Nevertheless, we obtained relatively low success rate. Retarded ejaculation is an underestimated medicalproblem, probably due to its low prevalence. It is probably a mixedorganic and psychological sexual dysfunction problem. At presentthere are no objective data relating to the etiology, treatment andoutcome. This condition warrants Further research.

P-05-044

Further validation of the newly developed PrematureEjaculation Diagnostic ToolSymonds, T.1; Perelman, M.2; Althof, S.3; Giuliano, F.4; Martin, M.5;Abraham, L.1; Crossland, A.6; Morris, M.6; May, K.7

1Pfizer Ltd, Worldwide Outcomes Research, Sandwich, United Kingdom;2Cornell University, Weill Medical College, New York, USA; 3Case WesternReserve Universit, Medical School, Cleveland, USA; 4Raymond PoincareHospital, Urology Department, Paris, USA; 5Health Research Associates,Health Research Associates, Seattle, USA; 6Pfizer LTD, Clinical Statistics,Sandwich, United Kingdom; 7Pfizer ltd, Clinical Development, Sandwich,United Kingdom

Objective: To assess the Premature Ejaculation Diagnostic Tools(PEDT) diagnostic capability against expert clinical diagnosis (con-vergent validity), and also designed to assess retest reliability.Methods: 102 men aged 20 to 75 years old (Mean = 37.5, SD 10.4)were recruited and interviewed: 35 men without PE (aged 26 to 75,Mean = 38.9, SD = 10.4) and 67 men with PE (aged 20 to 60, Mean= 36.8, SD = 10.4). Men were screened as PE positive if they reportedejaculating in less than 2 minutes at least 50% of the time and wereexperiencing distress as a result of their PE. The non-PE group hadno problems with PE, or any other sexual dysfunction. Men inde-pendently completed the PEDT and were then interviewed by anexpert clinician who had no knowledge of their responses to thePEDT. The Kappa statistic was used to determine level of agreementin diagnosis between the two methods. Two weeks after the diagnos-tic interview, each participant was mailed a retest PEDT questionnaireto complete. The Intraclass Correlation Coefficient was used to assessPEDTs reliability.Results: The frequency of agreement between the PEDT and expertdiagnosis was high: 0.82 (95% CI = 0.70 to 0.94). The PEDT onlydiagnosed 6 men (16%) who were not diagnosed as having PE by theexperts (false positives). Conversely, the PEDT only failed to diagnosePE in 2 men (3%) who were diagnosed as having PE by the experts(false negatives). Test-retest reliability of the PEDT was high—0.88 (n= 87); indicating excellent stability over time.Conclusion: The development and validation of the PEDT haveresulted in a new, user-friendly, self-report questionnaire to be used todiagnose PE for future clinical trials and also screen men in clinicalpractice.Policy of full disclosure: Symonds, Abraham, Crossland, Morris andMay are all employees of Pfizer Ltd Perelman, Althof, Giuliano wereall paid consultants to Pfizer Ltd.


J Sex Med 2007;4(suppl 2):105–127

P-05-045

TEMPE, a novel aerosol delivery form of lidocaine-prilocaine for the treatment of premature ejaculationDinsmore, W.1; Hackett, G.2; Goldmeier, D.3; Waldinger, M.4; Dean, J.5;Wright, P.6; Callander, M.7; Wylie, K.8; Novak, C.9; Keywood, C.9; Heath, P.10; Wyllie, M.11

1Royal Victoria Hospital, Genito-Urinary Medicine Depart, Belfast, Ireland;2Good Hope Hospital, Genito-Urinary Medicine Depart, Sutton Coldfield,United Kingdom; 3St Mary’s Hospital, Genito-Urinary Medicine Depart,London, United Kingdom; 4Haga Hospital, Urinary Medicine Department,The Hague, Netherlands; 5The Salisbury Clinic, Genito-Urinary MedicineDepart, Plymouth, United Kingdom; 6Belmont Surgery, Genito-UrinaryMedicine Depart, Durham, United Kingdom; 7Alliston Medical Centre—,Genito-Urinary Medicine Depart, Manchester, United Kingdom; 8Poter-brook Clinic, Urinary Medicine Department, Sheffield, United Kingdom;9Plethora Solutions, Clinical development, London, United Kingdom;10Plethora Solutions, Medical Officer, London, United Kingdom; 11PlethoraSolutions, London, United Kingdom

Objective: To evaluate the efficacy and tolerability of TEMPE as atreatment for premature ejaculation.Methods: Men with PE (defined via DSM-IV criteria) aged between18–75 years were enrolled into a double-blind, placebo-controlledstudy in the UK and The Netherlands. Patients were randomised toself-apply three sprays of TEMPE (delivering a total of 22.5 mg lido-caine and 7.5 mg prilocaine) or placebo prior to sexual intercourse on four consecutive occasions. Efficacy variables included the meanchange in intravaginal ejaculatory latency time (IELT) from baseline,and the effect of TEMPE on the index of ejaculatory control (IEC;patient only), and sexual quality of life for both patients and partners.IELT was recorded using a stopwatch and adverse events were alsorecorded.Results: Fifty four patients were randomised and received study treat-ment. The observed mean change in IELT from baseline to the endof the treatment period was higher in the TEMPE group; 3.8 minutescompared to 0.7 minutes in the placebo group. After adjusting the datafor baseline and centre, the mean change in IELT from baseline was2.4 times higher in the TEMPE group compared to placebo (p < 0.01).55% of TEMPE-treated patients and 35% of placebo-treated patientshad an IELT ≥ 2 minutes (i.e. normal duration of sexual intercourse)on at least two occasions post-treatment. Improvements in the IECscore and sexual quality of life were observed from the TEMPE groupcompared to baseline. Mild to moderate local numbness occurred in11.5% of TEMPE-treated patients but there were no discontinuationsdue to this.Conclusion: TEMPE produced a statistically and clinically significantincrease in IELT compared with placebo. TEMPE was well tolerated,devoid of systemic side effects, and offers a convenient treatmentoption for patients with PE.

P-05-046

Effects of selective phosphodiesterase inhibitors onthe contractile responses of isolated human seminalvesicle tissueBazrafshan, S.1; Ückert, S.1; Mayer, M.2; Jonas, U.1; Stief, C.2

1Hannover Medical School, Dept. of Urology, Germany; 2University Hospi-tal Grosshader, Dept. of Urology, Munich, Germany

Objective: It has been speculated that the capability of the PDE5-inhibitor sildenafil citrate (VIAGRA) to retard the ejaculatory responsemay include modulation of the contraction of the seminal vesicles (SV).Indeed, it has been shown that PDE inhibitors can reverse the tensionof isolated human SV smooth muscle and enhance the tissue produc-tion of cyclic AMP and cyclic GMP. In order to elucidate further thismechanism we examined the effects of selective PDE inhibitors on the

spontaneous and EFS-induced contractions of isolated human SVsmooth muscle.Methods: SV tissue was obtained from 15 male subjects (mean age:68 years) who had undergone pelvic surgery. Using the organ bathtechnique, the effects of increasing concentrations (1 nM–10 mM) ofthe PDE inhibitors vinpocetine (PDE1-inhibitor), rolipram (PDE4-inhibitor), sildenafil and vardenafil (PDE5-inhibitors) on phasic contractions of SV tissue strips either mediated by electrical field stim-ulation (EFS) or the alpha-receptor agonist norepinephrine wereinvestigated.Results: The contractions induced by field stimulation were sensibleto TTX and the alpha-adrenoceptor antagonist prazosin. The con-tractile activity in response to EFS was dose-dependently reversed bythe PDE inhibitors. The rank order of efficacy was: rolipram > silde-nafil 3 vardenafil > vinpocetine. Mean Rmax values were determinedas 89.6% (rolipram) 61.3% (sildenafil), 62% (vardenafil), and 46%(vinpocetine). No differences were registered with regard to the effectsof sildenafil or vardenafil on the inhibition of the contraction ampli-tudes. The frequency of the spontaneous contractions (amplitudes/5min) was reduced by 50% in the presence of 2 µM rolipram, 5 µMsildenafil or vardenafil, and 8 µM vinpocetine.Conclusion: Our results demonstrate that PDE-inhibitors can inhibitEFS-induced and spontaneous contractile activity of isolated humanSV tissue. These findings might be of importance with regard to thepharmacological treatment of premature ejaculation.

P-05-047

Does sildenafil alleviate premature ejaculation—a double blind, placebo control cross-over studyChen, J.1; Bar-Yosef, Y.1; Sofer, M.1; Mabjeesh, N. J.1; Greenstein, A.1;Matzkin, H.1

1Tel-Aviv Sourasky Medical Cent, Urology, Israel

Objective: To evaluate the role of sildenafil in the treatment of pre-mature ejaculation (PE).Methods: Sixty-one men (mean age 32, range 21–49 years), sufferingfor PE and having normal erectile function (EF > 26 on the Interna-tional Index of Erectile function—IIEF), were enrolled in a doubleblind, placebo control cross-over study. Men were randomly treatedwith either sildenafil or placebo for 4 weeks, and following a washoutperiod crossed-over for a further 4 weeks. Treatment efficacy wasassessed using self administered questionnaires before and after eachtreatment period including International index of ejaculatory control(IIEC), PE question of Center for Marital and Sexual Health(CMASH) questionnaire, specially designed visual scale ejaculatorylatency time questionnaire (ELTQ), IIEF, and a global assessmentquestion (GAQ): Did you have better control over your ejaculationduring treatment?—yes/no.Results: Five participants withdrew from the study. Significantimprovement was observed in all scores of IIEC during sildenafilperiods, as compared to placebo (P < 0.001), except for the frequencyof ejaculation (P = 0.2). Patients improving on sildenafil returned tobaseline pretreatment scores when crossed-over to placebo. Score ofCMASH PE question increased from 4.07 (STD ± 1.92) to 6.61 (STD± 1.59) (P < 0.01) while using sildenafil, with no change during placeboperiod 5.93 (STD ± 2.01) to 6.79 (STD ± 1.70). ELTQ score increasedfrom 3.75 (STD ± 1.45) to 5.61 (STD ± 1.85) during sildenafil treat-ment (P < 0.01), with no changed while on placebo. The numbers ofpatients responding positively to the GAQ while on sildenafil was sig-nificantly higher than those on placebo (P < 0.001). No statisticallysignificant improvement was observed in the EF domain score of theIIEF in both groups.Conclusion: Sildenafil treatment of men with PE provides a statisti-cally significant improvement, as assessed by self administered ques-tionnaires.Policy of full disclosure: The study was funded by an independenteducational grant from Pfizer.


J Sex Med 2007;4(suppl 2):105–127

P-05-048

Comparison of sertralin vs. sertralin+PDE5 inhibitorsin the treatment of premature ejaculationAkkus, E.1; Alici, B.1; Ozkara, H.1; Onal, B.1; Hattat, H.1

1Cerrahpasa School of Medicine, Urology, Istanbul, Turkey

Objective: Efficacy of SSRI treatment in Premature Ejaculation (PE)is still debatable for various reasons. This is a clinical evaluation andcomparison of the efficacy of sertralin (a SSRI) vs sertralin + PDE5inhibitors in PE.Methods: 96 cases were enrolled for the study. 60 cases had completedthe study. Patients were between 22–61 years of age and described PEof <1 minute with a duration of at least 6 months. All cases had stabi-lized partners. 30 cases received sertralin 50 mg only and 30 cases ser-tralin 50 mg + PDE5 inhibitors (15 sildenafil 50 mg or 15 vardenafil10 mg) for 3 months. Patients were evaluated at the end of 3 monthstreatment by their subjective clinical evaluation according to the ques-tion of 3 options. 1) No change 2) slight improvement 3) significantimprovement.Results: 30 cases with sertralin 50 mg 14 (46.6%) reported no change,11 (36.6%) had slight improvement, 5 (17.7%) had significantimprovement. In group sertralin + PDE5 inhibitors 7 (23.3%) had nochange 13 (43.3%) had slight improvement and 10 (33.3%) reportedsignificant improvement. Efficacy of sildenafil or vardenafil in im-proved cases were similar. Minor side effects due to SSRI and/or PDE5inhibitors were temporary.Conclusion: Based on a clinical observation study, combination ofSSRI + PDE 5 inhibitors in the treatment of PE seems promising.Randomized placebo controlled studies may reveal scientific efficacyof such treatments.Policy of full disclosure: I had been participated on clinical studiesof Pfizer, Bayer, and Lilly companies. I had and have been participatedas a speaker in various meetings for the abovementioned companies.

Wednesday, 6 December 200608.00–09.30 ZeremoniensaalP-06 Erectile Dysfunction following Radical

ProstatectomyChairpersonsM. Marberger, AustriaA. Briganti, Italy

P-06-049

Identification of predictors of functional outcome ofopen nerve-sparing radical prostatectomyAlbersen, M.1; Joniau, S.2; van Poppel, H.2

1Antwerpen, Belgium; 2University Hospitals Leuven, Urology, Belgium

Objective: To report functional outcome of open nerve-sparingradical retropubic prostatectomy (NS RRP), and to identify predictorsof postoperative erectile function, ability to achieve orgasm and continence.Methods: Between January 2001 and November 2004, 272 patientsunderwent uni- or bilateral NS RRP at our institution. At a minimumof 18 months post-surgery, patients received a questionnaire on erec-tile function, ability to achieve orgasm, and continence. Patientsreporting erectile dysfunction pre-operatively, and patients whoreceived adjuvant therapy (radiotherapy and/or hormone treatment)were excluded.Results: The response rate was 71.7% (n = 195). A further 34 patientswere excluded, leaving 161 patients for the final analysis. Mean age was59.44 years (range 45–75). 55% Underwent bilateral, 45% unilateralor partial bilateral nerve sparing surgery. Overall full recovery rate ofpotency using single-item assessment (erections firm enough for pen-etration) was 36.1%. Postoperatively, 29.3% of patients reported anor-gasmia, where pre-operatively none of the patients had anorgasmia.One patient (0.6%) suffered from incontinence grade 3, indicating paduse of more than one pad per day.Conclusion: Because of an increased detection of organ confinedprostate cancer, the demand for nerve-sparing surgery is rising. In ourgroup, recovery of potency, continence and orgasm were mainly cor-related with age and blood loss. The single factors that can be influ-enced are blood loss and quality of nerve-sparing, which stresses theimportance of proper anatomical surgical technique.

P-06-050

Severe drop-off rate from the treatment for erectiledysfunction in non-counselled patients after bilateral nerve sparing radical prostatectomy(BNSRRP)Salonia, A.1; Gallini, A.1; Zanni, G.1; Briganti, A.1; Doha F.1; Suardi, N.1;Sacca, A.1; Capitanio, U.1; Petraia, G.1; Rigatti, P.1; Montorsi, F.1

1IRCCS San Raffaele, Urologia, Milano, Italy


J Sex Med 2007;4(suppl 2):105–127

Objective: The aim of this prospective study was to assess the dis-continuation rate from erectile dysfunction (ED) treatment in patientsnon specifically counselled after a BNSRRP.Methods: From November 2002 to September 2005, 1032 consecu-tive patients underwent RRP at our institution. Overall, 500 (48.4%)patients underwent BNSRRP. We analyzed discontinuation data of 100consecutive, age-comparable, BNSRRP patients who at the dischargefrom the hospital freely decided whether to use or not any ED therapy,and who did not receive any specific counselling about the ED treat-ment throughout the entire follow-up period.Results: All exclusions resulted in 78 (78%) (mean age at surgery: 61.7± 5.8 yrs) evaluable patients. Exclusively according to their own pref-erence, patients were assigned to: Group 1, 38 (49%) patients whodecided not to use any compound to recover postoperative EF; Group2, 28 (36%) patients who preferred a prn phosphodiesterase type 5inhibitor (PDE5-I); Group 3, 12 (15%) men who decided to use aPDE5-I with a continuous posology. At the 18-month FU, the overalldrop-off rate from both prn and continuous PDE5-I treatment was72.5%. Treatment effect below expectations was the main reason oftreatment drop-off, following by loss of interest in sex due to patient’spartner causes.Conclusion: A significant proportion of non adequately counselledpatients discontinued PDE5-I treatment after BNSRRP. Main reasonsfor this significantly high drop-off rate are effects below the expecta-tions and loss of interest in sexual activities for both the patients andthe patient’s partners.

P-06-051

The impact of nerve sparing surgery and the recovery of erections on penile shortening afterradical prostatectomyGalzerano, M.1; Magnani, C.2; Castigli, L.3; Mondaini, N.4; Gontero, P.5

1Universita’ Piemonte Orientale, Igiene, Novara, Italy; 2Universita’Piemonte Orientale, Statistics, Novara, Italy; 3Univerista’ di Firenze,Urology, Italy; 4Clinica Urologica Firenze, Urology, Novara, Italy; 5Novara,Italy

Objective: Aim of the present study was to assess penile changes byperforming serial penile measurements starting at the time of catheterremoval up to 1 year postoperatively. The potential effect of nervesparing surgery and the recovery of erectile function on the degree ofpenile shortening was also evaluated.Methods: One hundred and twenty six consecutive patients wereenrolled. Penile measurements (flaccid and stretched length, girth)were undertaken immediately before surgery, at catether removal andat 3, 6 and 12 months postoperatively. Sexual function was assessed atbaseline and at 3, 6 and 12 months by the erectile function (EF) domainof the IIEF.Results: Study compliance was high with 1 year measures available for83% of the enrolled cohort. The maximum degree of shorteningoccurred at catether removal (mean value of 0.84 cm, CI 0.62–1.06, p< 0.0001 for stretched penis). All penile parameters showed a lesserbut significant decrease at all subsequent time intervals. On univariateanalysis, baseline penile length was the only variable significantly asso-ciated with penile stretched changes at catether removal. Age, nervesparing surgery and the recovery of erectile function were strong predictor of penile size at 1 year from surgery. Multivariate analysisretained nerve sparing surgery (<0.0001) and the recovery of erectilefunction (p = 0.053) as independent predictors of the final changes inpenile size.Conclusion: Penile shortening after RP peaks at the time of catetherremoval and it continues to a lesser but yet significant degree at leastup to one year. Nerve sparing surgery and recovery of erectile func-tion showed an independent protective effect on penile length loss at1 year. These figures should be taken in consideration when coun-selling patients for RP.

P-06-052

Histological alterations in cavernous tissue afterradical prostatectomyVerze, P.1; Iacono, F.1; Imbimbo, C.1; Fusco, F.1; Longo, N.1; Mangiapia, F.1;Mirone, V.21University “Federico II”, Urology, Naples, Italy; 2University, Urology,Naples, Italy

Objective: Radical prostatectomy often results in erectile dysfunctionbecause of lesions to the erectile nerves. In this study we evaluated his-tomorphological alterations in cavernous smooth muscle and collagencontent after radical prostatectomy.Methods: A total of 19 patients between 57 and 69 years old withprostate adenocarcinoma and normal erectile function, as reported andvalidated by RigiScan (UroHealth Systems, Laguna Niguel, Califor-nia) testing, underwent corpora cavernosa biopsy in the operatingroom before radical prostatectomy, and 2 and 12 months after surgery.No patient underwent hormone therapy before or after surgery andnone was diabetic. Elastic fibers (manual counting), muscle specificactin (immunostaining) and collagen content (computerized morpho-metric imaging) were measured in the 3 biopsies.Results: In all cases the first postoperative histological assessmentrevealed some disorganization. Trabecular elastic fibers (p < 0.0003)and smooth muscle fibers were decreased and collagen content was sig-nificantly increased (p < 0.0003) compared with preoperative biopsies.One year after surgery elastic fibers (p < 0.0003) and smooth musclefibers were decreased and collagen content was significantly increased(p < 0.0003) compared with the first postoperative biopsy. Moreover,organized collagen and trabecular protocollagen deposits wereincreased.Conclusion: Progressive fibrosis in the corpora cavernosa after radicalprostatectomy probably results from denervation and/or an ischemicprocess, which is caused in turn by the ligation of anomalous puden-dal artery branches or of venous plexuses that drain to or from thecorpora cavernosa. Fibrosis and the subsequent loss in elasticity andfunction of erectile tissue probably together cause erectile dysfunction.

P-06-053

Effect of sildenafil administration on penile hypoxiainduced by cavernous neurotomy in the ratVignozzi, L.1; Morelli, A.1; Filippi, S.2; Marini, M.3; Vannelli, G. B.3; Forti, G.1; Maggi, M.1

1University of Florence, Clinical Physiopathology, Italy; 2University of Flo-rence, Pharmacology, Italy; 3University of Florence, Anatomy Histology andForensic, Italy

Objective: Radical prostatectomy is an effective therapy for men withclinically localized prostate cancer. A significant number of mendevelop erectile dysfunction after radical prostatectomy (PPED) dueto intraoperatory cavernous nerve injury causing hypoxia and fibrosisof corpus cavernosus. We established an experimental model of bilat-eral cavernous neurotomy (BCN) in the rat in order to investigatewhether sildenafil treatment in PPED patients could prevent peniletissue damage.Methods: One, 5 and 10 days after neurotomy, animals were treatedor not with a single dose of sildenafil (25 mg/kg orally) one hour beforesacrifice. To analyze penile oxygenation, rats of each experimentalgroup received (one hour before sacrifice) an intraperitoneal injectionof the bio-reductive drug pimonidazole hydrochloride (hypoxypro-beTM-1, 60 mg/Kg), which has been recognized as a standard markerfor in vivo imaging and quantification of hypoxia.Results: With immunohistochemistry for hypoxiprobeTM, we foundthat BCN induced massive hypoxia at all times investigated in corporacavernosa sections from the experimental rats, as revealed by com-puter-assisted quantitative image analysis. This tissue hypo-oxygena-tion was significantly reduced in sections from sildenafil treated rats at1 and 5 days after neurotomy, while at 10 days this reduction was lessevident and not significant. In addition, functional studies indicatedthat hypoxic corpora cavernosa tissues were hypersensitive to the relax-


J Sex Med 2007;4(suppl 2):105–127

ant effect of the endothelin receptor type B (ETB) agonist IRL-1620,due to the previously described hypoxia-induced overexpression ofETB receptors. Accordingly, ETB mRNA expression (real time RT-PCR) was significantly increased in corpora cavernosa from BCN rats,and was restored to control levels by sildenafil administration at alltimes investigated.Conclusion: Our results indicate that sildenafil treatment can posi-tively influence penile tissue oxygenation after cavernous nerve injury,with its effect being more evident the earlier it is administered.

P-06-054

Low-dose sildenafil improves recovery of erectilefunction after nerve-sparing radical 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 Schleswig-, Dept. of Urology, Kiel, Germany

Objective: In previous prospective studies we showed nocturnal peniletumescense and rigidity (NPTR) in the acute phase during the firstnight after catheter removal in 93% of the patients after nerve-sparingradical prostatectomy.Methods: 43 sexual active patients were operated by nerve-sparingretropubic radical prostatectomy. All patients completed an IIEF-5questionnaire preoperatively. NPTR-measurement (Rigi-Scan®) wascarried out at the following night after catheter removal. 23 patientswith preserved nocturnal erections detected during NPTR-recordingsreceived sildenafil 25 mg/d at night. 18 patients underwent follow upwithout PDE-5-inhibitors. IIEF-5 questionnaire was performed 6, 12,24, 36 and 52 weeks after operation.Results: The preoperative IIEF-5 was >16 in all patients. 41 of 43patients (93%) showed 1–5 erections during the first night aftercatheter removal. In the group of daily sildenafil the IIEF-5 scoredecreased from preoperative 20.8 mean score to 3.6 at 6 weeks, 3.8 at12, 5.9 at 24, 9.6 at 36 and 14.1 mean score at 52 weeks after prosta-tectomy. In the control group preoperative IIEF-5 mean score 21.2decreased to 2.4 at 6 weeks, 3.8 at 12, 5.3 at 24, 6.4 at 36 and 9.3 at52 weeks. Statistical evaluation showed a significant difference in IIEF-5 score and time to recovery of erectile function (p < 0.05) with potency rates of 86% vs. 66%.Conclusion: The measurement of NPTR after nerve-sparing radicalprostatectomy showed erectile function even at the “first” night aftercatheter removal. In case of early penile erections the cavernous nervewas well preserved during surgery providing good neuronal integrityand daily low dose PDE-5 inhibitors lead to a significant improvementof recovery of erectile function and is supportive to the organic rehabilitation.

P-06-055

A prospective, randomized, placebo-controlledmulticentre study on the effectiveness of oral sildenafilin preventing postoperative erectile dysfunctionfollowing radical retropubic prostatectomyKunelius, P.1; Häkkinen, J.2; Ohtonen, P.3

1Oulu, Finland; 2Tampere University Hospital, Urological Department,Oulu, Finland; 3Oulu University Hospital, Urological Department, Finland

Objective: To determine whether the regular use of sildenafil reducesED after radical prostatectomy. To determine the general satisfactionwith erections before vs. after operation with the regular prophylacticuse of sildenafil.Methods: A prospective, randomized, double-blind, placebo-controlled clinical study carried out as multicentre study. Totally 115men without ED (sexually active, IIEF score 20 or more) did attendto preoperative visit, 107 men were randomized to the study (54 inplacebo group, 53 in sildenafil group). Men receiving active treatmenttook a 100 mg sildenafil tablet every night, control group a placebotablet. Medication did last 6 months and at one year after operation

was a control visit. IIEF, side-effects and state of condition was evalu-ated at every visit.Results: Preoperatively IIEF-(erectile functions 1–15,15)-score was inplacebo group 23.8 and 22.7 in sildenafil group. One month after oper-ation IIEF-score was 4.5 and 6.9 respectively. Three months afteroperation IIEF-score was 6.5 and 7.3, respectively and 6 months after7.5 and 8.3, respectively. After 6 months of continous medication (1year after operation) IIEF-score was 13.0 and 10.5. Men with IIEF-score 11 or more after one month of operation had IIEF-score at 6months control 13.0 in placebo group and 17.5 in sildenafil group.85% of placebo group and 60% of sildenafil group did use some EDmedication at one years control.Conclusion: There were no significant differences between theplacebo and active medicin group during and after the medication noteven in the group of patients with slight erection after operation (IIEF-score > 11). Remarkable decrease of IIEF-score after operation wasseen despite of the fact, the operation was done as nervesparingmethod. Sildenafil was well tolerated during the study.Policy of full disclosure: Study was done with the financial help ofPfizer.

P-06-056

Long-term follow-up (FU) of intracavernous (IC)injection therapy for erectile dysfunction (ED)Salonia, A.1; Barbieri, L.1; Gallini, A.1; Briganti, A.1; Doha, F.1; Zanni, G.1;Suardi, N.1; Pellucchi, F.1; Firaz, A.1; Rigatti, P.1; Montorsi, F.1

1IRCCS San Raffaele, Urologia, Milano, Italy

Objective: To assess the long-term FU of IC injections for ED at theSexual Medicine Centre in an academic unit.Methods: From January to July 2006, 72 ED patients (mean age +/−SD: 59.7 +/− 8.4 years) with a previously use of IC therapy for morethan 6 months were re-assessed during a regular follow-up visit.Patients were assessed with a medical and sexual history. Data are pre-sented as mean +/− standard deviation of the mean (SD).Results: At the 120-month median FU (mean: 111.5 +/− 30.8; range:24–164 months), 70 (97.2%) had already tried a PDE5-I, but 56(77.8%) were still successfully using IC injections because oral pillswere neither effective nor satisfactory. Ten (62.5%) out of the patientswho discontinued IC injections preferred PDE5-Is. All patients startedwith a low-dose four-drug therapy (PDE1, papaverine, phentolamineand atropine); thirty-three (58.9%) out of the 56 patients still on ICinjections up-titrated to the high-dose IC injection therapy, 12 (21.4%)kept the same dose, and 11 (19.7%) down-titrated. A direct compari-son showed a significant increase in IIEF-EF vs baseline among ICpatients (i.e. 11.6 +/− 3.5 vs 25.9 +/− 3.2, P < 0.0001) and a significantreduction of the current monthly regimen of injections as comparedwith that at beginning (i.e., 5.2 +/− 2.2 vs 6.0 +/− 1.8, P = 0.03).Current monthly frequency of IC injections was significantly corre-lated neither with patient’s age (P = 0.43) nor with length of IC injec-tions usage (P = 0.26).Conclusion: At the 120-month median FU a significant number ofpatients still successfully used IC injections.

P-06-057

The use of the IIEF-5 questionnaire for evaluation of erectile dysfunction following nerve-sparing radical prostatectomyAlbersen, M.1; Joniau, S.2; van Poppel, H.2

1Antwerpen, Belgium; 2University hospitals Leuven, Urology, Belgium

Objective: Because of an increased detection of organ confinedprostate cancer, the demand for nerve-sparing surgery is rising. In the vast majority of studies concerning erectile dysfunction followingnerve-sparing radical prostatectomy (NS RRP), single item assessmentis used for reporting of ED post-surgery. However, potency rates differwidely between various groups. We therefore aimed to investigate theuse of the IIEF-5 for the reporting of ED following NS RRP. Objec-


J Sex Med 2007;4(suppl 2):105–127

tives: To study the results of the use of the IIEF-5 questionnaire forevaluation of post-NS RRP erectile dysfunction.Methods: At a minimum of 18 months post-surgery, patients receiveda questionnaire on erectile function including single item assessmentand IIEF-5. Ninety-one patients who reported on having no erectiledysfunction pre-operatively, who stated to be sexually active, who didnot receive adjuvant therapy were included.Results: 50 patients (55%) underwent bilateral NS RRP, 41 patients(45%) underwent unilateral or partial bilateral nerve sparing surgery.When using the IIEF-5 questionnaire, we found that a mean of 25.5%had no ED (IIEF-5 score of 22–25). However, with single-item assess-ment we saw a far higher potency rate (table).Conclusion: We studied the effect of the use of the validated IIEF-5questionnaire on reporting of erectile dysfunction following nerve-sparing surgery, and found that it results in a significantly lower per-centage of men classified as having no ED. However, it is expected tohave a higher level of validity, accuracy, and reliability, and seems morestable than the single-item assessment. We therefore think it is anexcellent instrument for the reporting of ED following RRP.

Wednesday, 6 December 200610.30–12.00 ZeremoniensaalP-07 Surgery and Peyronie’s DiseaseChairpersonsS. Droupy, FranceE. Austoni, Italy

P-07-059

Total phalloplasty using musculocutaneous latissimusdorsi free transfer flap—penile size according to thepatients wishPerovic, S.1; Djordjevic, M.2; Bumbasirevic, M.1; Djinovic, R.1; Sansalone, S.3

1School of Medicine, Belgrade U, Urology, Serbia and Montenegro; 2University Children’s Hospital, Urology, Belgrade, Serbia and Montenegro;3Tor VergataUniversity, Urology, Rome, Italy

Objective: Evaluation of long-term results of total phalloplasty tech-niques using different flaps shows unsatisfied results regarding penilesize. We present technique using latissimus dorsi free flap to creationneophallus with size according to the patients wish as well as its per-formance in children population.Methods: From April 1999 to January 2006 total phalloplasty was per-formed in 27 patients aged between 10 and 46 years (mean 26 years).Indications were: micropenis (4 patients), small penis after failed epis-padias, hypospadias or intersex repair (8), penile trauma (4) and trans-sexualism (11). A musculocutaneous latissimus dorsi free flap washarvested with thoracodorsal artery, vein and nerve. The flap was tab-ularized and transferred to the pubic region and than, anastomozed tothe femoral artery, saphenous vein and ilioinguinal nerve. Two-stagedurethroplasty was performed in 20 patients using buccal mucosa (12)or buccal mucosa combined with split thickness skin graft (8). In 7patients a Mitrofanoff channel had been created previously. Donor sitewas closed primary in 23 patients, while in the remaining 4 split thick-ness skin graft was used. Penile prosthesis was implanted in 11 patients(inflatable in 4, semirigid in 7).Results: Follow-up was from 6 to 83 months (mean 34). Penile sizevaried from 13 to 19 cm in length and from 10 to 15 cm in circum-ference. No flap necrosis, neither partial nor total, was noted. Thedonor site healed acceptably in 21 while in the remaining 6 cases mod-erate scar occurred. Function of implanted penile prostheses was satisfactory.Conclusion: The technique enables creation of neophallus with sizeaccording to the patient wish. Also, it presents possible choice for phal-loplasty in children that enables good neophallic size as in adults andavoids new surgery after puberty.

P-07-060

Efficacy of Injectable mixed collagenase subtypes forPeyronie’s disease: Treatment-related improvementsin sexual function and sexual satisfactionJordan, G.1

1Eastern Virginia Medical School, Urology, Norfolk, Virginia, USA

Objective: We conducted a 9-month open-label study to evaluate theefficacy of injectable mixed collagenase subtypes (AA4500; AuxiliumPharmaceuticals, Inc.) in patients with Peyronie’s Disease (PD).Methods: Patients with well-defined PD (n = 10) received 3 injectionsof 0.58-mg AA4500 over 3–8 days; injections were repeated after 6 and12 weeks. The primary efficacy outcome was change from baseline indeviation angle and plaque size; a 25% reduction in either measure was considered a clinical success. Investigators’ global assessment ofimprovement was recorded. Sexual functioning was assessed at base-line and 9 months after the first injection series using the Peyronie’sPatient Questionnaire. Responses ranged from 1 (worst/least) to 5(best/most).

P-06-058

Reconsidering the use of IIEF questionnaire inevaluating the preoperative erectile function status ofpatients undergoing radical prostatectomyPapadoukakis, S.1; Kusche, D.1; Löppenberg, B.1; Stolzenburg, J. U.2; Truss, M. C.1

1Klinikum Dortmund, Urology, Germany; 2University Leipzig, Urology,Germany

Objective: It is well know that IIEF has been the major epidemiologicand diagnostic questionnaire to evaluate the erectile dysfunction. Thesurgical modifications of the radical prostatectomy that allow the preserving of the neurovascular bundle have made the use of IIEF apreoperative necessity. However, the patients themselves have oftenreported that the results of the questionnaire for the time interval inquestion (the last four weeks) are nor representative.Methods: The last 123 patients that underwent endoscopic radicalprostatectomy filled in the IIEF score, and the EF domain score. Thetime interval between the diagnosis of the disease and the surgery wasmore than a month. Additionally the patients filled in the same ques-tionnaire but regarding to the last four weeks prior to their prostatebiopsy, as a modificated index of their sexual status (IIEFm).Results: The average age of the patients was 64.6 years (52–78) andhad no impact on patients’ potency. The preoperative clinical stage ofdisease was cT1c (35%), cT2a (50%), cT2b (5%) and cT2c (10%).The mean IIEF score of those patients was 42.61 while their mean EFdomain score was 17.43. Simultaneously the patients filled in the“modificated” IIEF (IIEFm) questionnaire. The mean IIEFm was54.82 while the EFm domain score was 23.59. All the differences werestatistical significant.Conclusion: The patients reported that they had major psychologicaldepression after the diagnosis of their disease and that had a discour-aging effect on their libido. Additionally, they reported symptoms suchas post biopsy prostatitis, bleeding, perineal pain and hemospermiathat had also an inhibiting effect on their sexual life. Therefore wesuggest that, any decision about a nerve-sparing radical prostatectomyshould be considered also with respect to the patients’ potency priorto the prostate biopsy.


J Sex Med 2007;4(suppl 2):105–127

Results: AA4500 significantly reduced deviation angle from baselineto month 9 (P < 0.001), and clinical success was achieved in 89% ofevaluable patients (n = 9). The investigator deemed 67% of patients“improved” or “very much improved.” Patient-reported sexual func-tion showed significant improvements from baseline in enjoyment ofintercourse (P = 0.023), satisfaction with sexual relationships (P =0.043), and freedom from pain during erection (P = 0.009). At base-line, 4 patients reported no sexual activity; only 1 patient reported“highly” or “very highly enjoyable” experiences. By month 9, all evalu-able patients were sexually active (9/9), and 4 reported “highly” or“very highly enjoyable” experiences. At baseline, 5 patients were “verydissatisfied” with their sexual relationships; by month 9, none were“very dissatisfied.” At baseline, 6 patients reported moderate/minimalpain with erection; by month 9, all patients had pain-free erections.Ten patients experienced treatment-related adverse events, mostlymild in severity and consistent with treatment expectations.Conclusion: AA4500 improved physical symptoms of PD and patient-reported sexual function and satisfaction up to 9 months after treat-ment. Larger controlled trials are needed to confirm these promisingresults.Policy of full disclosure: Auxilium Pharmaceuticals, Inc—ClinicalTrial Engineers & Doctors—Consultant & Clinical Trial Mentor—Clinical Trial American Medical Systems—Consultant & Clinical TrialConsortium Erectile Function—Lecturer CES Surgical—Royalties.

P-07-061

Tight-skin (Tsk) mice as new experimental model ofPeyronie’s diseaseSorrentino, R.1; Fusco, F.2; Palmieri, A.2; D’Emmanuele di Villabianca, R.1;Arcaniolo, D.2; Verze, P.3; Mirone, V.41University “Federico II,” Experimental Pharmacology, Naples, Italy; 2Uni-versity “Federico II”, Urology, Naples, Italy; 3University “Federico,”Urology, Naples, Italy; 4University, Urology, Naples, Italy

Objective: Peyronie’s disease is a disorder characterized by fibroticplaques of the tunica albuginea of the penis. At the present there isonly one animal model developed in 1997 that shares some featureswith the human disease and that has been widely used in the past yearsto investigate on the molecular mechanism and/or mediators involvedin Peyronie’s disease. Here we describe the characterization of a newmodel of Peyronie’s disease naturally occurring in tight-skin (Tsk)mice.Methods: This strain of mice has been followed for 2 years, in orderto characterized the development of the diseases from both a mor-phological and biochemical viewpoint through histological analysis,immunohistochemistry and RT-PCR.Results: Tsk mice spontaneously develop a Peyronie’s like disease andat the age of 12 months display visible penile curvature. The histo-logical analysis confirmed the involvement of collagen in the fibrosisobserved. Immunohistochemistry study clearly showed that TGFbetawas involved at early stage of the disease, up to 9–12 months. Thequantitative RT-PCR showed that TGFbeta levels were higher after 6months and significantly declined at 12 months when collagen levels,measured as hydroxyproline, were higher. Interestingly, iNOS levelshad an opposite pattern being low at 6 months and increasing steadilythereafter. In conclusion Tsk mice is a Peyronie’s disease animal modelthat shares many key features with the human disease.

P-07-062

Penile prosthesis in patients with Peyronie’s disease:Our tips and tricksScheplev, P.1; Danilov, I.1; Gvasaliya, B.1; Garin, N.11RMAPE, Urology, Moscow, Russia

Objective: High social concern about PD is cased by its influenceupon a patient’s life style. At present we have at our disposal multiplemethods of surgical treatment of PD. All of them have their specificpeculiarities, advantages, and drawbacks.

Methods: We revewed the results of penile prosthesis implantation in112 patients with PD. The indication for surgical operation was com-bination of PD with erectile dysfunction (ED). 41% suffered from dia-betes. Penile prosthesis implantation was performed to 41 patients; 57cases required corporotomy with defect correction by gortex. Penileprosthesis implantation, corporotomy, and glanduloplastics was per-formed in 14 patients. We used plastic penile prosthesis in 89 patientsand inflatable prosthesis—in 23 patients. Additional matrix penileenlargement was performed in 12 patients. The follow-up was 3 years.Results: Restoration of sexual function was observed in 100% cases.The intraoperative complications were: perforation of cavernous bodyin 3 cases, urethral injuries—2 and septal perforation—1. The post-operative complications were: prosthesis infection—2, which requiredprosthesis reimplantation; inflatable prosthesis malfunction—1, thepatient was treated by reimplantation of a plastic prosthesis.Conclusion: Penile prosthesis implantation is an effective method oftreatment of PD. But otherwise there are some particularities in sur-gical technique that are to be remembered.

P-07-063

Total phallic construction using the forearm free flapGaraffa, G.1; Christopher, N.1; Ralph, D.1

1St. Peter, Department of Andrology, London, United Kingdom

Objective: This paper reports our 9-year experience using the radialartery forearm free flap for neophallus construction.Methods: A total of 86 patients with a mean age of 35 years (range22–54) have had a neophallus constructed using the forearm-free-flap-operation. The indication for surgery was Micropenis (n = 5), Female-to-male transsexualism (n = 70) and following penile amputation forTrauma (n = 4) or Cancer (n = 7). The procedure involves formationof the phallus from the non-dominant forearm with an incorporatedurethra. The microsurgical transfer consists of 1 arterial, 3–5 venous,2–3 nervous and a urethral anastomoses. In transsexuals the neourethrais fashioned in 2 stages with creation of a scrotum. Fashioning of theneo-glans using a non-hairy skin graft can be performed during a sub-sequent stage. Surgical outcome, complications, cosmesis and patients’satisfaction were recorded.Results: After a median follow up of 26 months (range 1–66), 72patients (84%) were very satisfied with the phallus size, cosmesis andsensation. Of the 66 patients that have had the native and neourethrajoined 63 (95%) were able to void standing, although this requiredrevision surgery to correct urethral fistulae and strictures in 37 cases(56%). An arterial thrombosis occurred in 1 patient which was successfully re-explorated and one phallus was lost due to a venousthrombosis. Minor areas of skin loss on the phallus were treated con-servatively although split skin grafts were required in 5 patients forcontractures. One patient developed Volkman’s contracture of thehand and persistent swelling and numbness were reported respectivelyby 3 and 4 patients.Conclusion: The radial artery based forearm free flap phalloplastyyields excellent cosmetic and functional results. Patients must bewarned that it involves multiple stages, often with revision surgeryneeded and a significant donor site scar.

P-07-064

Implantation of inflatable penile prosthesis without dilatation of the corpora. Analysis of 50consecutive casesMoncada, I.1; Jara, J.1; Martinez-Salamanca, J. I.1; Cabello, R.1; Monzo,J. I.1; Hernandez, C.1

1Hospital Gregorio Maranon, Dept. of Urology, Madrid, Spain

Objective: The standard technique of penile prosthesis implantationincludes the dilatation of both corpora prior to the insertion of thecylinders. This unnecessary maneuver damages the erectile tissue,takes some time and may produce perforations in the proximal or distalends of the corpora. The technique of implantation without dilatation


J Sex Med 2007;4(suppl 2):105–127

has been published before, is easy and fast. Furthermore, preservingerectile tissue may enhance a more natural response to sexual stimu-lation even in patients implanted with a penile prosthesis. This analy-sis was undertaken to investigate the advantages or disadvantages ofthis technique.Methods: 50 men undergoing virgin penile prosthesis surgery consti-tuted the study population; parameters studied were surgical time,intraoperative complications, postoperative complications, postopera-tive pain and residual erectile activity. This series was compared to aprevious series of 50 consecutive virgin implants with the standardtechnique including dilatation.Results: All patients included in this analysis were implanted with 3-piece inflatable prosthesis AMS 700 series with or without antibioticcoating. Surgical time was significantly shorter when dilatation was notperformed (35 min vs 47 min p < 0.01), intraoperative complicationswere less frequent (1 crural perforation vs 2 crossover, 1 crural perfo-ration and 1 urethral perforation). Postoperative complications weresimilar with 2 cases of infection and 3 scrotal hematomas in both series.There was a very significant difference between postop pain lasting 3weeks in the non-dilatation series compared to 5 weeks in the dilata-tion series. Also, 38% of patients in the non-dilatation series claimedsome residual erectile activity upon sexual stimulation while in the dila-tion series only a 7% had this response.Conclusion: Our study suggests that, in the virgin penile implant,non-dilatation of the corpora cavernosa prior insertion of hydrauliccylinders is a technique carrying less surgical time and fewer compli-cations than the standard technique including dilatation.

P-07-065

Concurrent dual inflatable penile prosthesis andincontinence implant (AMS-1500) after radicalsurgery. Transversal incision approach. Ourpreliminary experience: VIDEO 10 minSedigh, O.1; Paradiso, M.1; Graziano, M. E.1; Rossi, R.1; Ferrando, U.1

1Molinette, Urologia 3, Torino, Italy

Objective: Surgical management of concurrent medically unrespon-sive erectile dysfunction (ED) and urinary incontinence in patients following radical surgerys (the most significant side effects), oftenrequires 2 separate surgical procedures and/or 2 incisions: increasedoperative time, risks of multiple anestesia, devices injury and infec-tions. The treatment of urinary incontinence depends, principally onits severity. Sometimes the incontinence is more severe generally, dueto an intrinsec malfunction of urinary sphincter so the only alternativeis the implantation of artificial sphincter although the use of slings isbecoming more popular. We present our preliminary experience (first6 dual current implants) with transversal peno-scrotal approach afterradical prostatectomy and cystectomy.Methods: 6 patients with severe ED and Incontinence followingradical surgerys, timing after 2 years, unresposive to medical therapywere studied with cystoscopy, Video. Urodynamics and dynamic(trimix) doppler-ultrasonography. All patients sub-sequently under-went concurrent placement of Inflatable penile implant AMS-CXR &AMS 800 urinary device, throught the transversal penoscrotal 3 cmapproach. The Wilson retractor was utilized with excellent exposureto the corpora and proximal–bulbar urethra in patient in extendedlithotomy position.Results: Surgical average time was about 100 min. The patients weredischarged home within 24 hours post-operativly on an oral quinoloneantibiotics for 10 days. No infection was observed and all patientsreported excellent erectile function and good quality of life and urinarycontinence.Conclusion: This preliminary data suggests that, in patients withorganic ED and Severe Incontinence, dual Implant (Penile Inflatableand Urinary device) can be easily, quickly and safely placed during asingle corrective surgical scrotal approach eliminating the need formultiple procedures, anesthetic exposures and incisions. This videoshow the surgical technique of one case of simultaneos dual implanta-tion of AMS-CXR penile inibizone implant and AMS-800 urinarydevice in radical prostatectomy.

P-07-066

The role of preoperative MRI in revision penileimplant surgeryLi, C.1; Anderson, P.2; Ralph, D.1; Minhas, S.1

1Institute of Urology, London, Andrology, United Kingdom; 2Solihull, UnitedKingdom

Objective: As the cause of complications following penile implantsurgery are not always apparent on history and examination, the aimof this study was to assess the role of MRI in the assessment of penileimplant failure.Methods: A retrospective review of 54 penile implant patients, with91 separate presenting complaints and assessments. 21 MRI were per-formed, their findings and its accuracy in predicting patient outcomewere assessed.Results: n (%), MRI, No MRI, Total Revision 10 (14), 64 (86), 74(100) Prosthesis removed 1 (17)*, 5 (83), 6 (100) No surgery required10 (91), 1 (9), 11 (100) Total 21, 70, 91 *Pre-prosthesis MRI. Overall,65% of the MRI findings agreed with the final outcome of the patient.Of those who had revision surgery, although only 10 required MRI,80% agreed with the final outcome. Of those who did not requiresurgery, 50% of the MRI findings predicted the final outcome.Conclusion: MRI is a useful imaging modality to demonstrate theanatomy of the penis. However, for patients who required revision ofpenile implants, clinical assessment alone was usually adequate. Inthose where clinical indication for implant failure was not apparent,MRI is a useful tool to prevent unnecessary surgery.Policy of full disclosure: I am a senior clinical fellow at the Instituteof Urology. My post is funded by American Medical Systems.

P-07-067

Infection rate after implantation of three-componentpenile prosthesis using a new pre- and postoperativeprotocol: Short term follow-upDeho, F.1; Henry, G.2; Salonia, A.1; Briganti, A.1; Zanni, G.1; Savoca, G.3;Abdollah, F.1; Matloob, R.1; Rigatti, P.1; Montorsi, F.1

1IRCCS San Raffaele, Urology, Milano, Italy; 2Regional Urology, Urology,Shreveport, Louisiana, USA; 3Ospedale San Raffaele Giglio, Urology,Cefalu’, Palermo, Italy

Objective: To assess effectiveness, complication rate, and infectionrate of a new protocol of skin preparation and both pre- and postop-erative management of patients with ED undergoing an inflatablepenile prosthesis (IPP) implantation.Methods: From 1988 to March 2006, 112 IPP have been implantedunder the same conditions (i.e., operating room, materials and peno-scrotal access). Beginning September 2005 a new perioperative proto-col was introduced in patients undergoing this surgery: 1) scrub withchlorhexidine 4% and alcohol for 10 minutes; 2) reduction of the intra-operative time of implant preparation; 3) using of a skin glue for repar-ing the scrotal wound; 4) compressive scrotal medication and avoidingof any transcrotal drainage. Fourteen patients received an AMS 700CX InhibiZone with the above described new protocol.Results: Ten (8.9%) of the 112 implanted patients were re-operated;6 (5.3%) had a IPP infection and 4 (3.6%) had a prosthesis malfunc-tioning. Infection occurred after a period of 21 ± 12 days; 2 (33.3%)infected IPP were in diabetic patients, with normal level of glycosilatehemoglobin. An immediate re-implantation of the prosthesis was donein 3 (50%) out of the 6 patients using Mulchay procedure. In one ofthe re-operations there was an extrusion of the left cylinder after 42days from the date of the re-operation. 28 (25%) of the IIP patientsreceived a antibiotic-coat; interestingly, none out of those developedinfection. In a follow-up of 41 ± 21 days no one of the 14 IPP withthe new protocol has developed infection. All the prosthesis had anantibiotic-coat.Conclusion: The use of this new protocol for perioperative care,coupled with the contemporary use of antibiotic-coated prosthesesseem to promote the implant of IPP as a safe procedure, having sig-nificantly decreased the overall infection rate.


J Sex Med 2007;4(suppl 2):105–127

P-07-068

Frenular grafting—An alternative to circumcisionGaraffa, G.1; Keyes, O.1; Minhas, S.1; Christopher, N.1; Ralph, D.1


Objective: Frenuloplasty lengthens the frenulum at the expense ofnarrowing the inner prepuce. It is therefore contraindicated in patientsthat already have a degree of phimosis. In patients who do not wish tohave a circumcision an alternative procedure, described here, is to skingraft the frenular bed after its division, thereby both lengthening thefrenulum and widening the prepuce.

Methods: A total of 7 patients, with a mean age of 25 years (range18–35 yrs), presented with a combination of a tight frenulum and phi-mosis. The operation consists of a wide transverse incision in thefrenulum to create the classical diamond shaped defect. A skin graft isthen sutured into the defect and the foreskin replaced over the glans.The donor site used for the graft was initially inner thigh (n = 2) andlatterly a horizontal ellipse of dorsal inner preputial skin.Results: All patients are sexually active and are happy with the resultof surgery at a mean follow up of 10 months. Graft take was 100%,the foreskin retractable in all and no revision surgery needed.Conclusion: Frenular grafting is a minor procedure that is reliablysuccessful and allows the patient to maintain his foreskin.

MODERATED POSTER SESSION ABSTRACTS

tone in vitro. The aim was to compare efficacy of neuropeptides asso-ciated with sexual function in both rabbit vaginal strips and isolatedvaginal arteries.Methods: Experiments were carried out in compliance with UKHome Office guidelines. For tissue bath experiments, the vagina fromterminally anaesthesised New Zealand rabbits (∼3 Kg) was dissectedinto eight longitudinal strips. Isometric recordings were made follow-ing equilibration for 1 hour at 19.6 mN. For myography, isometricrecordings experiments were made from 2 mm vessel rings equili-brated for 30 minutes at 2.94 mN. Tissues were perfused with Krebsat 37°C and gassed with 95% CO2/5% O2. For relaxation experi-ments, preparations were precontracted with phenylephrine (10–20 µM).Results: PACAP and VIP relaxed both preparations with greaterpotency in arteries implying expression of different receptor subtypes(see tables). In contrast, oxytocin (OT) and vasopressin (AVP) con-tracted vaginal preparations and were antagonised by the V1A antag-onist SR49059 (Serradeil-Le Gal et al., 1998; strip, pKB = 8.15, n = 5;arteries, pKB = 9.6). NPY only contracted arteries, which was antag-onised by the NPY Y1 receptor antagonist BIBP 3226 (pKB = 7, n =3–9).Conclusion: NPY Y1, V1A antagonists and VPAC/PAC agonists maybe useful in female sexual arousal. Differences between efficacy andpotency of neuropeptides between preparations raise the questionwhether vascular or non-vascular vaginal smooth muscle is importantfor female sexual arousal.Policy of full disclosure: Pfizer Global Research and Development.

128

J Sex Med 2007;4(suppl 2):128–151

Monday, 4 December 200610.00–11.30 ForumMP-01 Female Sexual HealthI. Goldstein, USAD. Richardson, United Kingdom

MP-01-069

In vivo neuronal activity in the hypothalamus varieswith oestrus cycle in female rats: Baseline conditionsand effects of dopamine receptor agonismRichards, N.1; Allers, K.1

1Pfizer Global R&D, Discovery Biology, Sandwich, United Kingdom

Objective: The central nervous system plays an important role insexual behaviour. Currently there is very little information regardingthe involvement of the paraventricular nucleus (PVN) of the hypo-thalamus in female sexual behaviour. Sexual behaviour is known to varyacross stages of the oestrus cycle in the female rat, and this could inpart be due to hormonal variations in PVN neuronal activity. The aimof this study was to determine to what extent PVN neuronal activityvaries across a natural oestrus cycle, and how responses to the non-selective dopamine receptor agonist apomorphine (erectogenic inmales) vary with hormonal status.Methods: All experiments were conducted in compliance with UKlegislation. Animals were anaesthetised with urethane, and a tail veinwas cannulated for drug administration. Standard methods for in vivosingle unit recordings were used to measure the firing properties ofindividual PVN neurones in differing oestrus cycle stages, and theirsubsequent response to intravenous apomorphine (100 ug/kg) admin-istration. PVN local field potentials were recorded to identify effectsof hormone levels and apomorphine stimulation on PVN networkactivity. Estrous cycle stage was assessed with saline lavage.Results: Baseline firing rates of single units differed across stages ofthe oestrus cycle with a higher proportion of ‘fast’ firing neurones inmetestrous. Apomorphine administration led to increased firing ratein 12/17 neurones and decreased firing rate in 5/17 neurones. Basallocal field potential also varied between stages and post-apomorphine.Conclusion: The most noticeable differences on all measures wereseen in metestrus, a stage where progesterone levels are high but estro-gen levels are relatively low. These differences were apparent both inbaseline activity and during dopamine receptor agonism. This suggeststhat progesterone and estrogen may influence PVN neuronal activityand this may contribute to variations in sexual receptivity across thecycle.

MP-01-070

Pharmacological differences of neuropeptides betweenrabbit vaginal smooth muscle and vaginal arteries in vitroAughton, K.1; Hamilton-Smith, K.2; Wayman, C.2; Jackson, M.2

1Pfizer PGRD, Discovery Biology, Sandwich, United Kingdom; 2Pfizer Ltd,Discovery Biology, Sandwich, United Kingdom

Objective: Vascular and non-vascular smooth muscle relaxation in thevagina is believed to be important for female sexual arousal (Park etal., 1997). To date, in vitro studies have only focussed on relaxationmechanisms within vagina smooth muscle strips. Ziessen et al. (2002)investigated the effect of neuropeptides in rabbit precontracted vaginastrips and reported that vasoactive intestinal peptide (VIP) and pitu-itary adenylate cyclase activating peptide (PACAP) induced relaxation.We recently developed a vagina arterial technique to measure arterial

MP-01-071

Is sexual function different in obese women?Altay, B.1; Turna, B.1; Aliyeva, U.1; Kaan, O.1; Muktharov, E.1; Cetinkalp, S.2; Yilmaz, C.2; Semerci, B.1

1Ege University School of Med., Urology, I.zmir, Turkey; 2Ege University

School of Med., Endocrinology, I.zmir, Turkey

Objective: To determine the role of body-mass index (BMI) on femalesexual dysfunction (FSD).

Moderated Poster Session Abstracts 129

J Sex Med 2007;4(suppl 2):128–151

Methods: In the study 60 women’s data, applied to Obesity Centre,were prospectively recorded. Women were categorized into 3 groups:women with normal body-mass index (BMI < 30, n = 20), women withhigh BMI (30–35, n = 22) and obese women (BMI > 35, n = 18). Ageand menopausal status were also determined. Hormonal status ofwomen (FSH, LH, prolactin, SHBG, DHEAS, estradiol, free and totaltestosterone) were analyzed. All women completed FSFI and Beck-depression scale. Mann-Whitney-U and Student-t tests were used forstatistical analysis.Results: Women were categorized into 3 age groups: 30–45 years old(n = 12); 46–55 years old (n = 29); 56 and over (n = 19). Mean age was51.3 ± 6.9 years old. There were 35 postmenopausal and 25 pre-menopausal women. In our study, patients had higher FSH and LHlevels and lower estradiol levels (p < 0.05) with increasing age. Therewas no statistical difference between normal BMI and high BMIwomen with regards to sexual function, however there was a statisti-cal difference between high BMI and obese women with regards tosexual function. Sexual function of 30–45 and 46–55 years old womenhad significant statistical differences with women over 56 years old (p< 0.05). There was no statistical influence of menopause status onsexual function (p > 0.05). Obese women had significantly low FSFI(p < 0.05). Women with BMI < 30 and age < 45 years old had the bestFSFI values.Conclusion: Obesity is a serious health problem that lead to many co-morbidities such as FSD. In this study, we emphasize that obesewomen had the worst FSFI values compared to women with normaland high BMI in the same age group. In addition age seems to have anegative effect but only menopause status does not worsen sexual func-tion in this group.

MP-01-072

Effects of intra-nasally administered testosterone on sexual behaviour in female capuchin monkeys(Cebus apella)Topic, B.1; Tavares, M. C.2; Tomaz, C.2; Huston, J. P.3; Mattern, C.41Universität Düsseldorf, Physiologische Psychologie, Germany; 2PrimateCenter and Lab. of Neur., University of Brasilia, Brazil; 3Physiological Psy-chology, Center for Biol. + Med. Research, Düsseldorf, Germany; 4MatternResearch AG, Pharmaceutical Development, Stans, Switzerland

Objective: Sexual dysfunction in the female has been associated witha decrease in androgen levels, which can be reversed by testosteronetreatment, however, bearing the risk of adverse side effects. Nasallyadministered testosterone could be an effective method for androgenictreatment avoiding the first-pass intestinal and hepatic metabolism andside effects.Methods: Here we examined the effects of chronic intra-nasal admin-istration of testosterone on sexual behavior in female capuchinmonkeys (Cebus apella) that lived with male cohorts. During 8 days ofbaseline 10 females were observed for their sexual and non-sexualbehavior without drug. They then received daily intranasal testos-terone- (0.24 mg per nostril, n = 5 per group) or placebo gel for 5 days,followed by 5 days of wash out, followed by 5 days of daily intranasalapplication, whereby the animals that had received testosterone before,now received placebo and vice versa. Diverse sexual and non-sexualbehaviors were scored. Blood samples were collected and analysed fortestosterone and estradiol using EIAs.Results: The results revealed an increase in sexual behavior (eyebrowraising, chest rubbing, courtship behavior, masturbation) in thefemales during testosterone treatment, which seemed to be prolongedeven when testosterone treatment was disontinued. These behavioralresults were accompanied by an increase in plasma testosterone levels.Conclusion: This study demonstrates the efficacy of testosterone inenhancing sexual behavior in female capuchin monkeys by means ofintranasal application, which may be a useful alternative compared toother forms of administration.Policy of full disclosure: The study was sponsored by MatternResearch AG, Stans/Switzerland.

MP-01-073

Effects of hypoactive sexual desire disorder treatmenton relationshipsFelblinger, D.1; Koochaki, P. E.2; Wekselman, K.3

1University of Cincinnati, Academic Health Center, Cincinnati, Ohio, USA;2Procter & Gamble, Procter & Gamble Pharmaceuticals, Mason, Ohio,USA; 3Procter & Gamble, Procter & Gamble Pharmaceuticals, Mason,Ohio, USA

Objective: The purpose of this study was to examine effects of treat-ment for hypoactive sexual desire disorder (HSDD) on relationshipsbetween surgically menopausal women and their partners.Methods: Participants in this qualitative study were randomly selectedfrom a representative population of 132 women who participated in aclinical study and received transdermal testosterone or a placebo patch.These women had been interviewed about their experiences with thepatch in an additional study entitled: “Follow-up Qualitative andQuantitative Research with Surgically Menopausal Women in PhaseIII Clinical Trials Conducted to Evaluate Efficacy and Safety of Trans-dermal Testosterone.” One-on-one telephone and in-person inter-views were conducted by a trained, experienced female interviewerusing a discussion guide reviewed by a sex therapist with clinical andresearch expertise. In the present study, a secondary data analysis wasconducted using audio-taped, transcribed, de-identified interviewsfrom participants who reported receiving meaningful benefit fromHSDD treatment. Participant interviews were examined until satura-tion and redundancy in responses occurred after analysis of 14 inter-views. Data were analyzed for the presence of common themes andvariations within the themes.Results: Data analysis revealed themes of relational separation and sexas obligation prior to treatment for HSDD. During the study andwhile under treatment, the common theme of “the re-emergence ofus” surfaced, along with three thematic variations: reciprocal connec-tion, re-awakening of the self in a relational context, and cessation ofobligation.Conclusion: Women in this study with meaningful benefit fromHSDD treatment described re-discovery and re-emergence of positiverelationships with their partners. These findings add important infor-mation to the current body of knowledge regarding the clinical rele-vance of HSDD treatment.Policy of full disclosure: Dianne M. Felblinger: Research GrantRecipient, Procter & Gamble Pharmaceuticals. Patricia E. Koochaki:Employee, Procter & Gamble Pharmaceuticals. Kathryn Wekselman:Employee, Procter & Gamble Pharmaceuticals.

MP-01-074

To evaluate female sexual function after colpoperineoplastyHer, M.1; Kim, J.1; Kim, E.2; Lee, J.3; Cho, H.1

1Catholic University, Obgyn, Seoul, Youngdungpogu, Republic of Korea;2Catholic University, Obgyn, Buchun, Kyungkido, Republic of Korea;3Catholic University, Obgyn, Eujungbu, Kyungkido, Republic of Korea

Objective: To evaluate female sexual function after colpoperineoplasty.Methods: Women who visited regional clinic for colpoperineoplastyfrom June. 2004 ∼ Aug. 2004. filled in FSFI (The Female Sexual Func-tion Index) questionnarie before and 4 months after surgery. 6 weeksafter surgery, they start pelvic muscle training with HMT 2000.Results: Frequency of coitus, desire, arousal, lubrication and orgasmwas increased after colpoperineoplasty. Percentage of who had coitusmore than once a week increased from 18% to 63%. In sexual desire,about 18% felt sexual arousal more than or about half the time beforesurgery, but increased to 45% after surgery. In sexual arousal, per-centage of who felt sexually aroused during more than half of sexualactivity increased from 34% before surgery to 69% after surgery. InLubrication, percentage of who became lubricated during more thanhalf of sexual activity increased from 44% before surgery to 82% aftersurgery. Who reached orgasm more than half of sexual activityincreased from 29% before surgery to 70%.Conclusion: Colpoperineoplasty increased female sexual activity.

130 Moderated Poster Session Abstracts

J Sex Med 2007;4(suppl 2):128–151

MP-01-075

Prevalence of female sexual dysfunction in Germany:Results of the crossover-study “The Cologne 20.000community survey”Korda, J. B.1; Braun, M.1; Christ, H.2; Hellmich, M.2; Engelmann, U.1

1University of Cologne, Dept. of Urology, Germany; 2University of Cologne,Institute for Statistics, Epidem., Germany

Objective: The aim of the study was to evaluate the prevalence andthe risk factors for FSD among german women in the age of 20–80years.Methods: We developed an extensive questionnaire consisting of 55questions including the FSFI (Female Sexual Function Index). Thequestionnaire was sent to 10.000 women (Age 20–80 years) in Cologneand surroundings under consideration of data protection (responserate 41%, mean age 43 years).Results: 79.2% of the women have been in a stabile relationship.38.2% suffered from female sexual dysfunction. The prevalence ofFSD increased significantly with age. In the age group <30 years 25.6%have been affected, in the group 30–39 years 31.1%, in the group40–49 years 29.7%, in the group 50–59 years 44.8%, in the group60–69 years 59.3% and women older than 70 years have been affectedin 79.9% from FSD (p = 0.001). Risc factors seemed to be age, numberof child births, co-morbidities like diabetes, hypertension, heart dis-eases, coronary artery disease, incontinence and depression. Merely18.4% of women with FSD have sought for medical help!Conclusion: The prevalence of female sexual dysfunction is muchhigher than the prevalence of erectile dysfunction. However just aminority of these women is seeking medical help and therapy.

MP-01-076

Rethinking desire: Prevalence and correlates of desirediscordance in the Nurses Sexuality StudySand, M.1

1Dusseldorf, Germany

Objective: Low or inhibited desire is a common sexual concern ofwomen. It is unclear, however, how distressing this is for them. In arandom sample of female American Registered Nurses, we assessed theprevalence and correlates of desire discordance within the sample offemale nurses reporting a current male sexual partner.Methods: A random sample of 580 registered nurses was mailed a 58-item questionnaire in which the Female Sexual Function Index wasembedded. Two items addressed desire discordance. Differences inmeans between groups were tested using t-tests.Results: 133 responses from female nurses were returned, of whom112 reported a current male partner. 29.5% of women reported havingmore desire than their male partner, while 36.6% reported less desirethan their partner. Women who report having more desire for sexualactivity than their partner demonstrated lower total FSFI scores (21.42vs. 25.27, p = 0.023) and lower mean scores on all other FSFI domainsexcept lubrication and, paradoxically, desire. Women who reported lessdesire for sexual activity than their partner, in contrast, demonstratedequivalent FSFI scores (23.54 vs. 24.39, ns), but significantly lowerdesire domain scores than women who do not report discordance (2.80vs. 3.53, p = 0.01), and no statistical differences in the other domainsof the FSFI. Reporting higher desire than partners was significantlyassociated with having a partner with ED (p = 0.001), but not PE. Nocorrelations were found between having less desire than a partner andeither ED or PE.Conclusion: Desire discordance in this sample was prevalent, but onlywomen who indicted more desire than their partners reported lowersatisfaction levels. The prevalence of this particular type of desire dis-cordance and its strong association with erectile dysfunction under-scores the need to approach ED as a dysfunction affecting couples.Policy of full disclosure: I am an employee of Bayer HealthCare AG.

MP-01-077

Nocturnal vaginal pH-meter: Can it be a newscreening method for female sexual dysfunctionPeskircioglu, L.1; Goren, M. R.1; Dirim, A.1; Ozkardes, H.1

1Baskent University School of M, Department of Urology, Ankara, Turkey

Objective: Increased genital blood flow induced by sexual arousalresults with increased vaginal lubrication and elevated pH. This studyaims to show whether nocturnal vaginal pH monitorization can be ascreening test for female sexual function like nocturnal penile tumes-cence (NPT) measurements in men.Methods: Twelve pre-menopausal volunteers were included in thestudy. All women were within sexually active ages with normal hor-monal profile. Those with a history of vaginal/pelvic surgery or radio-therapy and infection were excluded. Female sexual function index(FSFI) scores and clitoral artery peak systolic velocity of all womenwere recorded. Nocturnal pH monitorization was performed in anambulatory manner by using Orion IITM (MMS, USA) recordingdevice and single crystal antimony pH catheters (Synectics Medical,Sweden).Results: The patterns of pH oscillations and pH peak and mean valuesduring night time suggested a possible correlation with FSFI scoresand clitoral artery peak systolic velocity. Five women with normal FSFIand clitoral artery PSV had nocturnal episodes of pH rise over 6. Onthe other hand 4 women with suboptimal FSFI and PSV had no orminimal pH elevations which were below 6.Conclusion: The results of this preliminary study though not enoughto make a statistical analysis and comment suggest that nocturnalvaginal pH monitorization may be a new screening technique in thefuture for the differential diagnosis of organic-psychogenic femalesexual dysfunction just like NPT. It is obvious that controlled studieson larger populations are required to define this technique and tocomment on its results better.

MP-01-078

Development and validation of a new screening toolfor hypoactive sexual desire disorder: The BriefProfile of Female Sexual Function© (B-PFSF©)Golombok, S.1; Derogatis, L.2; Rodenberg, C.3; Koochaki, P.3; Schmitt, S.4;Rust, J.5

1University of Cambridge, Centre for Family Research, United Kingdom;2University of Maryland, Baltimore, USA; 3P&G Pharmaceuticals, Cincin-nati, USA; 4P&G Pharmaceuticals, Schwalbach, Germany; 5University ofCambridge, United Kingdom

Objective: To develop a simple, multicultural, self-administeredscreening tool to identify women who may benefit from clinical eval-uation for Hypoactive Sexual Desire Disorder (HSDD).Methods: The Brief Profile of Female Sexual Function© (B-PFSF©)was developed using items from the Profile of Female Sexual Func-tion© (PFSF©) and the Personal Distress Scale© (PDS©), two vali-dated instruments developed for assessment of treatment response inclinical trials. A stepwise logistic regression analysis was used to selectitems best able to discriminate between women with HSDD (N = 743)and control women (N = 226). A screening cutoff score was identifiedusing a Receiver Operating Characteristics analysis. Validity and reli-ability analyses were conducted in an independent group of 147HSDD women and 104 controls in the US and Canada. A total of 41cognitive interviews were conducted in 4 countries (US, Germany,Italy, UK) to assess comprehension of the instructions for completingand scoring the questionnaire and to validate the cutoff score.Results: 7 items were found to adequately discriminate HSDD womenand controls and to be a reliable and valid tool for women’s self-assess-ment of low sexual desire with associated distress. At least 90% ofHSDD women and at least 95% of control women in the confirma-tory validation trial were classified correctly using the identified cutoffscore. In the cognitive interviews, all women stated that the question-naire was easy to complete, the instructions were clear, and that theitems covered the aspects of sexual function that are important to


J Sex Med 2007;4(suppl 2):128–151

women. Thirty-nine of 41 women interviewed stated that the classifi-cation determined by the cut-off score accurately described their conditions.Conclusion: The Brief Profile of Female Sexual Function (B-PFSF)is suitable for use as a self-administered screening tool to identify post-menopausal women who may benefit from clinical assessment to deter-mine whether they have HSDD.Policy of full disclosure: Drs. Golombok, Derogatis, and Rust areconsultants for Procter & Gamble Pharmaceuticals, Inc. Drs. Roden-berg, Koochaki, and Schmitt are employees of Procter & GamblePharmaceuticals, Inc.

MP-01-079

Development and initial validation of the FemaleAssessment of Male Erectile Dysfunction DetectionScale (FAME): Report of a pilot studyRubio-Aurioles, E.1; Arango de Montis, I.2; Roccatti, N. T.2; Sand, M.3

1Mexico; 2Asociacion Mexicana para la Sa., Clinical Research, Tlalpan,Mexico; 3Bayer HealthCare, Scientific Affairs, Wuppertal, Germany

Objective: Erectile dysfunction (ED) is a prevalent condition that canhave a significant negative impact on men’s quality of life and also thatof their female partners. The objective of this study was to develop ascale for the detection of ED, as assessed by the woman partner.Methods: Qualitative research was conducted via focus groups in-volving women whose male partners suffer from ED to identifythemes/clues. Item construction based on the sexual health inventoryfor men (SHIM) and qualitative results was subsequently tested usinga panel of experts and a panel of women with partners with ED, todocument face validity. Concurrent validity analysis was carried outwith Spearman’s rho between FAME and clinical diagnosis, SHIMscores, and erectile function domain of the International Index ofErectile Function (IIEF-EF), in a group of 83 couples. Reliability wastested with Cronbach’s alpha, and sensitivity and specificity werechecked against clinical diagnosis.Results: Qualitative analysis yielded 44 clues. Following item con-struction, 23 items were selected. Of these, 21 items demonstrated sta-tistical significance as the best discriminating items using a t-test forindependent samples. A final scale of 6 items was then tested for valid-ity and reliability. FAME correlated significantly with clinical diagno-sis (0.743, p < 0.001), SHIM score (0.829, p < 0.001), and IIEF-EFdomain (0.684, p < 0.001). Cronbach’s alpha was 0.941. Sensitivity was97.3% and specificity was 68.9%, compared with SHIM’s values of100.0% and 55.6%.Conclusion: Accurate detection of ED in males by the woman partneris possible. In this study, FAME (completed by the woman) had higherspecificity than the SHIM (completed by the man), and demonstratedvalidity, reliability and sensitivity in this population. Further researchis needed to assess the validity of this tool in other populations.Policy of full disclosure: Dr. Rubio-Aurioles is a speaker and con-sultant for Bayer Healthcare, Lilly ICOS LLC, and Johnson &Johnson/Janssen-Cilag and receives grant support from Bayer Health-care, Lilly ICOS, and Johnson & Johnson. Dr Arango de Montis, andDr Terrein Roccatti are both speakers and consultants for BayerHealthcare, Pfizer, and Lilly ICOS. Michael Sand is an employee ofBayer Healthcare.

MP-01-080

Presence of a sexual dysfunction may not always affectwomen’s satisfaction from their sexual functionFerenidou, F.1; Kapoteli, V.2; Moysidis, K.2; Koutsogiannis, I.2; Giakoumelos, A.3; Hatzichristou, D.31K. Melenikou 5, Thessaloniki, Greece; 2Aristotle University of Thessaloniki,Center for Sexual and Reproduc, Thessaloniki, Greece; 3PapageorgiouGeneral Hospital, 2nd Department of Urology, Thessaloniki, Greece

Objective: The FSFI inventory is widely used for the evaluation offemale sexual function, the detection of women with sexual dysfunc-tion and the evaluation of its severity. Although sexual dysfunction in

women is a situation which the patient alone declares, no data exist sofar which compare FSFI score with women’s self-perception of theirsexual function. SCSF is a self-evaluation tool proposed to screenwomen’s sexual function in the general population. The objective ofthe study was to compare the responses of the two instruments, inorder to evaluate if women’s sexual function correlates with their self-perception.Methods: The study population includes 74 women who visited ageneral hospital due to symptoms not related to sexual dysfunction andwere asked to complete a questionnaire which included demographiccharacteristics, FSFI and SCSF.Results: Mean patients’ age was 41 ± 13.7 (min 18, max 72) years and64.9% of the participants were married. The participants’ age was neg-atively related to all domains of the FSFI questionnaire: desire (p <0.001), arousal (p < 0.001), lubrication (p < 0.001), orgasm (p < 0.01),satisfaction (p < 0.01) and pain (p < 0.01). Based on the responses tothe SCSF, 79.7% declared to be satisfied by their sexual function, while20.3% declared being dissatisfied. The mean total score of the FSFIfor the “satisfied” group was 23.6 (±11.84), while the mean total scorefor the “dissatisfied” group was 17.45 (±7.78). Interestingly enough,the only domain of the FSFI where statistically significant differencesbetween the two groups were noticed was “pain”(p < 0.05).Conclusion: The presence of a sexual problem, except for pain, doesnot seem to differentiate the level of women’s satisfaction from sexualfunction. Physicians should be aware that the presence of a SD maynot always affect women’s satisfaction from their sexual function.

MP-01-081

Effect of Topical Misoprostole on ClitoralHemodynamicsPeskircioglu, L.1; Goren, M. R.1; Erdem, S. R.2; Oguzulgen, A.1; Ozkardes, H.1

1Baskent University School of M, Department of Urology, Ankara, Turkey;2Baskent University School of M, Department of Pharmacology, Ankara,Turkey

Objective: Genital blood flow plays an important role on femalesexual function. Increasing genital blood flow may be a therapeuticapproach for female sexual dysfunction. This study aims to show theeffect of topical misoprostol, a synthetic prostaglandin, on clitoralblood flow.Methods: 17 volunteers with female sexual dysfunction according tofemale sexual function index scores were included to the study. Allwomen were pre-menopausal and within their sexually active ages.Their hormonal profile was also normal. Those with suspected preg-nancy, history of pelvic or vaginal surgery or radiotherapy wereexcluded. Clitoral peak systolic velocity (PSV), end diastolic velocity(EDV) and clitoral artery diameter of all women were measured byusing Doppler ultrasound, at basal status, after placebo (ultrasound gel)and topical misoprostole gel (100 microgram).Results: Misoprostole gel caused a significant increase in clitoralartery PSV compared to basal level (p = 0.0001). On the other hand,placebo caused no significant increase in clitoral artery PSV. Remark-ably, misoprostole resulted with an increase of 118.3% of clitoral arteryPSV and 47.5% of clitoral artery diameter compared to their basallevels. No side effects were observed.Conclusion: Topical misoprostole can significantly increase clitoralblood flow without any unwanted effects and this finding may bepromising for the treatment of sexual dysfunction in the future.


J Sex Med 2007;4(suppl 2):128–151

MP-01-082

Effects of the dopamine receptor agonist,apomorphine on unconditioned sexual incentivemotivation in ovariectomised female ratsHawcock, T.1; Turner, L.1; Dawkins, T.1; Edmunds, N.1

1Pfizer Global Research & Devel, Discovery Biology, Sandwich, UnitedKingdom

Objective: Clinical studies have suggested therapeutic potential forapomorphine in treating FSD. However, experimentally apomorphineinhibits sexual incentive motivation in female rats (Ellingsen & Agmo,(2004) Pharmacol. Biochem, Behav. 77, 431–445). We investigatedfurther the effects of apomorphine on female sexual behaviour.Methods: All experiments were conducted in compliance with UKlegislation. Sexual incentive motivation was evaluated in a non-contactmodel of partner preference. Ovariectomised Long-Evans rats(250–300 g) were given either a suboptimal hormonal prime (estrogen1 µg and progesterone 100 µg s.c., 48 and 4 hrs prior to observation)or an optimal hormone prime (estrogen 5 µg and progesterone 250 µg). Primed rats were then treated with apomorphine (10, 30 and100 µg/kg, s.c.) or vehicle (saline). The time that the test female spentactively investigating an intact male relative to a castrated male, withina 10 minute observation window, gave an index of sexual proceptivity.Results: Apomorphine induced a dose-related increase in proceptivebehaviour in females given the suboptimal prime (Vehicle 2.3 ± 6.8 s,Apomorphine 30 µg/kg 22.8 ± 2.5 s) with the maximal effect equiva-lent to the optimal hormonal prime (29.2 ± 6.6 s) (Table1). The highestdose of apomorphine, 100 µg/kg, induced stereotyped locomotivebehaviour and failed to increase active investigations. Following theoptimal hormonal prime all doses of apomorphine tended to decreaseproceptive activity.Conclusion: This study demonstrates that apomorphine enhancessexual motivation in animals given a suboptimal hormonal prime, butcan have a deleterious effect when given to animals in behaviouralestrous (optimal prime). These data further suggest that apomorphineis unable to increase sexual incentive motivation above the level seenduring behavioural estrous. Moreover, stereotypy induced by highdoses of apomorphine can mask any prosexual effects.Policy of full disclosure: Pfizer Global Research & Development.

min) vehicle (saline) or naloxone (2 mg/kg, s.c.). Response to eachmount was graded (rejection 0; indifference 1; partial lordosis 2; fulllordosis 3), and the mean score per rat calculated as the RS.Results: Unlike the LQ, the RS resulted in normally distributed base-line data. Naloxone enhanced receptivity in rats primed with oestro-gen 5 µg plus progesterone 50 µg (Vehicle 1.09 ± 0.13, Naloxone 1.93± 0.14) but not oestrogen 2 µg plus progesterone 50 µg (Vehicle 1.37± 0.55, Naloxone 1.5 ± 0.3) (see Table). The optimal hormonal prime(oestrogen 5 ug and progesterone 1000 ug) resulted in full receptivity,RS = 2.8 ± 0.1.Conclusion: The use of normally distributed RS data allowed para-metric statistical data analysis, given even more power by the use ofpre-test RS data as a covariate. Improvements in sexual receptivity withnaloxone, following induction of a low level sexual receptivity with acombination prime, demonstrate the oestrogen-dependence of thisresponse.Policy of full disclosure: Pfizer Global Research & Development.

MP-01-083

“Receptivity score”: An improved measure of sexualarousal in the ratHawcock, T.1; Katechia, S.1; Edmunds, N.1

1Pfizer Global Research & Devel, Discovery Biology, Sandwich

Objective: Lordosis is a hormonally-dependent reflexive postureassumed by a receptive female rat in response to appropriate flankstimulation by a male. Experimentally lordosis is quantified using the lordosis quotient (LQ), however this relies on an all-or-nothingresponse resulting in zero inflated, skewed data that is unsuitable forrobust statistical analysis. The aims of this study were to develop anovel lordosis scoring scheme, designated “receptivity score” (RS), val-idate the scheme with the positive control compound, naloxone, andinvestigate the hormonal dependence of this response.Methods: All experiments were conducted in compliance with UKlegislation. Ovariectomised female rats (Sprague Dawley, 250–300 g)were primed with oestrogen (2 or 5 µg) and progesterone (50 or 1000µg) respectively 48 h and 4 h before testing. A sexually vigorous malerat was allowed to mount the test female 10 times, before and after (30


J Sex Med 2007;4(suppl 2):128–151

Monday, 4 December 200615.30–17.00 ForumMP-02 PharmacologyChairpersonsE. Akkus, TurkeyK. Hatzimouratidis, Greece

MP-02-084

A comparison of vardenafil and sildenafil: Treatmentsatisfaction among men with erectile dysfunction andcardiovascular risk factors, and their partnersRubio-Aurioles, E.1; Porst, H.2; Eardley, I.3; Goldstein, I.4

1Mexico; 2Private Practice, Urology, Hamburg, Germany; 3Pyra Depart-ment of Urology, St. James University Hospital, Leeds, United Kingdom;4Private Practice, Urology, Milton, USA

Objective: This pooled analysis of two studies (one US and one Euro-pean/Mexican) was performed to compare treatment satisfaction withvardenafil versus sildenafil, among men with erectile dysfunction (ED)and their partners.Methods: Men aged ≥18 years with ED for >6 months according toNIH criteria and risk factors for cardiovascular disease (diabetes mel-litus, hypertension and/or hyperlipidaemia) were eligible to participatein the two randomised, double-blind crossover studies. All participantshad to be in a stable, heterosexual relationship for more than the last6 months. After screening, patients were randomised to receive var-denafil 20 mg or sildenafil 100 mg for 4 weeks, followed by 1 week ofwashout, then 4 weeks’ therapy with the second drug. The TreatmentSatisfaction Scale (TSS) was completed by patients and their partnersat the end of each treatment period.Results: A total of 1,057 men were randomised to treatment. After 4weeks’ treatment, vardenafil was shown by LS mean scores to be supe-rior (nominally significant) to sildenafil in 12/19 patient TSS questions(p < 0.05; no questions showed significantly greater improvement withsildenafil). A numerical advantage with vardenafil was observed in 6questions, while a numerical trend in favour of sildenafil was observedin 1 question. Partners’ TSS results showed equal LS mean scores forsexual desire, and a trend in favour of vardenafil in 14/18 questions.Vardenafil was superior to sildenafil (nominally significant) in the 3questions relating to duration of erection, hardness of erection and sexwhen you felt like it.Conclusion: The TSS demonstrated superior satisfaction (nominallysignificant) among men treated with vardenafil versus sildenafil in12/19 questions, and numerically higher satisfaction with vardenafil in all but one question. Among partners, the LS mean score with vardenafil was numerically higher than that with sildenafil in 17/18questions.Policy of full disclosure: Dr. Rubio-Aurioles is a speaker and con-sultant for Bayer Healthcare, Lilly ICOS LLC, and Johnson &Johnson/Janssen-Cilag and receives grant support from Bayer Health-care, Lilly ICOS, and Johnson & Johnson. Mr. Eardley and Prof. Porstare both speakers and consultants for Bayer Healthcare, Pfizer, andLilly ICOS. Dr. Goldstein is a lecturer and consultant for Bayer, Pfizer,Lilly ICOS, Auxillium, Mentor, and Surface Logix.

MP-02-085

Efficacy of tadalafil dosed once a day to treat erectiledysfunction in men with comorbid moderate or severelower urinary tract symptoms secondary to benignprostatic hyperplasiaStief, C.1; Steidle, C. P.2; Kaufman, J. M.3; Feldman, R. A.4; Gittelman, M. C.5; Andersson, K.-E.6; Loughney, K.7; Hirman, J. W.7;Denes, B.7

1LMU, Hospital Grosshadern, Dept. of Urology, München, Germany;2Northeast Indiana Research LLC, Fort Wayne, IN, USA; 3Urology ResearchOptions, Aurora, CO, USA; 4Connecticut Clinical Research, Waterbury, CT,USA; 5South Florida Medical Research, Aventura, FL, USA; 6Wake ForestInstitute for Reg., Wake Forest University School, Winston Salem, NC,USA; 7ICOS Corporation, Bothell, WA, USA

Objective: Erectile dysfunction (ED) is considered difficult to treat in men with multiple comorbid medical conditions; including lowerurinary tract symptoms (LUTS). The improvement in erectile func-tion following tadalafil treatment was compared for patients with EDand either moderate or severe LUTS secondary to benign prostatichyperplasia (BPH).Methods: This post hoc analysis used data from a randomized, doubleblind, placebo controlled, parallel group, dose escalation, multicenterUS study on the efficacy and safety of tadalafil dosed once a day inmen with moderate to severe LUTS/BPH (International ProstateSymptom Score (IPSS) >= 13). Following a placebo run-in (4 weeks,single blind), patients were randomized to tadalafil (5 mg, 6 weeks fol-lowed by dose escalation to 20 mg, 6 weeks) or placebo (12 weeks). Inthis LUTS/BPH study, 81% (228/281) men were sexually active and68% (156/228) of those also had a medical history of ED. Responsesof these 156 patients (placebo, 76; tadalafil, 80) were stratified by base-line LUTS severity, and 6 and 12-week changes in International Indexof Erectile Function (IIEF) Erectile Function (EF) Domain scoreswere evaluated.Results: Tadalafil 5 mg (6 weeks) and 5/20 mg (12 weeks) significantlyimproved IIEF EF Domain scores vs placebo. At 6 weeks (tadalafil 5mg) and at 12 weeks (tadalafil 5/20 mg), IIEF EF Domain scores forpatients with moderate LUTS were not significantly different thanscores for patients with severe LUTS. Improvements in IIEF EFDomain scores at 12 weeks were comparable to those reported in pre-viously studied general ED populations.Conclusion: Tadalafil dosed once a day significantly improved erec-tile function compared with placebo in sexually active men with EDand moderate to severe LUTS secondary to BPH. In this study pop-ulation, there were no significant differences between the responses ofpatients with moderate or severe LUTS. Funded by Lilly ICOS LLCPolicy of full disclosure: Consultant for Lilly ICOS.


J Sex Med 2007;4(suppl 2):128–151

MP-02-086

Erection hardness and quality correlate with erectilefunction, emotional well-being, and treatmentsatisfaction: Double-blind, placebo-controlledmultinational trial of Viagra® (Sildenafil Citrate)Depko, A.1; Kadioglu, A.2; Grohmann, W.3; Levinson, I.4; Carlsson, M.4;Collins, S.4

1Warszawa, Poland; 2Istanbul Universitesi, Department of Urology, Capa,Istanbul, Turkey; 3Praxis, Munich, Germany; 4Pfizer Inc, Pfizer Inc, NewYork, USA

Objective: To seek correlations between erection hardness and qualityand erectile function, emotional well-being, and erectile dysfunction(ED) treatment satisfaction.Methods: At 25 European and South American centers, men with ED(scored ≤25 on the International Index of Erectile Function [IIEF]Erectile Function domain) received flexible-dose Viagra (sildenafil 25,50, or 100 mg, PRN) for 6 weeks in a randomized, double-blind,placebo-controlled trial. At the occasion of sexual stimulation, thepatient graded his erection on the Erection Hardness Grading Scale(EHGS); efficacy was the percentage of occasions with grade 3 (hardenough for penetration but not completely hard) or grade 4 (com-pletely hard) erections. Other assessments were erection quality(Quality of Erection Questionnaire [QEQ]); erectile function (IIEF);self-esteem, confidence, sexual relationship, and overall relationship(Self-Esteem And Relationship questionnaire [SEAR]); and treatmentsatisfaction (Erectile Dysfunction Inventory of Treatment Satisfac-tion [EDITS]). Between-group differences were based on estimatedchanges (least squares means ± SE using analysis of covariance).Results: Mean (range) age was 45 (18–55) years and ED duration was2 (<1–21) years. Baseline to end-of-treatment improvements in all effi-cacy measures were greater with Viagra (n = 154) versus placebo (n =153); (P < 0.0001). Even in the subgroup that improved from func-tionally hard (grade 3) to completely hard (grade 4), SEAR and mostIIEF scores improved, and the EDITS Index was high (P < 0.05).Change in erection hardness (EHGS) correlated positively (Pearsoncoefficients) with change in IIEF scores (r = 0.23–0.65 across domains)and SEAR scores (r = 0.37–0.46 across components) and with theEDITS Index (r = 0.43), as did change in satisfaction with hard-ness (QEQ question 5: r = 0.30–0.69, r = 0.50–0.68, and r = 0.60,respectively).Conclusion: Erection hardness and quality increase in men treatedwith Viagra for ED, and correlate with erectile function and psy-chosocial measures.Policy of full disclosure: Pfizer, Inc Investigator.

MP-02-087

Clinical Experience with Invicorpâ at Good HopeHospital ED Clinic 1996–2006Hackett, G.1; Larsen, F.11Holly Cottage, Lichfield, United Kingdom

Objective: The Erectile Dysfunction (ED) Clinic at Good Hope Hos-pital has been prescribing Invicorp® (a named patient use drug) since1996 for the following reasons: • Low rate of post-injection pain • Reports from clinical trials of a “more natural feeling erection” • Very low rate of priapism (and none in our experience) • No require-ment to titrate the dose for safety.Methods: Patient records (n = 410) were reviewed retrospectively inAugust 2006 and data were collected to assess the following parame-ters: • Ages of patients treated • Co-morbid conditions • Responsesto initial test injections • Strengths of Invicorp injected (1 or 2) • Adverse events.Results: • Mean age of the patients was 62.84 (33–82). 49 patients(12%) were >75 years old. • High degree of co-morbidity with hyper-

tension (28%), coronary heart disease (26%) and diabetes (26%) beingthe most prevalent • Eighty-five per cent of patients achieved a satis-factory erection and subsequently received a follow on prescriptionfrom the pharmacy. • A review of all pharmacy prescriptions sinceApril 2004 showed that 89% of prescriptions issued were for Invicorp2 and 11% for Invicorp 1 • The most common AE seen in the clinicwas facial flushing (40% observed by physician; 20% spontaneousreporting by patient). Tolerability was good and no cases of significantprolonged erection (as distinct from prolonged tumescence) wereobserved.Conclusion: These data suggest high levels of efficacy and safety withInvicorp over a 10 year period during which the drug has been usedfirst line. Elderly patients have been successfully treated with Invicorpat both doses and the efficacy and safety profile is consistent with thatin the general population.

MP-02-088

Vardenafil improves sexual function in men witherectile dysfunction and their female partnersFisher, W.1; Rosen, R.2; Mollen, M.3; Brock, G.4; Karlin, G.5; Pommerville,P.6; Goldstein, I.7; Bangerter, K.8; Herman-Gnjidic, Z.9; Taylor, T.10; Derogatis, L.11

1University of Western Ontario, Department of Psychology, Canada; 2NewEngland Research Institute, Urology, Watertown, USA; 3Arizona ResearchCenter, Clinical Research, Phoenix, USA; 4St Joseph’s Medical Center,Lawson Research Institute, Ontario, Canada; 5Lawrenceville Urology Prac-tice, Urology, USA; 6CAN-MED Clinical Research Inc, Clinical Research,Ontario, Canada; 7Private Practice, Urology, Milton, USA; 8Bayer Health-care, Biometry, West Haven, Canada; 9Bayer Healthcare, Clinical, Toronto,Canada; 10Bayer Healthcare, Global Clinical Development, West Haven,USA; 11Johns Hopkins, Center for Sexual Health and M, Baltimore, USA

Objective: To assess the influence of vardenafil on erection quality inmen with erectile dysfunction (ED). Also, to determine whether treat-ment-induced changes in men’s erectile function were associated withimprovement in sexual function of their female partner.Methods: 12-week, randomised, double-blind, multicentre, flexible-dose, parallel-group study involving men aged ≥18 years with ED for>6 months and their female partners. Men initially received placeboor vardenafil 10 mg, which could be titrated to 5 mg or 20 mg at weeks4 and 8. Outcome measures included patients’ responses to EF domainof the IIEF (IIEF-EF) and EQS, and partners’ responses to the FSFI.Results: 227 patients (mean age 59 years) were randomised to varde-nafil (n = 113) or placebo (n = 114). Baseline IIEF-EF scores in thevardenafil and placebo groups were 13.2 and 13.4, indicating moder-ate ED. At LOCF, IIEF-EF scores were significantly higher in the vardenafil group compared with placebo (22.8 vs 12.7; p < 0.0001).This indicated a considerable increase in IIEF-EF scores in vardenafilpatients (from moderate to mild ED) and no change in placebopatients. The EQS LS mean scores increased significantly from 15.3at baseline to 36.1 at LOCF in the vardenafil group (p < 0.0001) butchanged little in the placebo group from 14.8 at baseline to 14.6 atLOCF. Among vardenafil-treated couples, treatment-related improve-ment in patients’ IIEF-EF and EQS scores were significantly corre-lated with improvement in partners’ FSFI total score (vardenafil r =0.49 and 0.48 vs placebo r = 0.14 and 0.19) and all individual domainscores.Conclusion: Men with ED showed significant improvement in erec-tion quality (measured by EQS) and IIEF-EF scores following treat-ment with vardenafil. Importantly, untreated women partnersexperienced improvement in sexual function associated with restoringerectile function in men.Policy of full disclosure: Drs Fisher, Rosen, Mollen, Brock, Karlin,Pommerville, Goldstein, and Derogatis are all speakers and consult-ants for Bayer Healthcare, Pfizer, and Lilly ICOS. Drs Taylor,Bangerter and Herman-Gnjidic are all employees of Bayer Healthcare.


J Sex Med 2007;4(suppl 2):128–151

MP-02-089

Improvement in erection hardness for men withmilder erectile dysfunction is associated withimprovements in measures of psychosocial well-beingKadioglu, A.1; Grohmann, W.2; Depko, A.3; Levinson, I.4; Carlsson, M.4

1Istanbul Universitesi, Dept. of Urology, Capa, Istanbul, Turkey; 2Praxis,Munich, Germany; 3Polish Society for Sexual Medicine, Warszawa, Poland;4Pfizer Inc, Pfizer Inc, New York, USA

Objective: To understand the impact of milder erectile dysfunction(ED) on measures of well-being before and after treatment withViagra® (sildenafil citrate).Methods: 6-week, double-blind, placebo-controlled Viagra trial(DBPC) followed by 6-week open-label extension (OLE) conductedin men with ED. Changes in erection hardness (Erection HardnessGrading Scale), erectile function (IIEF), and well-being (SEAR) wereassessed for men who shifted from having milder ED (grade 3, hardenough for penetration but not completely hard) at baseline to havinggrade 4 erections (completely hard and fully rigid) after the OLE. Sat-isfaction with treatment (EDITS) and erection quality (QEQ) was alsodetermined.Results: 279 men completed the 12-week study. Before randomiza-tion, 5% of patients achieved grade 4 erections. After the DBPC trial,57% of sildenafil-patients and 15% of placebo-patients achieved grade4 erections, which increased to 67% and 61%, respectively, after theOLE. For sildenafil-patients who improved from grade 3 to grade 4erections (vs placebo-patients), least squares mean ± SE improvementin EF domain (8.7 ± 0.8 vs 5.5 ± 0.8) and SEAR (31 ± 3.2 vs 14 ± 3.2)scores were significantly higher after the DBPC. After switching tosildenafil in the OLE, placebo-patients from the DBPC achievedscores similar to those of patients taking sildenafil in both phases.Among all patient scores, IIEF and SEAR scores correlated positively(0.30–0.69) with satisfaction with erection hardness (QEQ Q5), andall men (100%) who shifted from grade 3 to grade 4 erections weresatisfied with sildenafil treatment (EDITS Index ≥50) after the OLE.Conclusion: Anything less than completely hard and fully rigid erec-tions impacts erectile function and measures of well-being. Amongmen with milder ED, sildenafil improved erection hardness, whichcorrelated with improvements in erectile function, well-being, andtreatment satisfaction.Policy of full disclosure: Pfizer, Inc Investigator.

MP-02-090

Therapeutic effect of combination of alagebrium andsildenafil on erectile function in diabetic ratsUsta, M. F.1; Sagdic, G.2; Gurbuz, N.2; Sanli, A.1; Gurkan, R.1; Baykal, A.2

1Akdeniz University, Urology, Antalya, Turkey; 2Akdeniz University, Bio-chemistry, Antalya, Turkey

Objective: Recently, the relationship between Advanced Glycationend Products (AGEs) and erectile dysfunction (ED) has been reported.The present study aimed to investigate whether a combination of anAGE cross-link breaker (Alagebrium) and sildenafil could enhance theerectile capasity in STZ-diabetic rats.Methods: Four groups of animals were utilized: (1) age-matchedcontrol rats, (2) streptozotocin (STZ)-induced diabetic rats (40 mg/kgi.p.), (3) STZ-rats + sildenafil (5 mg/kg p.o.), (4) STZ-rats treated witha combination of sildenafil (5 mg/kg p.o) + Alagebrium (10 mg/kg p.o.)for the final one month of two months of diabetes period. At 2 monthsafter i.p. injection of STZ, all animals underwent cavernosal nervestimulation (CNS) to assess erectile function. Penile tissue AGEs,MDA (Malondialdehyde), cGMP (ELISA), iNOS, nNOS, eNOS(Western Blot), NF-kB, MAP-kinase (Immunohistochemistry), apop-tozis (TUNEL) analyses were performed in all group of ratsResults: STZ-diabetic rats had a significant decrease in erectile func-tion as determined by the peak intracavernosal pressure (ICP) and totalICP (area under the erectile curve; AUC) after CNS when comparedto control rats (p < 0.05). The increase in both ICP and AUC of STZ-

diabetic rats treated with combination sildenafil + ALT-711 was gretaerthan STZ-diabetic rats treated with sildenafil alone. Additionally com-bination tretment decreased AGE, iNOS, NF-kB, MAP kinase andapoptozis levels, while it preserved eNOS, nNOS and cGMP contentsin diabetic penile tissue.Conclusion: In summary, decreased AGE, iNOS, NF-kB, MAPkinase and increased eNOS, nNOS and cGMP levels at the combina-tion (Alagebrium + sildenafil) therapy group increased both the peakICP and total ICP to CNS in the STZ-diabetic rat, which was similarto the response observed in control rats.

MP-02-091

Efficacy of sildenafil citrate treatment after re-instruction in normogonadal patients with sildenafil failed patientsBasar, M.1; Atan, A.2; Tuncel, A.2; Tuglu, D.31University Kirikkale School, Department of Urology, Turkey; 2AnkaraNumune Hospital, Department of Urology, Kirikkale, Turkey; 3Universityof Kirikkale School, Department of Urology, Turkey

Objective: To evaluate the efficacy of sildenafil citrate treatment afterre-instruction about sildenafil citrate usage in normogonadal sildenafilfailed patients.Methods: Forty-three male patients who were non-responders tosildenafil citrate monotherapy according to first five questions of theInternational Index of Erectile Function (IIEF-5) and having normalserum testosterone levels (4.7 ± 1.2 ng/ml, 3.1–8.9 ng/ml) wereinvolved. The patients were re-informed in detail on sildenafil usage.The patients were asked for taking at least six times 100 mg sildenafilcitrate in two months.Results: Mean age was 51.3 ± 7.1 (34 to 67) years. The mean pre andpost-treatment IIEF-5 scores were 9.1 ± 4.3 (1–16) and 15.6 ± 6.9(1–25), respectively (p < 0.000). The improvement ratio of the erec-tile function was 71.4% (Table).Conclusion: Re-instruction about sildenafil citrate usage improves thedrug’s efficacy in sildenafil citrate failed patients who had normalserum testosterone level.

MP-02-092

A normal endothelium increases the therapeutic roleof Tadalafil in vasculogenic erectile dysfunctionMancini, M.1; Guazzi, M.2; Nerva, F.1; Contalbi, G.1; Colpi, G. M.11San Paolo Hospital, Andrology, Milan, Italy; 2San Paolo Hospital, Cardi-ology, Milan, Italy

Objective: Impaired arterial penile inflow is a frequent cause of erec-tile dysfunction (ED). Clinical and emodynamic advantages by chronicSildenafil in ED patients with different degrees of vascular impairmentwere reported. Furthermore, many papers showed in ED patients, animpaired brachial artery flow mediated vasodilation (FMD), indicatingan impaired endothelium. Our aim is to evaluate if the therapeutic role of Tadalafil in arteriogenic ED patients could be influenced byendothelium.Methods: Twenty-four ED patients underwent brachial FMD, to testendothelial function, IIEF questionnaire and dynamic duplex sonog-raphy of cavernosal arteries (US). Twenty patients were consideredvasculogenic. All accepted to take Tadalafil 10 mg on alternate days,for thirty days, just before sleeping. All the patients treated underwentDS and IIEF after the end of treatment. Based on the brachial FMD,


J Sex Med 2007;4(suppl 2):128–151

the twenty patients were divided in two groups: Group A (n = 10) witha high FMD, and Group B (n = 10) with a low FMD. The averagepeak systolic velocity (PSV) values of the right and left cavernosalarteries before and after treatment were compared in both Groups.Results: A significant correlation between the average PSV andbrachial FMD was found (Pearson Correlation: n = 24; r2 = 0.018; P = 0.03). After Tadalafil treatment, the average cavernosal PSVincreased in Group A (26.8 ± 6.4 cm/s to 32.5 ± 4.9 cm/s; P = 0.03)with a high FMD, and remained constant in Group B (24.9 ± 5.8 cm/sto 25.3 ± 7.2 cm/s; P = N.S.) with a low FMD. The IIEF value sig-nificantly increased in both Groups.Conclusion: A chronic regular intake of Tadalafil showed an emody-namic result in cavernosal PSV of arteriogenic ED patients particu-larly when endothelial function was preserved. These preliminaryresults seem to show the ideal ED subpopulation to be successfullytreated with chronic iPDE5 to gain an emodynamic advantage.

MP-02-093

Vardenafil and Alfuzosin polypharmacotherapy forerectile dysfunctionBhatia, V.1

1Specialized Medical Care Hospital, Urology & Andrology, Al Ain, UnitedArab Emirates

Objective: This study compares the efficacy and safety of combinedAlfuzosin (ALF) and Vardenafil (VAR) versus Vardenafil alone in maleswith erectile dysfunction (ED) and benign prostate hyperplasia (BPH)Methods: Patients comprised 78 males, mean age 64 years. Themedian international index of erectile function score (IIEF) was 14.2.The international prostate symptom score (IPSS) was <12, post voidresidual urine < 50 ml, peak flow rate > 12 ml/sec, PSA < 4 ng/ml.Patients were subjected to detailed history taking, physical examina-tion and “goal directed ED evaluation”. The obvious ED risk factorsincluded-diabetes mellitus (23), hypertension (19), obesity (29), andsmoking (23). The patients were randomized into 2 groups-Group A(39)-VAR 10 mgm twice a week orally, 30 minutes before sexual activ-ity and Group B (39)- VAR 10 mgm twice a week orally, 30 minutesbefore sexual activity and ALF 10 mgm daily at night. A gap of 4–6hours was advised between the two drugs. Patients were evaluted at sixweeks.Results: The evaluation criteria used- A) SEP 3, B) SEP 4, C) globalefficacy question (GEQ), D) Partner satisfaction grade I, II and III(fair, good and excellent), E) side effects. The IIEF improved to 19.4in group A and to 20.6 in group B. The GEQ success rate was 76%and and 88% in group A and B respectively. The partner satisfactionrates were 78% in group A and 84% in group B. The side effects weresimilar in both the groups-headache (16%), flushing (14%) and dys-pepsia (12%). No patient had clinically significant hypotension or ejac-ulatory dysfunction.Conclusion: The combination of VAR and ALF appears to be moreeffective than VAR alone in the management of ED with BPH. Noadditional side effects were noted with the combination therapy.

MP-02-094

Phosphodiesterase type 5 inhibitor-naive men witherectile dysfunction can achieve completely hard and fully functional erections with Viagra® (Sildenafil Citrate)Collins, S.1; Stecher, V.1; Wang, H.1

1Pfizer Inc, New York, USA

Objective: To determine responsiveness of the Quality of ErectionQuestionnaire (QEQ) to erectile dysfunction (ED) treatment and cor-relations with measures of erection hardness and function.Methods: In this 10-week, open-label Viagra® (sildenafil citrate 50 or100 mg) study in men with ED, patients reported erection hardness(Erection Hardness Grading Scale [EHGS]), erectile function (Inter-national Index of Erectile Function [IIEF] Erectile Function [EF]domain), psychosocial well-being (Self-Esteem And Relationship ques-

tionnaire [SEAR]), treatment satisfaction (Erectile Dysfunction Inven-tory of Treatment Satisfaction [EDITS]) and intercourse success/failure (sexual activity logs).Results: 107 phosphodiesterase type 5 inhibitor-naäve men wereenrolled (mean [range] age, 53 [20–82] y; ED duration, 4 [<1–18] y).From baseline to week 10, mean ± standard deviation (SD) total QEQscore improved from 22.0 ± 21.1 to 69.9 ± 35.9 (P < 0.0001), the per-centage of occasions at which a grade 3 (hard enough for penetration)or grade 4 (completely hard) erection was achieved increased from28% to 75% (P < 0.0001), the mean ± SD EF domain score increasedfrom 12.3 ± 5.8 to 23.4 ± 8.5 (P < 0.0001), and the percentage of suc-cessful sexual intercourse occasions improved from 13% to 68% (P <0.0001). Using Pearson’s product moment analysis, correlations(95%CI) between QEQ total change score and changes in grade 3(hard enough for penetration but not completely hard) or 4 (com-pletely hard) erection frequency and EF domain scores were 0.66(0.53–0.77) and 0.86 (0.80–0.91), respectively. For men who shiftedfrom grade 3 to grade 4 erections, scores for all IIEF, SEAR, andEDITS components were significantly improved and correlated posi-tively with improvement in the score of QEQ question 5 (satisfactionwith erection hardness).Conclusion: Men initiating ED therapy with Viagra reported signif-icantly improved erection hardness, function, and quality, with con-current improvements in successful sexual intercourse.Policy of full disclosure: Pfizer Inc Employee.

MP-02-095

Vardenafil improves erectile function in men andtreatment satisfaction in couples affected by erectiledysfunction previously untreated with PDE5 inhibitorsEdwards, D.1; Hackett, G.2; Collins, O.3; Curram, J.3

1White House Surgery, Chipping Norton Oxon, United Kingdom; 2GoodHope Hospital, Urology, Birmingham, United Kingdom; 3Bayer plc, MedicalScience, Newbury, United Kingdom

Objective: To evaluate satisfaction with vardenafil treatment incouples where men with erectile dysfunction (ED) were naäve toPDE5 inhibitor therapy, and to assess efficacy and tolerability of var-denafil in the man.Methods: A 12-week, multicentre, randomised, double-blind,placebo-controlled study involving men aged ≥18 years with ED for>6 months. Starting dose of vardenafil was 10 mg, which could betitrated to 5 mg or 20 mg at weeks 4 and 8 depending on efficacy andtolerability. Efficacy measures included patient responses to the erec-tile function domain of the International Index of Erectile Function(IIEF), and patient and partner responses to questions on the Treat-ment Satisfaction Scale (TSS).Results: 260 men were randomised to vardenafil (n = 194) or placebo(n = 66), with a median age of 55 years. Vardenafil significantlyincreased IIEF-EF scores compared with placebo (p < 0.0001). Atbaseline, the overall mean IIEF-EF domain score was indicative ofmoderate ED. At LOCF, mean IIEF-EF scores were 23.5 (mild ED)and 15.8 (moderate ED) for patients treated with vardenafil andplacebo. At LOCF, 56% of vardenafil-treated patients compared with20% of placebo-treated patients had ‘normal’ erectile function, defined as an IIEF-EF score of ≥26 (p < 0.0001). Vardenafil signifi-cantly improved TSS scores compared with placebo across all domains(satisfaction with orgasm; erectile function satisfaction; satisfactionwith medication; confidence; pleasure; and ease of erection) for bothmen and their partners (p < 0.0001). Vardenafil was generally well tol-erated. The most common adverse events (vardenafil vs placebo) wereflushing (7% vs 0%) and headache (5% vs 0%).Conclusion: Vardenafil is an effective first-line treatment for ED inPDE5-naïve men. Vardenafil significantly improved erectile functionto ‘normal’ in almost 60% of men with ED. Both men and their part-ners expressed a considerable and mutually agreed level of treatmentsatisfaction.Policy of full disclosure: Dr Edwards and Dr Hackett are both speak-ers and consultants for Bayer Healthcare, Pfizer, and Lilly ICOS. DrCollins and Dr Curram are both employees of Bayer plc.


J Sex Med 2007;4(suppl 2):128–151

MP-02-096

Dapoxetine has no significant qt interval or otherelectrocardiographic effects in healthy menModi, N.1; Staehr, P.2; Dresser, M.1; Rivas, D.3

1ALZA Corporation, Clinical Pharmacology, Mountain View, CA, USA;2ALZA Corporation, Clinical Development, Mountain View, CA, USA;3J&J Pharmaceutical Research, Internal Medicine/Urology, Raritan, NJ,USA

Objective: Premature ejaculation (PE), a common male sexual dys-function, does not vary in prevalence with age or the presence of cardiovascular comorbidity. Dapoxetine is a short-acting selectiveserotonin reuptake inhibitor that is rapidly absorbed and eliminatedand is being developed as an on-demand oral treatment for PE, usingdoses up to 60-mg daily. These studies evaluated the electrocardio-graphic (ECG) pharmacodynamics of dapoxetine in comparison withthose of placebo or moxifloxacin, a synthetic fluoroquinolone antibi-otic that has been shown to prolong the QT interval, to serve as anactive control.Methods: Two single-center, randomized, placebo- and positive-con-trolled crossover studies were conducted in healthy adult male subjects(age, 18–45 years). In Study 1 (N = 48), subjects received 4 single-doseoral treatments: dapoxetine 60 mg; dapoxetine 120 mg; moxifloxacin400 mg; or placebo. In Study 2 (N = 48), subjects received 3 oral treat-ments: 2 doses of dapoxetine 120 mg, given 3 hours apart; 1 dose ofmoxifloxacin 400 mg; or 2 doses of placebo given 3 hours apart. End-points included pharmacokinetic parameters for dapoxetine and moxiflaxicin, safety data, and ECG results, including QT interval (corrected for changes in heart rate, using various methods; QTc).Results: Dapoxetine was rapidly absorbed and eliminated. The 90%confidence interval for changes in the QTc interval for moxifloxacinversus placebo did not include zero, indicating that moxifloxacin, thepositive control, increased the QTc interval. Dapoxetine did not haveclinically significant ECG effects vs. placebo at any dose studied, anddid not prolong the QTc interval. Adverse events reported were gen-erally mild in severity, with nausea the most common.Conclusion: Dapoxetine (a single dose of 60 or 120 mg, or 2 doses of120 mg) was generally well tolerated, with no clinically significantECG effects or significant prolongation of the QT interval in healthyadult males.Policy of full disclosure: These studies were funded by ALZA Cor-poration, Mountain View, CA.

Objective: To compare the efficacy of sildenafil citrate treatment onlyto efficacy of sildenafil citrate plus testosterone combination in nor-mogonadal patients who did not benefit from previous sildenafil citratetreatment for erectile dysfunction.Methods: Sixty-eight male patients who were non-responders tosildenafil citrate monotherapy according to first five questions of theInternational Index of Erectile Function (IIEF-5) were involved. Thepatients were informed in detail on sildenafil usage. Thirty patientswere asked for taking at least six times 100 mg sildenafil citrate inGroup 1. Group 2 consisted of 38 patients and they were asked fortaking at least six times 100 mg sildenafil citrate and 5 gr transdermaltestosterone gel per day. The treatment period was two months foreach group. Serum total testosterone (TT) and prostate specificantigen (PSA) levels were measured in each group before and aftertreatment.Results: Median age was 54.2 ± 7.3 (34 to 67) years. The mean ageof the patients in Group 1 and Group 2 was 49.5 ± 7.2 and 58 ± 4.9years (p = 0.000). Patients’ data are shown in Table.Conclusion: Although sildenafil citrate monotherapy is efficient inyoung patients, testosterone plus sildenafil citrate combination treat-ment should be recommended in elder patients.

MP-02-098

Factors influencing continuation of tadalafil treatmentfor erectile dysfunction at 6 months: Results from theDETECT studyArver, S.1; Perimenis, P.2; Heidler, H.3; Roumeguère, T.4; Belger, M.5

1Karolinska University Hospital, Andrology and Sexual Med, Stockholm,Sweden; 2University Hospital, Urology, Patras, Greece; 3Linz Hospital,Urology, Austria; 4Erasme Hospital, Urology, Brussels, Belgium; 5Eli Lilly,Medical, Earl Wood, United Kingdom

Objective: Objectives: To determine factors associated with continu-ation of tadalafil therapy at 6 months.Methods: The DETECT study is a prospective 12 month Europeanmulti-centre observational study in patients with erectile dysfunction(ED) initiating or changing treatment to tadalafil. 1900 patients wereenrolled. Data were available on tadalafil use from 1564 patients at 6months with similar baseline characteristics as the initial cohort.1406patients (90%) were taking tadalafil, 124(8%) had discontinued treat-ment and 34(2%) reported they no longer had ED. A multivariatelogistic regression model was used to identify factors either at baselineor after one month therapy that were associated with continuedtadalafil treatment at 6 months.Results: At baseline, depression (p = 0.02) and no sexual attempt (p =0.0009) were negatively associated with tadalafil use at 6 months.Other baseline factors: age, ED severity or etiology, previous ED treat-ment, patients expectations, partner age were not associated with useat 6 months. Satisfaction with tadalafil treatment (ED Inventory ofTreatment Satisfaction, EDITS score) after one month, was stronglyassociated with treatment continuation at 6 months (p < 0.0001). Ahigher EDITS total score was itself associated with less severe ED,greater improvement from baseline and higher number of sexualattempts. Good tolerance to treatment after one month, was also pos-itively associated with treatment continuation (p = 0.006).Conclusion: In men with ED, response to tadalafil treatment asreflected in patient satisfaction after one month was the main predic-tor for continuation of treatment at 6 months.

MP-02-097

Comparison the efficacies of sildenafil only to thesildenafil plus testosterone treatment after re-instruction in sildenafil failed normogonadal patientsAtan, A.1; Basar, M. M.2; Tuncel, A.1; Tuglu, D.21Numune Hospital, Third Department of Urology, Ankara, Turkey;2Kirikkale University, Urology, Turkey


J Sex Med 2007;4(suppl 2):128–151

Tuesday, 5 December 200610.00–11.30 ForumMP-03 Physiology and PathophysiologyChairpersonsG. Corona, ItalyU. Simonsen, Sweden

MP-03-099

Expression of cyclic AMP-dependent protein kinase-1isoforms in human cavernous arteries (HCA) andcorpus cavernosum (HCC): Relation to vasoactiveintestinal polypeptide-containing nerves and PDE4Waldkirch, E.1; Ueckert, S.1; Langnäse, K.2; Richter, K.2; Sohn, M.3; Jonas, U.1; Wolf, G.2; Andersson, K.-E.4; Stief, C. G.5; Hedlund, P.41MHH/Hannover Medical School, Urology, Germany; 2Otto-von-Guericke-University, Medical Neurobiology, Magdeburg, Germany; 3St. Markus Aca-demic Hospital, Urology, Frankfurt, Germany; 4Lund University Hospital,Clinical and Experimental Pharmacology, Sweden; 5Academic HospitalGrosshadern, Urology, Munich, Germany

Objective: Erectile dysfunction (ED) shares the same risk factors withcardiovascular diseases (CVD). Endothelial dysfunction might be one of the links between CVD and ED. Flow-mediated vasodilation(FMD) is not only dependent on NO-signaling, but is also facilitatedby prostanoids activating cAMP-mediated mechanisms. The cAMP-dependent kinase-1 (cAKI) is considered a key enzyme in the cAMP-dependent regulation of smooth muscle tone. We investigated thedistribution of the cAKI isoforms A and B in relation to VIP-contain-ing nerves and PDE4 within HCA and HCC.Methods: HCA and HCC segments were processed for immunohis-tochemistry for VIP, PDE4 and cAKI A and B. For western blots, freshfrozen tissue samples were cryostate cut into 20 m slices and collectedin Eppendorf tubes. Tissue was homogenized and samples centrifugedto remove unhomogenized material. Western blots were done on5–20% gradient gels. Blots were developed using the ECL system withanti cAKI A and B antibodies.Results: PDE4 and cAKI A was abundantly observed within thesmooth muscle cells of the media of HCA, the endothelial cells of thearterial wall and the trabecular smooth musculature of HCC. cAKI Bcould not be detected in HCA and HCC specimens. VIP was confinedto nerve fibers adjacent to trabecular smooth muscle cells (HCC) andthe media of HCA. Results for the expression of PKA isoforms wereconfirmed by western blot analysis.Conclusion: Our results demonstrate the occurrence of cAKI A notonly within the smooth musculature of HCA and HCC but also withinendothelial cells of the arterial wall in colocalization with PDE4 andin close relation to VIP-containing nerves. The findings are in supportof a contributory role of cAMP-mediated signaling in FMD and there-fore might have a considerable influence on penile perfusion and erection.

MP-03-100

Relationship between well-being and erectile functionand autonomic variables in male with/without sexual dusyfunctionDogru, T.1; Kocak, O. M.2; Basar, M. M.3; Erberk-Ozen, N.2; Batislam, E.3

1University of Kirikkale, Cardiology, Ankara, Turkey; 2University ofKirikkale, Psychiatry, Ankara, Turkey; 3University of Kirikkale, Urology,Ankara, turkey

Objective: In this study, we investigated that autonomic nervoussystem (ANS) variables are suitable to be biological markers of thewell-being and sexual status.

Methods: Participants (n = 74) were recruited from persons whoapplied cardiology clinic for check-up. Well being was assessed withSF-36. Additionally, sexual status including libido and erectile func-tion were assessed with. According to scores of IIEF, patients withscores less than 25 were accepted as erectile dysfunction; patients withscores less than 19 also accepted as having an additional deficiency oflibido. ANS parameters were also determined by 24 hours holter mon-itorization and heart rate variability measurements.Results: Energy (p = 0.009) and emotion (p = 0.005) sub scores of SF-36 test was statistically significant between patients with/without erec-tile dysfunction (n = 48, n = 26, respectively). These changes were fundin patients with normal (n = 33) and decreased libido (n = 33). Energyshowed positive correlation with parasympathetic activity (r = 0.450,p = 0.000) and negative correlation with sympathetic activity (r =−0.310, p = 0.011). On the contrary, emotion was related withparasympathetic activity (r = 0.0316, p = 0.009). Sympathetic activitywas higher in patients with ED and decreased libido comparing towithout these problems (p = 0.022, p = 0.011, respectively).Conclusion: ANS variables can be suitable markers of well-being,however, there are quality differentiations. Parasympathetic activity isa general, two dimensional marker of well-being while sympatheticactivity shows linearity in only health. If there is an illness its levelsincrease and exceeding a critic level disturbs this linearity. Energy andemotion effect on erectile capacity and libido of men. Moreover, sym-pathetic activity showed decreasing effect on sexual function.

MP-03-101

The role of rho/rhokinase pathway in serotonin-induced contraction in diabetic and nondiabetichuman corpus cavernosumMurat, N.1; Burak, B. C.2; Demir, O.3; Gidener, S.2; Esen, A.31Dokuz Eylul University, Advanced Professional School O, Izmir, Turkey;2Dokuz Eylul University, Pharmacology, Izmir, Turkey; 3Dokuz Eylul Uni-versity, Urology, Izmir, Turkey

Objective: The contractile effect of serotonin (5-HT) had been shownin the regulation of human and animal penile smooth muscle. The aimof our study is to examine the role of Rho-kinase in the contractileresponse of serotonin in diabetic and nondiabetic human corpus cavernosum (HCC).Methods: The effect of 5-HT on isolated HCC was investigated usingorgan bath technique. Corpus cavernosum strips were obtained fromdiabetic and nondiabetic patients who were recommended for penileprosthesis implantation due to the failure of other treatment options.In study protocol, after calculating EC80 dose of phenylephrine andIC50 dose of Rho-kinase inhibitor, Y-27632, serotonin dose-responsecurves were obtained in the absence and presence of IC50 dose of Y-27632 in both diabetic and nondiabetic HCC. Maximum contractionof 5-HT was calculated according to the percent (%) response to EC80dose of phenylephrine.Results: Y-27632 caused a higher maximal relaxation response in non-diabetic group than diabetic group (p < 0.05, table 1). 5-HT caused adose dependent contraction in nondiabetic and diabetic HCC stripsbut there was no significant difference between diabetic and nondia-betic groups (p > 0.05, table 1). Pre-incubation with Y-27632 signifi-cantly suppressed the contractile response of 5-HT in both group (*p< 0.01 diabetic, ** p < 0.05 non-diabetic group, table1). When diabeticand nondiabetic groups were compared there was a significant differ-ence between maximal contraction of serotonin in the presence of Y-27632 (p < 0.05, table 1).Conclusion: We have demonstrated that Rho/Rho-kinase pathwaymay have a role in the 5-HT induced contraction in both diabetic andnondiabetic human corpus cavernosum. The activity of this pathwayis enhanced in diabetic patients.


J Sex Med 2007;4(suppl 2):128–151

MP-03-102

Increased levels of endothelin-1 as a marker of ageneralized vascular disease manifested byvasculogenic erectile dysfunctionRokkas, K.1; Vlachopoulos, C.1; Ioakeimidis, N.1; Vasiliadou, C.1; Dima, I.1;Antoniou, G.1; Askitis, A.1; Stefanadis, C.11Hippokration Hospital, 1st Department of Cardiology, Athens, Greece

Objective: Endothelial dysfunction is a key-event in the pathophysi-ology of erectile dysfunction (ED) and coronary artery disease (CAD).Increased levels of endothelin-1, which is a peptide with potent andprolonged vasoconstrictor activity, are found in conditions associatedwith increased risk for developing atherosclerosis such as hyperten-sion, diabetes and obesity. Aim of this study was to investigate whetherlevels of endothelin-1 are associated with ED.Methods: A total of 91 men (mean age 59 yrs) matched for age, body-mass index (BMI) and vascular risk factors were studied: 38 men hadED without evidence for CAD, 25 men had ED and angiographically

documented CAD and 28 men were controls with normal erectilefunction and no CAD. Men with ED were evaluated for penile vascu-lar disease severity by penile Doppler ultrasound. Endothelin-1 wasmeasured using ELISA.Results: There was a progressive increase in endothelin-1 levels fromcontrol to ED-no CAD subgroup and to ED plus CAD subgroup (leftplot). In men with ED, peak systolic velocity (PSV) showed strongnegative correlation with endothelin-1 levels (r = −0.55, p < 0.001).The association between PSV and endothelin-1 analyzed separately forthe ED-no CAD subgroup (r = −0.63, p < 0.001) and for the ED plusCAD subgroup (r = −0.17, p = 0.41) is presented in the right plot. Inmultivariate regression analysis for the ED subgroups, with PSV as thedependent variable, endothelin-1 was shown to be the predictor of EDwhen adjusting for age, BMI, mean arterial pressure, CAD and historyof hypertension, diabetes and smoking (b = −0.50, p < 0.001, R2 =0.42).Conclusion: Endothelial dysfunction as expressed by increasedendothelin-1 level is implicated in the pathophysiology of ED. Thisfinding is perhaps associated with a higher cardiovascular risk inpatients with ED.

MP-03-103

Correlation of penile Doppler findings of arterial flowand severity of coronary artery diseaseVlachopoulos, C.1; Rokkas, K.1; Ioakeimidis, N.1; Aggeli, C.1; Roussakis, G.1;Soulis, D.1; Askitis, A.1; Michailides, A.1; Stefanadis, C.11Hippokration Hospital, 1st Department of Cardiology, Athens, Greece

Objective: Vasculogenic erectile dysfunction (ED) has been reportedas the first sign of a generalized vascular disease. Aim of the presentstudy was to investigate whether penile Doppler findings are relatedto severity of coronary artery disease (CAD).Methods: A total of 105 consecutive men (mean age 60 ± 11 years)with symptoms of ED were evaluated for penile vascular disease sever-ity by penile Doppler ultrasound: 38 men with angiographically doc-umented CAD and 67 men without clinical and stress evidence forCAD, matched for age and risk factors. Cut-off value of mean systolicvelocity (PSV) to define ED as arteriogenic was 35 cm/sec. A meanPSV between 25 and 35 cm/sec was considered to indicate borderlinepenile arterial function and below 25 cm/sec arterial insufficiency.Results: The mean PSV of the patients with CAD was 28 ± 10 vs. 34± 11 cm/s (p < 0.01) in those without CAD. Penile Doppler results andcoronary angiographic findings are presented in the table. The speci-ficity and sensitivity of this value to diagnose CAD was 79.5 % and68.7 % respectively. Of the patients with CAD, eight had 3-vesseldisease, fifteen had 2-vessel disease, fifteen had 1-vessel disease andseven had coronary artery ectasia, which are localized or diffuse non-obstructive lesions of the epicardial coronary arteries with a luminaldilation exceeding the 1.5 fold of normal adjacent segment or vesseldiameter. A significant association was found between coronary angio-graphic findings and mean PSV. Furthermore, of the patients with 2-vessel and 3- vessel disease, 20 (87%) had arteriogenic ED (mean PSV< 35 cm/s). Finally, six out of seven patients with coronary arteryectasia had arteriogenic ED.Conclusion: Coronary angiographic findings correlate significantlywith increasing severity of penile vascular disease. This may reinforcethe link between ED and increased cardiovascular risk.


J Sex Med 2007;4(suppl 2):128–151

MP-03-104

Erectile dysfunction is associated with increased aortic stiffness in patients with and without coronaryartery diseaseVlachopoulos, C.1; Ioakeimidis, N.1; Rokkas, K.1; Tsokanis, A.1; Adamopoulos, D.1; Xaplanteris, P.1; Fassoulakis, C.1; Stefanadis, C.11Hippokration Hospital, 1st Department of Cardiology, Athens, Greece

Objective: Accumulating evidence suggests that erectile dysfunction(ED) may be an early manifestation of generalized vascular disease.Aortic stiffness is an independent marker and prognosticator of car-diovascular risk. We investigated whether ED is associated withincreased aortic stiffness.Methods: A total of 230 men (aged 58 ± 11 yrs) were studied: 98 menhad ED without evidence for CAD, 66 men had ED and angiograph-ically documented CAD and 31 men had angiographically documentedCAD and normal erectile function. 35 men were controls with normalerectile function and no CAD, matched for age and risk factors withthe other subgroups. Diagnosis of ED was based on the 5-item briefform of the International Index of Erectile Function. Aortic stiffnesswas evaluated with carotid-femoral pulse wave velocity (PWV), usinghigh-fidelity pulse wave analysis. Higher values of PWV indicate stifferaorta and vice versa.Results: PWV was significantly increased in patients with ED com-pared to subjects with normal erectile function, after adjusting for ageand mean pressure (8.6 ± 1.7 vs 7.8 ± 1.2 m/s, P < 0.001) In patientswithout CAD, subjects with ED had significantly increased PWVcompared to subjects without ED (8.2 ± 1.5 vs. 7.4 ± 0.9 m/s, P < 0.01,figure). Furthermore, in patients with CAD, subjects with ED had sig-nificantly increased PWV compared to subjects without ED (9.0 ± 1.5vs. 8.4 ± 1.4 m/s, P < 0.05). Interestingly, when patients with ED only,were compared with patients with CAD only, no difference was found(P = NS) in PWV, indicating that the unfavorable effect of ED on theinvestigated parameter is similar to that of CAD. There were no sig-nificant differences between the four subgroups regarding systolic anddiastolic pressures.Conclusion: ED is associated with increased aortic stiffness. Thisfinding provides further evidence for the potential link between EDand CAD.

2002) into the VMN whereas 5HT1A (Uphouse & Wolf, 2004), µopioid (Acosta-Martinez & Etgen, 2002) and corticotropin releasingfactor (CRF; Sirinathsinghji, 1983) agonists are inhibitory. The aimwas to establish an in vitro VMN technique to predict a compound’sability to predict lordosis.Methods: Brains were removed from female Sprague-Dawley rats(150–200 g) following cervical dislocation in compliance with UKHome Office guidelines. Coronal VMN slices (350 µm) were placedonto a 64 microelectrode chip, superfused with aCSF 5 mLmin-1 andstimulated (−150 µA, 0.1 ms, every 30 s) using MED64 Performer toevoke excitatory postsynaptic potentials (EPSPs).Results: EPSPs are abolished by tetrodotoxin (300 nM, n = 2; P <0.01) and the non-NMDA receptor antagonist DNQX (10 µM, n =51; P < 0.01) implying signals are due to nerve-evoked glutamaterelease. The GABAA antagonist bicuculline potentiates EPSPs (EC501.6 ± 0.6 µM, n = 7) suggesting glutamate release is under endogenousGABA control. Glutamate release is greatest during metestrous of theestrous cycle (n = 13; P < 0.01). Agents increasing lordosis via theVMN, decrease nerve-evoked glutamate release (endogenous GABA;noradrenaline EC50 3.8 ± 1.7 µM, n = 6). Conversely, agents decreas-ing lordosis via the VMN increase glutamate release (8-OH-DPATEC50 125 ± 34 nM, n = 7; DAMGO EC50 62.5 ± 18.6 nM, n = 2;CRF 0.3 ± 0.2 nM, n = 6).Conclusion: Here we present a novel robust VMN in vitro techniquethat a) confirms glutamate inhibits lordosis, b) can predict inhibitoryand facilitatory effects of agents acting via the VMN to modulate lor-dosis and c) examine the effect of hormones on compound efficacyprior to in vivo studies.Policy of full disclosure: Pfizer Global Research and Development.

MP-03-106

Exacerbated pressor response regulated by dailytreatment with sildenafil in an animal model ofmetabolic syndromeBehr-Roussel, D.1; Oudot, A.1; Compagnie, S.1; Gorny, D.1; Le Coz, O.1;Bernabé, J.1; Wayman, C.2; Alexandre, L.1; Giuliano, F.31Pelvipharm, Gif sur Yvette, France; 2Pfizer Global Research and D., SexualHealth, Sandwich, United Kingdom; 3AP-HP, Raymond Poincaré Hospit,Dept. of Physical Medicine and, Garches, France

Objective: Fructose is implicated in the development of the metabolicsyndrome and its associated cardiovascular disorders including hyper-tension. Daily treatment with PDE-5 inhibitors has beneficial effectson endothelial function in diabetic men. We postulated that sildenafilwould ameliorate arterial pressure (AP) and biological markers ofendothelial function in fructose-fed rats.Methods: Wistar rats were fed a standard chow (CONT, n = 12) or afructose-enriched diet for 9 weeks (FFR, n = 12) while receiving fromweek 5 through 8, sildenafil (twice a day sc, 20 mg/kg, FFR+SIL, n =14) followed by a 1-week wash-out period. Then, AP was recorded fol-lowing cumulative infusion of noradrenaline (NA) in a sub-group ofthese rats (n = 5) that had previously been implanted with telemetricdevices. In all rats, urinary levels of 8-isoprostane (IPT) and TxB2,tissue cGMP and ET-1 content from aortas and mesenteric arterieswere measured.Results: Fasting glycemia was unchanged while triglyceridemia wereelevated in FFR compared to CONT and corrected by sildenafil treat-ment. Resting AP was similar in all rats. Pressor responses to NA wereexacerbated in FFR and normalized by sildenafil treatment. Neithervascular cGMP nor ET-1 levels were modified by the fructose or silde-nafil treatment. The increased production of urinary IPT and TxB2in FFR were corrected by sildenafil treatment.Conclusion: In FFR, pressor responses to NA were potentiated, sug-gesting enhanced responsiveness of the vascular smooth muscle cell tovasoconstrictor stimuli. Chronic treatment with sildenafil was able tonormalize blood pressure regulation while restoring normal excretionof urinary biological markers of oxidative stress and vasoactive medi-ators in FFR. Both IPT and TxB2 could be considered as surrogate

MP-03-105

Electrical activity in the ventromedial nucleus in vitropredicts lordosis behaviourBooth, C.1; Wayman, C.1; Jackson, M.1

1Pfizer Ltd, Discovery Biology, Sandwich, United Kingdom

Objective: The ventromedial nucleus (VMN) controls female recep-tivity (lordosis; Malsbury et al., 1977). Lordosis can be facilitated byinjection of glutamate antagonists (Georgescu & Pfaus, 2006), adren-ergic (Gonzalez et al., 1993) and GABAA agonists (Hoffman et al.,


J Sex Med 2007;4(suppl 2):128–151

markers of endothelial function in clinical trials addressing cardiovas-cular risks.Policy of full disclosure: This work was supported by a restrictedgrant from Pfizer. Chris Wayman is an employee of Pfizer.

MP-03-107

Investigation of TGF- Beta 1 levels in patients withPeyronie’s disease (PD)Mazo, E.1; Ivanchenko, L.1; Moufagued, M.1

1Russian State Medical University, Urology, Moscow, Russia

Objective: To evaluate changes in the blood levels of TGF- β 1 inpatients with PD.Methods: Concentrations of TGF- β 1 were determined by enzyme-like sorbent analysis using commertial kit “DRG-Diagnostics”(Germany). Sensitivity of the method is 1,9 µg/ml. Study groupincluded 48 patients with PD. 35 patients had acute phase and 13—chronic phase of PD. Control group included 35 healthy men of thesame age. Statistical analysis was performed using Students t-test.Results: TGF- β1 levels were statistically significantly higher in PD patients than in control group (42.22 ± 1.4 µg/ml vs. 32.96 ±1.41 µg/ml respectively, p < 0.05). In the study group patients withacute phase had significantly higher levels of TGF- β1 than men withchronic phase of PD (46.27 ± 1.4 µg/ml vs. 30.5 ± 2.3 µg/ml respec-tively, p < 0.05). There were no differences in TGF- β1 levels betweenpatients with chronic PD and control group.Conclusion: Obtained results showed that measurement of TGF-β1blood levels can be used in clinical practice to determine the phase ofPD.

MP-03-108

Expression of messenger rna (mRNA) encoding forphosphodiesterase (PDE) isoenzymes in humanfemale genital tissuesÜckert, S.1; Ellinghaus, P.2; Albrecht, K.1; Jonas, U.1

1Hannover Medical School, Dept. of Urology, Germany; 2Bayer Vital GmbH,Pharma Research Center, Wuppertal, Germany

Objective: Recent findings have indicated a putative significance ofthe cyclic AMP- and cyclic GMP-pathway in the control of femalegenital tissues. Thus, the use of inhibitors of phosphodiesterase 5(PDE5) to treat symptoms of female sexual dysfunction (FSD) hasbeen suggested. Nevertheless, there has been relatively low success ofPDE5 inhibitors in FSD in comparison to male sexual dysfunction.The elevated expression of PDE5 in the human corpus cavernosum isconsidered the reason for the high clinical efficacy of PDE5-inhibitorsin the pharmacotherapy of male erectile dysfunction (MED). The aimof our study was to evaluate by means of molecular biology the expres-sion of mRNA encoding for PDE isoenzymes in female genital tissues.Methods: Human clitoral, vaginal (vaginal wall, epithelium), andlabial tissue was obtained from four female cadavers (age at death:18–42 years). The expression of mRNA encoding sequences specificfor PDE1, 2A, 4A, 5A, 10A and 11A was elucidated using RT-PCRanalysis. Human corpus cavernosum (HCC) was used as referencetissue.Results: RT-PCR revealed that mRNA encoding for almost all PDEisoenzymes are expressed in the female genital tissues. Different mag-nitudes of mRNA expression were observed: While there was a pre-dominant expression of mRNA encoding for PDE1A, only littleamounts of PDE1C, 1B, 10, and 11A mRNA were registered. WithPDE1A and 11A being the only exception, the intensity of mRNAexpression was higher in the HCC than in the female genital tissues.Especially, the expression of mRNA encoding for PDE5 was several-fold higher in the HCC.Conclusion: Our results demonstrated that, on the mRNA level,various PDE isoenzymes are expressed in female genital tissues. Itremains to be established as to whether the low expression of PDE5might be a negative predictor as to the success of PDE5 inhibitors inthe treatment of FSD.

MP-03-109

Sexual and erectile function after treatment oftesticular cancerLackner, J.1; Märk, I.1; Schatzl, G.1; Kratzik, C.1; Marberger, M.1

1Medical University of Vienna, Urology, Austria

Objective: Erectile dysfunction is supposed to be a sentinel markerfor peripheral vascular disorders. For some chemotherapeutic medica-tion used for treatment of testicular cancer, vascular side effects aredescribed, like Raynoud phenomenon for bleomycin or myocardialinfarction for cisplatin. The objective was to compare sexual and erec-tile function of patients after orchidectomy according to the adjuvanttreatment in using the IIEF-15 questionnaire.Methods: 131 patients after treatment of testicular cancer were asked toanswer the IIEF-15 questionnaire. According to the common treatmentoptions three groups were compared; group I following surveillancestrategy, group II following monochemotherapy (400 mg/m2 carbo-platin) and group III following polychemotherapy (40 mg/m2 cisplatin,100 mg/m2 etoposid and 15 mg/m2 bleomycin). The IIEF-15 score anderectile function domain from group II and III were compared to groupI, as the patients in group I received no further treatment.Results: The median age and median follow up time in group I was 39.0years and 35.5 months, in group II 39.0 years and 23.0 months and ingroup III 32.5 years and 33.5 months. The median IIEF-15 score andmedian erectile function domain were in the normal range in all threegroups; group I 67.0 and 29.0, group II 62.0 and 29.0 and in group III 67.0and 28.0. Statistically significant differences were present for the IIEF-15score between group I and group II (p < 0.05) and between group II andgroup III (p < 0.05). Thus neither mono-nor polychemotherapy impairsexual or erectile function in testicular cancer patients.Conclusion: Therapy of testicular cancer has no negative influenceon sexual function. Patients treated with drugs which are known forvascular side effects have no higher prevalence of erectile dysfunction.

MP-03-110

Erectile dysfunction may predict coronary arterydisease: Relationship with coronary artery calciumscoring and erectile dysfunction severityYaman, O.1; Gulpinar, O.2; Hasan, T.3; Ozdol, C.3; Ertas, S. F.3; Ozgenci, E.41University of Ankara, Faculty, Urology, Turkey; 2Ybni sina hastanesi,Üroloji A.D, Ankara, Turkey; 3University of Ankara, Faculty, Cardiology,Turkey; 4Ankara, Turkey

Objective: The aim of this prospective study is to evaluate patients witherectile dysfunction (ED) in terms of coronary artery calcium (CAC)levels assessed by multidetector computed tomography (MDCT) and tofind out if ED severity may predict coronary heart disease risk.Methods: Sixty men with a mean age of 55.7 (41–77) years with EDand 23 men with a mean age of 53.2 (39–76) years and without EDwho admitted to our clinic between January 2005 to December 2005were included into the study. All patients answered the standart Inter-national Index of Erectile Function (IIEF) forms and classified into 4groups as mild, moderate, severe ED and no ED. CAC levels wereassesed by MDCT protocol. CAC levels and IIEF scores were ana-lyzed within each group.Results: Pearson Correlation Test demonstrated significant negativecorrelation of IIEF score with CAC score (r = −497; p < 0.0001). CACscores increase statistically significantly with regard to IIEF scoresdecrease: IIEF 1–10 (n = 18); mean CAC: 557.7; IIEF 11–16 (n = 13);mean CAC: 541.3; IIEF 17–25 (n = 29); mean CAC: 84.6 and IIEF ≥26 (n = 23 [Control group]); mean CAC: 10,1. The difference betweenthe mean CAC scores of these 4 groups were statiscally significant (p < 0.0001). When we took cut-off the value for IIEF score 26 weobserved statiscally significantly higher CAC scores at the group ofIIEF < 26 (mean 325.5 vs 10.1 [p < 0.0001]).Conclusion: We observed positive correlation with ED severity andCAC levels. Therefore we think that detection and quantification ofpreclinical CAD by CAC scoring with a non-invasive metod migthhave a great potential for early heart preventive measures.

MP-03-112

Factors associated to bother from sexual problems:Results from the hoppes studyKirana, P.-S.1; Fridakis, M.2; Moisidis, K.2; Rosen, R.3; McKinlay, J.3;Hatzichristou, D.21Aristotle University Of Thessaloniki, Research Center for Health Pro.,Thessaloniki, Greece; 2Aristotle University Of Thessaloniki, Center ForSexual And Reproduction, Thessaloniki, Greece; 3New England ResearchInstitute, Dept of Health, Watertown, MA, USA

Objective: To identify factors associated to bother from sexual prob-lems in a random sample of patients attending a general hospital.Methods: HOPPES is a hospital-based survey investigating the relationship between psychosocial profile, patient-centeredness, symp-toms’ self-perception and health status in a random sample of patientsadmitted to a general hospital. The research included a representativecross section of each clinic and equal numbers of subjects in each of 6design cells defined by age (18–40/41–60/61–80 years) and gender.Subjective evaluation of sexual functioning was measured by SCSF, sat-isfaction with relationship by DAS-7, perceived health by one item ofSF-12 and bother and treatment seeking by single questions. Analysisincluded descriptives, significance tests (independent samples t-test,ANOVA, correlation coefficients) and interval estimates.Results: The sample (N = 454) consisted of 51.1% women and 48.9%men (mean age 50 + 16.5). Forty nine per cent (N = 221) reported atleast one SD; of them, 21.5% (N = 48) had a high level of bother fromtheir SD, 42.6% (N = 95) had a medium level, while 35.9% (N = 80)had no bother. Bother was associated to gender (r = 0.249, p = 0.011)and education (r = 0.234, p = 0.001); to ED (r = 0.617, p = 0) andcurved penis (r = 0.513, p = 0.002), while for females to pain (r = 0.369,p = 0.007) and difficulty reaching orgasm (r = 0.342, p = 0.014). Botherhad a negative association to satisfaction from sexual functioning (r =0.626, p = 0), and subjective well-being (p = 0.035), but positive asso-ciation to treatment seeking (r = 0.394, p = 0). Satisfaction with rela-tionship and perceived health did not affect bother.Conclusion: Factors that increase the level of bother from a sexualproblem are gender (male), higher education and low subjective well-being. This information has important implications for the help-seeking behavior and prevention policies.

MP-03-113

Influence of concomitant diseases on the sexualquality of life of patients with erectile dysfunction andtheir partnersGutierrez, P. R.1; Mas, M.2; Hernandez, P.1; Sanz, E. J.3; Cardenosa, O.4;Munoz, A.5; Artes, M.5

1University of La Laguna, Surgery and CESEX department, Santa Cruzde Tenerife, Spain; 2University of La Laguna, Physiology, Santa Cruz deTenerife, Spain; 3University of La Laguna, Physical medicine and pharmaco,Santa Cruz de Tenerife, Spain; 4Q.F. Bayer, Medical Department, Barcelona,Spain; 5Adelphi Targis, Health Oucomes Research, Barcelona, Spain

Objective: To evaluate the influence of concomitant diseases on thesexual quality of life of patients with erectile dysfunction (ED) andtheir partners.Methods: An epidemiological cross-sectional study was conducted onpatients diagnosed with ED who were not following pharmacologicaltreatment. Sexual quality of life was evaluated both in the patients andtheir partners by means of the SLQQ (Sexual Life Quality Question-naire), comprising 10 items (global score: 0–100). Sexual function wasevaluated by the IIEF (International Index of Erectile Function) questionnaire, comprising 15 items and 5 domains: erectile function(EF:1–30), orgasmic function (OF:0–10), sexual desire (SD:2–10),intercourse satisfaction (IS:0–15) and overall satisfaction (OS:2–10).Results: We obtained preliminary results for 77 patients with a meanage of 58.2 +− 9.3 years. 49% of the patients had hypertension, 38%diabetes, 13% hypercholesterolemia, 8% coronary diseases and 44%another unspecified concomitant condition. The patients who onlysuffered from ED obtained a sexual quality of life greater than those


J Sex Med 2007;4(suppl 2):128–151

MP-03-111

The quality of erection questionnaire for theassessment of erection quality, hardness, and durationin men with erectile dysfunctionStecher, V.1; Collins, S.1; Wang, H.1

1Pfizer Inc, New York, USA

Objective: To assess responsiveness of the Quality of Erection Questionnaire (QEQ) to treatment of erectile dysfunction (ED) with Viagra® (sildenafil citrate).Methods: In this 10-week, open-label Viagra (50 or 100 mg, PRN)study in phosphodiesterase type 5 inhibitor–naïve men with ED, theprimary endpoint was change from baseline in total QEQ score trans-formed onto a 0–100 scale (higher = better quality). Secondary end-points were change scores on the Erection Hardness Grading Scale(EHGS), International Index of Erectile Function (IIEF), Self-EsteemAnd Relationship questionnaire (SEAR), and Erectile DysfunctionInventory of Treatment Satisfaction (EDITS).Results: The mean age (range) of the 107 patients was 53 years (20–82 y). The mean ED duration was 4 years (<1–18 y). From baseline to week 10, the mean ± standard deviation (SD) total QEQ scoreimproved from 22.0 ± 21.1 to 69.9 ± 35.9, IIEF Erectile Function (EF)domain score improved from 12.3 ± 5.8 to 23.4 ± 8.5, and all QEQquestion scores improved. The QEQ total change score correlatedpositively (0.86) with the EF domain change score. Scores for all IIEF,SEAR, and EDITS components improved significantly with improve-ment from grade 3 (hard enough for penetration but not completelyhard) to grade 4 (completely hard) erections and correlated positivelywith improvement in the QEQ Q5 score.Conclusion: The QEQ is responsive to the benefits of treatment andis potentially useful for the comprehensive evaluation of erectionquality before and after ED therapy. Compared with grade 3 erections,achievement of grade 4 erections produced significant improvementsin erectile function and treatment satisfaction, suggesting that grade 4erections are the optimal ED treatment goal.Policy of full disclosure: Pfizer, Inc Employee.


J Sex Med 2007;4(suppl 2):128–151

suffering another concomitant disease (30.2 vs. 25.8, p = 0.032Student’s t test). The partners of the patients suffering from ED andhypercholesterolemia showed worse sexual quality of life (22 vs. 29, p= 0.036 Student’s t test). OF was lower in patients with ED and coro-nary diseases (4.5 vs. 6.5, p = 0.008, Student’s t test). The patients withother unspecified comorbidities showed worse EF, IS and OS (ranges:44 vs. 32, p = 0.022; 44 vs. 33, p = 0.024; 45 vs. 31, p = 0.004; Mann-Whitney U test, respectively).Conclusion: patients with ED and other comorbid conditions showlower sexual function and sexual quality of life scores (including theirpartners).Policy of full disclosure: This study has been finantially supportedby Q.F. Bayer.

Tuesday, 5 December 200613.30–15.00 ForumMP-04 Surgery, Peyronie’s Disease, and

PriapismChairpersonsC. Stief, GermanyS. Minhas, United Kingdom

MP-04-114

A trauma of the penis as an etyological factor ofPeyronie diseaseGurzhenko, Y.11Institute of Urology of AIS of, Dept. of Sexology—Andrology, Kiev, Ukraine

Objective: The purpose of this work is studying the etyological roleof a trauma of the penis as a potential reason for Peyronie disease (PD).Methods: The researches have been carried out on 815 PD patientsat the age of 19 to 86. During collecting the anamnesis all the patientswere offered to determine the reason for the beginning of PD fromtheir point of view.Results: The following results have been obtained. Out of all 815examined: •113 patients (13, 87%) report of the beginning of PDdirectly after a trauma during a sexual intercourse, accompanied by adistinctive crunch and a rather quickly disappearing pain; • 11 patients(1, 35%) connect the beginning of PD with a trauma not linked to acoition; •38 patients (4, 66%) name intercavernous injections as thereason for PD; •25 patients (3, 07%) consider a dramatic penis over-cooling as a factor having caused the beginning of PD; •97 patients(11, 9%) mention extremely frequent sexual excesses, although theydon’t connect directly the trauma of the penis with the beginning ofPD; •73 patients (8, 96%) consider that PD was caused by the manip-ulation treatment on the penis (urethrascopy, bougie probing, etc.).Conclusion: 458 patients (56, 19%) cannot connect the beginning ofthe disease with any reason due to either its being chronic or their neg-ligence to their health. Out of 815 patients only 73 (8, 96%) visited adoctor within the first month, and 498 patients (61, 10%) asked for amedical assistance only 6 months after the first symptoms of the diseasehad appeared.

MP-04-115

Geometrical principle in the surgical treatment of Peyronie’s disease—egydio procedure: Belgrade experiencePerovic, S.1; Djordjevic, M.1; Djinovic, R.1; Sansalone, S.2

1University Children’s Hospital, Urology, Belgrade, Serbia and Montenegro;2Tor Vergata University, Urology, Roma, Italy

Objective: To evaluate geometrical principle described by Egydio inthe repair of Peyronie’s disease i.e. tunical incision, proper defect sizecalculation and grafting in order to straighten and lengthen deformedpenis.Methods: Between October 2004 and February 2006, Egydio proce-dure was performed in 42 patients aged from 22 to 74 years (mean 51years) with long severe curvature and penile shortening caused by Pey-ronie’s disease. Penile deformities were dorsal in 22, dorsolateral in 11,lateral in 5, ventral in 2 and ventrolateral in 2 patients. Criteria forsurgery were: good preoperative erection with normal response topharmacologically induced erection and color duplex Doppler ultra-sound with peak systolic velocity above 40 cm/s and end-diastolicvelocity under 3 cm/s in both cavernous arteries, without relevant co-morbid risk factors. Circumferential tunical incision up to the urethralborders was forked at the ends in order to form rectangular/trapezoiddefect. Defect was grafted with bovine pericardium. Average graft sizewas 2.5 cm in width and 8.1 cm in length. This way, precise correc-tion of all deformities was made and checked with artificial erection.Postoperatively, using of PDE5 inhibitors (from fifth day) and phys-iotherapy with vacuum device (after 2 weeks) were recommended.

Results: Penile length gain in erect state was from 1.9–3.6 cm (mean3.1 cm). PGE1-induced erection confirmed penile straightening in 36patients, while in 6 patients recurvation was revealed. Erection wasmaintained in 36 patients and preserved in 4 patients with PDE5inhibitors or intracavernosal PGE1 injection. Erectile dysfunction was occurred in two patients and treated with penile prosthesis implantation.Conclusion: This technique creates the most precise tunical defectand presently is the best for repair of the most severe penile deformi-ties despite some weaknesses.

MP-04-116

The role of MRI in the management of ischaemic priapismAnderson, P.1; Allen, C.2; Minhas, S.3; Ralph, D.3

1Solihull, United Kingdom; 2Institute of Urology, London, Radiology, UnitedKingdom; 3Institute of Urology, London, Andrology, United Kingdom

Objective: To determine the viability of cavernosal smooth muscle inprolongued ischaemic priapism, comparing a non-invasive technique(MRI) with conventional biopsy.Methods: Six men (age range 33–61) underwent MRI, performedusing a 1.5 Tesla Siemens Avanto. High resolution T2 weighted multiplanar imaging through the penis was followed by dynamicallyenhanced T1 weighted scans using gadolinium. Five men had low flowpriapism (as shown by corporal blood gas analysis) of 30 hours to 6weeks duration. One man presented with problems following seem-ingly successful shunt surgery for low flow priapism.Results: All patients were found to have lack of perfusion of the eitherall or part of the corpora on MRI. The appearance on MRI correlatedwell with smooth muscle viability gauged clinically at operation andmicroscopically where biopsies were taken (four patients). In additionMRI demonstrated other pathologies hitherto unsuspected (one renalcancer, one ureteric tumour).Conclusion: This represents the first study of the use of MRI in pri-apism. It allows the clinician to discuss with the patient preoperativelythe need for prostheis insertion or shunt procedure dependant uponthe viability of cavernosal smooth muscle as determined by its MRIappearance.Policy of full disclosure: I am a senior fellow in andrology at theinstitute of urology, London, and my post is funded by AmericanMedical Systems.

MP-04-117

Andrologic aspects of the exstrophy-epispadias-complex after functional bladder reconstructionEbert, A.1; Bals-Pratsch, M.2; Seifert, B.2; Roesch, W. H.11Klinik St. Hedwig, Paediatric Urology, Regensburg, Germany; 2Center forReproductive Medicine, Regensburg, Germany

Objective: Genital and reproductive functions have a strong impacton quality of life of adolescent and adult male patients with the Exstro-phy-Epispadias-Complex (EEC). In the limited available literatureearly exstrophy reconstruction as well as recurrent infectious or oper-ative trauma are made responsible for the low fertility rates.Methods: We evaluated 14 male patients with EEC (median age 22.1years, range 16–27). 11 patients had undergone single-stage recon-struction, 1 had a staged approach, 1 had urinary diversion and 1 onlyan external genital reconstruction in epispadias. All were evaluatedwith a questionnaire, a clinical examination, hormone and semenanalysis.Results: All patients reported erections and ejaculations. 12 patients(85.7%) proved prograde and 1 patient retrograde ejaculations; 2patients were not able to retrieve their specimen. 13 patients hadregular testicular size, 2 of them had irregular sonographic findings,and 1 had bilateral small testicles. From 12 patients with a normalhormone analysis 3 showed normospermia, 3 asthenospermia, 3oligoasthenospermia, 1 azoospermia and 2 no results. 2 patients hadelevated gonadotropins, 1 with an oligoasthenospermia and 1 with


J Sex Med 2007;4(suppl 2):128–151

azoospermia and hyperthyroidism. Fructose was on average 983 µg/ml(normal 1200–4500), zinc 21.5 µg/ml (normal 70–250) and alpha-glucosidase 15 mU/ml (>20).Conclusion: Single-stage reconstruction with consequent placementof the colliculus seminalis in the posterior urethra can provide normalejaculation in 90.9% of EEC patients. Not only for continence, butalso for ejaculation and fertility the primary successful and anatomicalcorrect approach to the bladder neck seems to be the key point in func-tional reconstruction of the EEC. Despite that severely impairedsperm quality and hormonal findings demand adequate diagnostics andtreatment options for EEC patients with wish for a baby.

MP-04-118

Phalloplasty using of radial forearm flap with thereimplantation of distal fragment of penisSokolschik, M.1; Gagarina, S.1; Vasiev, Y.1; Petrovich, R.1; Sadakova, I.11NMSC, Andrology, Moscow, Russia

Objective: Actually, it was many variants of phalloplasty. We tried toperform phalloplasty using a distal fragment of penis, which includesglans penis, corpora cavernosa and covering tissue, with the help oftransitory transplantation of radial forearm flap in patient with seriousexternal genital pathology (hypogonadism, anorhy, micropenis).Methods: The elevation of radial forearm transplant on radial vesselswas performed. After that neophallus on malleable prostheses was fash-ioned. The neophallus included corpus and neourethra. The length ofprostheses was selected in accordance with the length of neophallus,distal and proximal part of corpus cavernosum and was regulated withthe help of rear tips. Then the mobilization of penis skin in the radixregion, mobilization of neurovascular bundle and urethra, amputationof corpus cavernosum, preparing of recipient place with timely keepingof blood flow in distal part of penis. After that the approach to inter-nal epigastrical vessels was performed in the region of medial part ofmusculus rectus abdominis, to vena safena magna in the region ofupper part of femoral. Then the transposition of neophallus to therecipient place and fixation of phalloprotheses in corpora cavernosa ofcrura penis were performed. After that urethra-neourethroanastomo-sis was made, radial vessels were anastomized with inferior epigastri-cal vessels and vena safena magna. Then distal fragment of penis wastransferred to the distal part of neophallus. Fixation of corpora caver-nosa on prostheses, anastomosis of penis dorsal vessels with radialartery and vein, neourethro-urethroanastomosis were performed.Results: The duration of operation was 9 hour. There were no com-plications during postoperative period, the time of hospital stay was 20days. This unique surgery was performed for the first time in the world.Conclusion: Of course this method needs to be discussed for the optimizing of surgical technique, reducing of operation time andreaching better esthetic and functional results.

MP-04-119

The 10 years’ experience in grafting corporoplastyknow-how and quality-factors. Keep spacers patches:Video 10 minParadiso, P.1; Sedigh, O.1; Milan, G. L.1; Graziano, M. E.1; Ferrando, U.1


Objective: The therapeutic treatment of IPP is still uncertain undermany aspects. Even surgical therapy is characterized by a few steadypoints and different personal interpretations. The purpose of this workis to outline—that the disease has reached surgical solution—such analgorithm of behaviour and strategic choices as to achieve widespreadsuccess.Methods: 150 patchworks were performed in the last 10 years withdifferent biomaterials. Fifty men with a mean-age of 49, were assessedafter 2-years of plaque incision/excision and grafting with differentbiomaterials.Conclusion: Results&conclusions: Penile grafting is not associatedwith a significant patient dissatisfaction rate and orgasmic morbility.The experience acquired have been worked out in a therapeutic


J Sex Med 2007;4(suppl 2):128–151

module consisting of the 5 following major strategic factors: 1. Thepresence of E.D. anyway found or documented (patient’s opinion orinstrumental result) is an indication to prosthetic-implant. 2. IPP is anretracting disease. Within corrective-surgery it is unlikely that a cor-rectly informed patient, can give his consent to such an reducing inter-vention like Nesbit. 3. The so-called patchwork surgery pursues acorrective aim, sometimes an elongation on the retracted-organ. Thesurgeon who performs it, pursues the cure of the disease as well as atissue replacement, process induced by a biomaterial in accordancewith the principle of inductive surgery (regenerative-medicine, tissue-bioengineering). 4. The quality of the patch is not, the primary factorin terms of surgical results. All biomaterials act as a scaffold colonizedby the host tissue and involved in a tissue replacement process. Timeand manner of hystotransformation may vary. Best results obtainedwith saphenous, S.I.S. and Intexen. 5. The most important qualityfactors were surgical technique and early postoperative rehabilitation(daily stretching with vacuum device).

MP-04-120

Penile fracture. Differential diagnosis, management,and outcomeCabral Ribeiro, J.11Hospital São Marcos, Urology, Braga, Portugal

Objective: Penile fracture is a rare but increasingly reported acutepenis. Clinical presentation is usually diagnostic, but vascular lesionsthat have a very similar presentation should be included in differentialdiagnosis. We report our experience in managing this type of urologicemergency.Methods: We reviewed the clinical files of the patients surgicallytreated for presumed penile fracture from Dec 1995 to Mar 2006.Results: Eleven patients ranging 18 to 49 years old (m 28.7) wereadmitted 1 to 60 hours (m 16) after presumed penile fracture. Tenpatients reported a typical clinical history. A patient reporting atypicalpicture had a ruptured superficial dorsal vein. Trauma occurred duringsexual intercourse (6), masturbation (2), forced manipulation (2) androlling over an erect penis during sleep (1). Eight patients presentedsevere penile or penoscrotal haematomas. In these patients 5 eco-doppler exams, (2 cavernosal tears and a vein rupture diagnosed), twocavernosographies (only one diagnostic) and an urethrography wereperformed. The urethrogram, performed in a patient with a bloodyfirst voiding, was negative. Surgical exploration carried out by a sub-coronal (9), inguinoescrotal (1) or penile longitudinal (1) incisions,permitted drainage of the haematoma, identification of C. cav rupture(10 cases-one with associated C. spongiosum lesion) and a rupturedvein (1). The corpora rupture was proximal and right sided in 7 cases.All patients reassumed sexual activity between 4 and 12 weeks. In thefollow-up all patients reported full rigid painless erections with onepresenting a slight penile deviation.Conclusion: Clinical picture is usually diagnostic. When doubts existan ecodoppler exam by screening both C. cavernosum tears and vas-cular lesions is a useful exam. In our small series, surgical correctionhad good functional and aesthetic results.

MP-04-121

Emblematic case of penile ventral deformation (120°)with ED. Albuginea modeling and straithening withpenile Implantation: Video 8 minSedigh, O.1; Paradiso, M.1; Graziano, M. E.1; Liberale, F.1; Ferrando, U.1


Objective: penile implantation is complicated with End Organ Disease,for Peyronie’s disease, retracted fibrotic penis after previous radicalsurgery and ED patients. Often penile implantation is not enough, forlocal adverse conditions (LAC) and deformation of the organ.Methods: We use contemporary the penile inflatable implantation andthe straightening corporoplasty. First we implant a prosthesis 2 cmlonger than corpora cavernous, then we incise the albuginea. In hard

calcified or in bone tissue in Peyronie’s, we excise the disease and madethe combination of implanting and grafting (SIS, Intexen). We implantalways the best: tree peace penile implants, for functional and psycho-logical satisfaction of patients. Recently we use the new antibioticcoated prosthesis (Inibizone) that decreased infections. CRX AMSprosthesis with only 10 mm of diameter is excellent: we can leave cav-ernous tissue, between the penile implant, even inflated, and the albug-inea incisions in order to cover the implant with the Buck fascia only,with out any kind of grafting that must reduce a lot the risk factor ofinfections. CRX is useful also in severe fibrosis for less dilatation,making the penis longer with a small loss in diameter in order toprevent the short penis syndrome. In the last five years, we implantedover 80 penile implants (10 CRX AMS): 44% for end stage fibroticand short penises (in the same period the database of AMS shows only10% in the USA patients with the same disease); 21% in both coun-tries after radical surgery. We used more than 60% of 12 and 15 cmcylinders length for LAC and in USA 18 and 21 cm cylinders.Conclusion: Patients with severe penile curvature may be offered thissurgical alternative: an emblematic case of penile Deformation+ED(120°) and the technical details of albuginea modeling with penileinflatable implants.

MP-04-122

Radial artery urethroplasty in phalloplastyChristopher, N.1; Ralph, D.1

1Institute of Urology, Andrology, London, United Kingdom

Objective: Neo-urethral construction is the most difficult aspect ofphalloplasty. Complication rates range from 30% to as high as 90% insome series. Radial artery forearm flap phalloplasty gives good resultsand a logical extension of this is to use a free flap based urethroplasty.Methods: 5 FTM transsexual patients with a pre-existing insensatepubic phalloplasty underwent radial artery urethroplasty. A 4 cm widefascio-cutaneous strip based on the radial artery in the non-dominantforearm was harvested including 1 cutaneous nerve. This was tubedover a 16 F stent and tunneled into the phalloplasty to the tip. Thebottom end was spatulated to the side of the clitoris. Arterial anasto-mosis was performed to the inferior epigastric artery and venae comi-tantes to venae comitantes, with cutaneous nerve to the ilio-inguinalnerve. The forearm defect was covered with full or split thickness skingraft as required. The stent was removed at 7 days prior to discharge.Results: Patient Stage reached

Complication #1 Urethra removed—Necrosis #2 Join-up to bladder—None #3 Join-up to bladder, penile implant—None #4 Awaiting join-up—None #5 Awaiting join-up—None

Conclusion: Patient #1 was non-compliant with post-operative careand managed to wrench the arterial anastomosis apart by violentlymanipulating the phallus on day 7 post op. Although arterial and venousanastomoses were immediately repaired the microcirculation was notrecoverable. The others have had no complications and cosmeticallythe appearances of the forearm graft is very acceptable. In addition theurethral meatus is at the tip and sensation has developed in patients #2and #3 in the urethra. The pubic phalloplasty with radial artery ure-throplasty combination is therefore comparable to a complete radialartery urethroplasty with less forearm donor site cosmetic defect.

MP-04-123

Long term results of primary penile venous leakagesurgery with crural ligation in men with erectiledysfunction at a single university hospitalCayan, S.1; Acar, D.1; Akbay, E.1

1University of Mersin, Department of Urology, Turkey

Objective: To report our long term results of penile venous surgerywith crural ligation for primary venous leakage in men with erectiledysfunction.

Methods: The study included 19 men with erectile dysfunction whounderwent penile venous surgery for primary venous leakage at a singleuniversity hospital. All patients underwent penile venous surgeryincluding resection of superficial and deep dorsal vein, ligation of cav-ernosal vein and 2 crura proximal to the entrance of the cavernosalartery with umblical tapes and preservation of the dorsal artery andnerve on both sides. Postoperative evaluation included 5-item versionof the international index of erectile function score (IIEF-5), physicalexamination, duplex ultrasound and cavernosography, if necessary.Degree of improvement in erectile functions and patient satisfactionwere also assessed as complete, partial and none.Results: The mean age of the patients at surgery was 33.7 ± 7.1 years(range 24 to 57), and the mean postoperative follow-up was 28.6 ± 19.7months (range 6 to 50). No postoperative complication was observedin all patients. Mean IIEF-5 score increased from 6.17 ± 3.54 to 12.8± 4.3, revealing highly statistically significant difference (p = 0.000).Postoperative erectile functions improved completely in 7 men(36.8%), partially in 6 (31.6%) and remained unchanged in 6 (31.6%).Nine patients maintained satisfactory erection with the use of PDE-5inhibitors which were not working preoperatively. Patient satisfactionwith no any additional treatment or with the use of PDE-5 inhibitorswas complete in 11 (57.9%), partial in 5 (26.3%), and 3 patients(15.8%) were not satisfied with the surgery.Conclusion: Penile venous surgery with ligation of the crura forvenous leakage has excellent long term results and patient satisfaction,and therefore should be offered in young men with primary cavernosalerectile dysfunction.

MP-04-124

The use of dermal fillers in andrologyGaraffa, G.1; Minhas, S.1; Kell, P.1; Ralph, D.1


Objective: Dermal fillers are used in aesthetic medicine to augment aparticular region of the body, commonly the face. This paper describedtheir use in Andrology.Methods: Hyaluronic acid gel (Restylane®, Pureagen®) was injectedsubdermally, using a 27 G needle and without anesthetic, into the penisof 25 patients in the Andrology clinic. The indications for treatmentwere: Peyronie’s Disease indentations (n = 6), soft glans syndrome (n= 2) and girth augmentation (n = 17). In the Peyronie’s patients an arti-ficial erection was given to highlight the indentation to be filled. Mea-surements pre and post treatment and satisfaction rates were recorded.Results: The volume of filler injected ranged from 2–12 mls. All thePeyronie’s patients were satisfied with the uniform shape of their penis.Both patients with the soft glans syndrome found the injection painful,limiting the amount injected and reduced the desired result. In theaugmentation group the penile girth increased from a mean of 8.6 cm(7.8–9 cm) to 10.2 cm (9.2–11 cm). All patients were satisfied but 10patients requested additional injections.Conclusion: The use of dermal fillers are simple to use and may deferpatients from seeking surgery for otherwise cosmetic reasons.

MP-04-125

Penile enlargement corporoplasty with prostheticimplant: Original reconstructive technique for sexualand erectile dysfunctionColombo, F.1; Cazzaniga, A.1; Guarneri, A.1; Romano, A. L.1; Austoni, E.1

1San Giuseppe Hospital, Dept. of Urology, Milan, Italy

Objective: The techniques currently used for penile augmentation incongenital hypoplasia or penile dysmorphophobia represent a contro-versial problem in aesthetic and reconstructive surgery, because of thelack of technique standardization and the differing patient selectioncriteria. When patients’ clinical condition are associated with erectiledysfunction, surgical treatment becomes more complex. The authorspropose an original technique of corpus cavernosum enlargement incombination with inflatable prosthesis implantation.


J Sex Med 2007;4(suppl 2):128–151

Methods: From March 1998 through January 2006, 28 patients withcomplete erectile dysfunction underwent prosthesis implantation andpenile enlargement. Six of them presented with penile hypoplasia, 10with fibrous or retraction of the penis and eight of them penile dys-morphophobia. The first surgical step included “penile degloving”,implantation of endocavernous prosthetic cylinders (Mentor or AMStype) and positioning of the reservoir in an intraperitoneal space, viamid suprapubic access. The second step consisted in structural widen-ing of the corpora cavernosa using two free grafts of saphenous vein,inserted after double longitudinal full-length incision of the albuginea.The tunica albuginea subsequently is modelled and adapts to the newsize of the penis thanks to repeated cycles of prosthesis inflation/deflation.Results: This surgical technique was well tolerated and no significantcomplications occurred. In particular we did not observe any hemor-rhagic, infectious or ischemic complications. The aesthetic and functional evaluation was verified after a 6-month follow-up. Theincrement of penile diameter ranged from 1,1 cm to 2,1 cm. Moreoverpatients and their partners reported achieving satisfactory sexual activ-ity, in absence of functional damages of the implant or endocavernousprosthetic cylinders extrusions or herniation.Conclusion: The association of inflatable prosthetic implants and veingraft corporoplasty offers a valid solution for corpora cavernosaenlargement, in case of related erectile dysfunction. This techniquedemands experience in corpus cavernosum surgery and knowledge oftissue transplantation techniques.

MP-04-126

Outcome from penile prostheses revision surgeryAnderson, P.1; Agarwal, V.2; Soden, F.2; Ralph, D.2; Minhas, S.2

1Solihull, United Kingdom; 2Institute of Urology, London, Andrology, UnitedKingdom

Objective: The aim of this study was to assess the indications andoutcome for penile prosthetic revisions carried out at a UK tertiaryreferral centre.Methods: 50 men underwent penile prosthetic revision surgerybetween 2001 and 2004. The indications for primary prosthesisimplantation were vasculogenic ED (35), Peyronie’s disease (10) and Priapism (5). 16 men had diabetes. 19 men were referred revision surgery with a penile prosthesis in-situ from other hospitals.Results: The mean age and follow-up was 55 yrs (range 31–82) and 9months (range 1–24 months) respectively. The indications for revisionwere infection—18 (36%), device malfunction—14 (28%), erosion—13 (26%), cylinder cross-over—5 (10%), dissatisfaction with malleableprosthesis—5 (10%), unhappiness with length—3 (6%), buckled cylin-ders—2 (4%), cylinder aneurysm—2 (4%), SST deformity—2 (4%),and fractured malleable rod in 1 (2%) patient. A total of 97 prosthe-ses were implanted. 29/42 (69%) were happy with the revision surgery(8 pts. did not re-attend). At follow-up, 8/50 patients were left withouta prosthesis.Conclusion: Infection remains the commonest cause for penile pros-thetic revision surgery followed by device malfunction. Revisionsurgery results in overall good patient satisfaction, although multipleprocedures may be required to achieve this.Policy of full disclosure: I am a senior fellow at the Institute of Urology, London, my post is funded by American Medical Systems.

MP-04-127

Long-term efficacy and patient satisfaction ofplication corporoplasty in congenital penile curvatureFranco, G.1; Cavaliere, A.1; Del Vecchio, G.1; Dente, D.1; Almoghalis, N.1;D’Amico, F.11La Sapienza University, U.Bracci Dept. Urology, Rome, Italy


J Sex Med 2007;4(suppl 2):128–151

Objective: Aim of the study is to evaluate the long term results oftunica albuginea plication in patients with congenital curvature of thepenis and to compare them with the Nesbit technique.Methods: 31 patients who underwent surgical correction of congen-ital curvature of the penis from 1988 to 2003 were evaluated. 19patients have had plication corporoplasty by means of one or moredouble crossed introflecting stitches with previous albuginea cruenta-tion (group A). 12 patients have had a traditional Nesbit techniquewith escission of small parts of tunica albuginea (group B). Mean ageof patients was: was 21 +/− 5 years in group A and 16 +/− 3 in groupB. All patients were re-evaluated with physical examination, a specificquestionnaire and self-photograph on erection after a mean follow-upof 88 months in group A and 141 months in group B. Student test wasemployed for statistical analisys.Results: 3 recurrences of curvature were observed in group A 1–3month after surgery, which required reintervention. In all three cases a reabsorbable suture (2-0 Dexon) was utilized. No recurrenceswere observed in group B (p: 0.15). In 6 patients of Group A (31%) and in 6 patients of group B (50%) a minimal persistent devia-tion was present (p: 0.29). However, these patients always reported anoptimal satisfaction. No hypercorrections were observed in bothgroups. A mild erectile dysfunction was reported in 3 patients of group A only (10%). A minimal hypo-sensitivity of glans and prepucewas reported in 7 pts of group A (38%) and 9 pts of group B (75%) (p: 0.03).Conclusion: Plication corporoplasty yields good and stable resultswhen compared to the Nesbit technique provided that unabsorbablesutures are used and special precautions are taken.

MP-04-128

Hypoxia-inducible factor-alpha is elevated inPeyronie’s disease plaques—hypoxia is an aetiological factor?Agrawal, V.1; Munson, P.2; Minhas, S.1; Freeman, A.3; Ralph, D.1

1Institute of Urology, Andrology, London, United Kingdom; 2UCL, Depart-ment of Histopathology, London, United Kingdom; 3Institute of Urology,Histopathology, London, United Kingdom

Objective: Patients with Peyronie’s Disease (PD) often have co-existent systemic vascular disease [1].This has led to the hypothesis that a hypoxic micro-environment may contribute to the formation ofthe PD plaques by causing up-regulation of pro-fibrotic cytokines (eg.TGF-β1). Hypoxia-inducible factor-1 α (HIF-1 α) is a known proteinmarker for tissue hypoxia [2]. This study examines its expression in thetunica albuginea (TA) of PD to help determine whether hypoxia playsa role in the aetiology of the disease.Methods: Tunical albuginea samples were obtained at the time ofsurgery from the plaques of 15 patients with PD and from 10 controlshaving surgery for other penile conditions. The 25 tissues were fixedin formalin, embedded in paraffin, and the cut sections underwentimmunocytochemistry with antibody against HIF-1 α. The sectionswere examined by 2 of the authors (VA, AF) who were blinded to thediagnoses. The results were analysed using Student’s t test and signif-icance was established at p < 0.05.Results: A positive expression for HIF-1α was present in the TA of12/15 (80%) PD patients compared with only 1/10 of the controls(10%) (p < 0.05).Conclusion: The results of this study show expression of HIF-1 α, awell characterised protein marker for tissue hypoxia, in PD plaques.This suggests that a local hypoxia may play a role in the aetiology ofPD and that the modulation of HIF-1α expression may open new ther-apeutic avenues of treatment. References (1) Kadioglu A et al. A ret-rospective review of 307 men with Peyronie’s disease. J Urol. 2002Sep;168 (3):1075–9 (2) Semenza GL. HIF-1: mediator of physiologi-cal and pathophysiological responses to hypoxia. J Appl Physiol. 2000Apr;88 (4):1474–80.

Wednesday, 6 December 200610.30–12.00 ForumMP-05 General Issues in Sexual MedicineChairpersonsN. Monteiro Pereira, PortugalB. Cuzin, France

MP-05-129

Plasma levels of dihydrotestosterone remain in thenormal range in men treated with long-actingparenteral testosterone undecanoateYassin, A.1; Saad, F.21Segeberger Kliniken, Clinic of Urology & Andrology, Norderstedt,Germany; 2Schering AG, Berlin and Gulf Medical College, Ajma, Germany

Objective: Endogenous and exogenouse testosterone are metabolizedto oestradiol and dihydrotesterone (DHT). DHT is much more biopo-tent than testosterone. Therefore, it’s interesting to investigate plasmalevels of DHT in patients receiving long-acting testosterone unde-canoate (TU).Methods: Totally 122 patients receiving TU injections i.m. were mon-itored. They followed the therapy protocol developed for TU.Results: Before treatment, three patients had elevated DHT levels ofover 600 ng/ltr. (DHT normal range: 40–575 ng/l, measured withArchitec,Abbott). One was started on 5-alpha reductase inhibitor forprostate safety issue, the other two refused to take this drug. Allpatients underwent blood sampling including total testosterone, DHTand PSA before treatment, after week 6 and week 18 and subsequentlyevery 12 weeks while receiving therapy. Plasma levels of total testos-terone were continuously within normal physiological range in all subjects (between 4.8 +/− 1.5 ng/ml; (Architec Abbott). DHT levelshowed no abnormally high/low levels and varied between 86 and 511 ng/l (normal range: 40–575 ng/l). The two patients with elevatedDHT who had refused therapy with 5-alpha reductase inhibitor forprostate safety, surprisingly, showed normalization of DHT levelsunder therapy with TU. No alterations were found in prostate safetyparameters so far.Conclusion: In patients receiving TU, no supraphysiological levels of either testosterone or DHT were recorded. DHT is derived fromtestosterone, and with exogenous testosterone the conversion oftestosterone to DHT might vary, which is the case with the classicalparenteral testosterone esters which often generate supraphysiologicallevels of testosterone and DHT, probably as a result of strongly fluc-tuating levels of testosterone, with periods of supraphysiological levels.Why the primarily elevated DHT levels in 2 patients normalized uponadministration of TU is not clear. It could be that normalization ofplasma testosterone normalizes 5alpha-reductase activity.

MP-05-130

Elevation of Asymmetrical Dimethylarginine (ADMA) in men with erectile dysfunction andmetabolic syndromeGamidov, S.1; Mazo, E.1; Iremashvili, V.1


Objective: Endothelial dysfunction is thought to be the major mech-anism of arteriogenic erectile dysfunction (ED), particularly in patientswith metabolic syndrome (MS). The endogenous NO synthaseinhibitor asymmetrical dimethylarginine (ADMA) has recently beenidentified as an independent risk marker for cardiovascular disease andit was the purpose of the present study to investigate the role ADMAin ED with and without MS.Methods: We determined plasma ADMA levels in 595 men withorganic ED. Patients were divided into a group of 385 men with MS(ED-MS) and a group of 210 men without clinical and laboratory evi-dence for MS (ED-No-MS). MS was defined using the NCEP/ATP

III criteria. Diagnosis of ED was based on the International Index ofErectile Function Score (IIEF).Results: Plasma ADMA concentrations in the ED-MS group wereelevated as compared to the ED-No-MS group (mean values 1.37 ±0.44 micromol/l vs. 0.71 ± 0.33 micromol/l, p < 0.001). Virtually allED-MS patients and 71.4% of ED-No-MS patients had elevated levelsof ADMA (>0.573 micromol/l).Conclusion: This study further supports the role of the endotheliumin pathogenesis of organic ED and the role of ADMA in the manifes-tations of endothelial dysfunction. Also the levels of ADMA were ele-vated in both groups of patients with organic ED, those, having MShad particularly high values of ADMA concentrations. The latter factunderlines the importance of considering the MS as a major cardio-vascular risk factor in men with ED.

MP-05-131

Erection hardness is critical for good sex and ahealthy relationship: The global better sex surveyGoldstein, I.1; Juenemann, K.-P.2; Mulhall, J. P.3; Stecher, V.41The Journal of Sexual Medicine, Milton, MA, USA; 2Klinikum der Christian-Albrecht, Direktor der Klinik für Urologie, Kiel, Germany; 3Weill Medical College of Corne, Department of Urology, New York, USA;4Pfizer, Inc, Pfizer, Inc, New York, USA

Objective: To determine what factors are important to men andwomen worldwide for a good sexual experience and a good loving relationship.Methods: The Global Better Sex Survey was a cross-sectional epi-demiologic survey conducted in 27 countries worldwide in 2005. Menand women were asked about their general attitudes toward sex and torate the importance of several aspects of sex for a good sexual experi-ence. Data for each country were weighted by population size toensure proper representation and reflect proportional differencesbetween countries.Results: Nearly all (≥90%) people (N = 12,553; men = 6291, women= 6272) reported that giving their partner pleasure during sex is impor-tant and a man’s confidence in his sexual ability is critical to having agood loving relationship. 94% of men and 87% of women reportedthat erection hardness is important for a good sexual experience.Although nearly all men and women reported that it is important tobe able to achieve and maintain an erection for a good sexual experi-ence, only 38% of men were very satisfied with their erection hard-ness (no self-reported ED = 55%; mild ED = 26%; moderate ED =14%; severe ED = 29%), and only 36% of women were very satisfiedwith their partner’s erection hardness (female partners of men withself-reported no ED = 50%; mild ED = 26%; moderate ED = 11%;severe ED = 16%). The majority of men would take a prescriptionmedication to improve their sexual experience (have better sex), andwomen would support such a decision.Conclusion: Most men and women are not fully satisfied with erec-tion hardness, and the majority of men and women would like toimprove their sexual experience. Achieving and giving pleasure duringsex is important to men and women, and both agree that a man’s abilityto achieve hard erections is a key component of a good sexual experi-ence and a good loving relationship.Policy of full disclosure: Grants/Research support from Pfizer,Bayer, Recordati, and Serono; consultant for Pfizer, Bayer, Lilly, andWyeth.

MP-05-132

Evolution with age of thoughts and views on sexualfunction & relationship in the 50+ population in BelgiumClaes, H.1; van Poppel, H.1

1UZ Gasthuisberg, Dept. of Urology, Leuven, Belgium

Objective: In order to provide further insight into the sexual ecologyof the 50+ population in Belgium, we developed separate question-


J Sex Med 2007;4(suppl 2):128–151

naires for men and women, which were distributed during a conven-tion for the 50+ population.Methods: During the 2005 convention, 1151 men and 1526 womenspontaneously completed the questionnaire.Results: In both men and women, the older they become the morethey agreed with the fact that: libido is diminished with age; creativ-ity in sexual life is necessary; an underlying loving relationship isimportant; sex is essential for the personal well-feeling. By gettingolder partners to become more in agreement with regards to contactwith the family in law, the organizing of the financial budget and thesolution of a conflict without capitulation of one of the partners. Butthere is no evolution in terms of philosophy of life, accepting eachothers friends and organizing the free time. The older they get, theless frequently men and women regret being married and the morethey are convinced that living in a couple is the best way. The olderthey are, the less they think sexual problems are due to stress, depres-sion and relation problems and the more they are convinced that theseproblems are a consequence of aging. Consequently, they would ratherdiscuss the issue with a physician (and more a GP than a specialist),than a sexologist or friend. From this consultation medication was pre-scribed in no more than 31% of cases. Moreover, the older they arethe less likely they are to take the medication.Conclusion: Although the cohort of the retired people appreciated asexual life as a couple and are aware of the important influence of agingfactors on sexual problems, there still exists a high reluctance inpatients as well as in doctors to treat ED.Policy of full disclosure: This study was performed with a grant ofBayer NV Belgium.

MP-05-133

Is there a link between erection hardness and overallhealth? Results of the global better sex surveyKing, R.1; Lehmann, V.2; Levinson, I.3

1Sydney Centre for Sex and Rela, Middle Cove, Australia; 2Brighton andSussex University, Brighton and Sussex University, East Sussex, UnitedKingdom; 3Pfizer Inc, New York, USA

Objective: Sexual health is a component of overall health. We soughtto determine the association between erection hardness and satisfac-tion with sex life, love and romance, and overall health.Methods: This was a survey of men and women from 27 countriestermed the Global Better Sex Survey (GBSS). The countries repre-sented the Americas (Brazil, Canada, Mexico, United States), Asia(Hong Kong, Indonesia, Japan, South Korea, Malaysia, Singapore,Taiwan, Thailand), Oceania (Australia), Europe (France, Germany,Italy, Spain, Switzerland, United Kingdom), the Middle East (Israel,Kuwait, Lebanon, Turkey, United Arab Emirates), and Africa (Egypt,Morocco, South Africa).Results: n total, 6291 men rated their satisfaction with their erectionhardness, sex life, love and romance, and overall health; 6272 womenrated their satisfaction with their sex life, love and romance, and overallhealth and their satisfaction with their partner’s erection hardness. Forthe majority of both men and women, there exists a strong associationbetween erection hardness and satisfaction with sex life, love andromance, and overall health. Approximately two thirds of men (65%)and women (66%) who were very satisfied with erection hardness werealso very satisfied with their sex lives and love and romance. 57% ofmen and 50% of women who were very satisfied with erection hard-ness were also very satisfied with their overall health.Conclusion: Erectile dysfunction is associated with chronic diseasesand may predict the severity and prognosis of cardiovascular diseasein men. The results of the GBSS show that satisfaction with erectionhardness was linked with satisfaction with sex life, love and romance,and overall health for both men and women. Successful treatment ofmen with erectile dysfunction may lead to improvement in overallphysical and emotional health.Policy of full disclosure: Served as advisor, consultant, lecturer, andinvestigator for Pfizer Inc.


J Sex Med 2007;4(suppl 2):128–151

MP-05-134

Clinical characteristics of erectile dysfunction patientswith and without metabolic syndromeMazo, E.1; Gamidov, S.1; Iremashvili, V.1


Objective: To investigate clinical characteristics of erectile dysfunc-tion in patients with and without metabolic syndrome.Methods: The study included 595 men with organic erectile dys-function (ED) of which 385 had (group 1) and 210 had not (group 2)metabolic syndrome (MS). MS was defined using the NCEP/ATP IIIcriteria. All patients underwent a comprehensive history and physicalexamination and completed International Index of Erectile Dysfunc-tion (IIEF) questionnaire. Statistical analysis was performed by usingStudent’s t-values and Pearson chi-square test as appropriate.Results: The mean age of the patients with and without MS was 49.7and 47.8 years respectively. The age of the onset of ED was signifi-cantly less (43.5 vs. 50.4 years, p < 0.05) and the duration of diseasesince first diagnosis was greater (6.4 vs. 3.6 years, p < 0.05) in the MSgroup. Mean EF IIEF score in the group 1 also was significantly lessthan in group 2 (12.5 vs. 15.3, p < 0.05). Severe ED was more preva-lent in patients with MS (49.1% and 24.3% in the first and secondgroups, respectively, p < 0.05).Conclusion: Men with MS are affected by organic ED earlier in theirlife and the disease is more severe in them, then in patients withoutMS. These findings underline the foremost impotence of recognizingthe association between ED and MS and of considering preventiveaction as the central objective for the men with MS.

MP-05-135

Erectile dysfunction and men’s health: Developing acomorbidity risk calculatorShabsigh, R.1; Sand, M.2

1USA; 2Bayer Healthcare, Scientific Affairs, Wuppertal, Germany

Objective: To generate a calculator for the risks of diabetes, hyper-tension, hyperlipidemia and angina in men with erectile dysfunction(ED), based on a longitudinal analysis of data from the Men’s Attitudesto Life Events and Sexuality (MALES) study.Methods: MALES was a multinational population-based study conducted in 2001, in which the prevalence of ED and comorbidmedical conditions was assessed in 27,839 men aged 20–75 years. In2004, men with ED (n = 1843) were re-contacted. Multi-step analysisof 2004 longitudinal data was performed, comprising data acquisition,data validation, data analysis, results validation and output generation.Data from 808 patients were included, and 289 variables were consid-ered. All variables were evaluated, and only those significantly corre-lated with outcome and those making clinical sense were retained. Alogistic regression model was applied to 90% of the sample; resultswere validated in the remaining 10%, with sensitivity and specificitytesting.Results: Of the 2004 cohort, 20.7% had been diagnosed with diabetes,44.3% with hypertension, 42.5% with hyperlipidemia, and 25.7% withangina. The following factors affected the risk of comorbidities, andare therefore included in the risk calculator: overall health (self-reported rating), severity of ED, having or not having a sexual partnerand waist size. The calculator produces a number between 0 and 7,where a score of ≥2.5 indicates high risk (≥60% probability of havinga comorbidity), a score of 1.5−<2.5 indicates medium risk (30–59%probability) and a score of <1.5 indicates low risk (<30% probability).Primary limitations of the calculator are that it is not longitudinallypredictive and some variables have a negative impact on the risk ofcomorbidity.Conclusion: ED is a key factor in calculating the probability of majorrisks to men’s health, such as diabetes, hypertension, hyperlipidemiaand angina.Policy of full disclosure: Ridwan Shabsigh is a consultant to: Pfizer,Lilly/ICOS, Bayer, GSK, Schering, Solvay, American MedicalSystems, Indevus, Auxilium, Boehringer Ingelheim; a speaker for:

Lilly/ICOS, Solvay, Schering; and an investigator: Boehringer Ingel-heim, American Medical Systems. Michael Sand is an employee ofBayer Healthcare.

MP-05-136

Socio-economic factors and sexual dysfunction in bothgenders results of the crossover-study “The Cologne20.000 community survey”Korda, J. B.1; Motia-Sharei, K.1; Braun, M.1; Christ, H.2; Hellmich, M.2;Engelmann, U.1; Korda, J. B.1

1University of Cologne, Dept. of Urology, Germany; 2University of Cologne,Institute for Statistics, Epidem., Germany

Objective: The aim of the study was to evaluate the correlation oferectile dysfunction/female sexual dysfunction and socio-economicfactors.Methods: A questionnaire consisting of 15 questions concerning thesocio-economic factors and the FSFI/KEED was mailed to respec-tively 10.000 men and women. The KEED is a questionnaire devel-oped in Cologne to determine erectile dysfunction. The response ratewas 41% in women and 46% in men. Mean age was 43 years in womenand 53 years in men.Results: A significant statistical association between socio-economicfactors and a sexual dysfunction appeared in both genders. 22.2% ofmen and 47.4% of women with a monthly income <499 € have beenaffected by sexual dysfunction, while the prevalence of ED/FSDinversely correlated with an increase of income down to 14%(men)/30.6% (women) (p = 0.001). We found equal results concern-ing the education. The higher the education have been the lower theprevalence of sexual dysfunction. Women with an secondary schoolqualification have been affected in 50.6% and men in 31.2% fromFSD/ED while women with an university degree have been affectedin 29.3% and men in 11.3% of sexual dysfunction (p = 0.001).Women/men with a high professional qualification have been affectedin 30.5%/11.7% while people with a low professional qualificationhave been affected in 50.9%/31.2%.Conclusion: Socio-economic factors play a significant role in thedevelopment of a sexual dysfunction in both genders.

MP-05-137

NPT-test: How to reduce the false positives?Colombo, F.1; Romano, A. L.1; Guerrer, C.1; Guarneri, A.1; Austoni, E.1

1San Giuseppe Hospital, Dept. of Urology, Milan, Italy

Objective: The computerized monitoring of nocturnal erections(Nocturnal Penile Tumescence Test) represents a recognized methodto diagnose organic Erectile Dysfunction (ED). This study intends toassess the usefulness of administering an hypnotic (Zolpidem tartrate10 mg) in order to reduce the adverse impact of variables such as thepoorer quality of sleep caused by the application of the device causeof false positives. Indeed, the accuracy of the NPT-test correlates withREM-non-REM cycles occurring in a physiological sequence.Methods: From april 2005 and april 2006 we enrolled 50 consecutivepatients presenting with undefined E.D. (average age: 51 years). Allpatients were provided with a RigiScan plus device to carry out mon-itoring for 3 consecutive nights at home. The patients were given onetablet of Zolpidem 10 mg to be taken bedtime on Night 2. Our analy-sis compared Night 2 and 3. We investigated 4 parameters: number oferectile episodes per night, single and overall duration of same, overallduration of the full rigidity phases (80–100%).Results: The comparison between Night 2 and Night 3 allowed tohighlight the following issues: —number of erectile episodes: 90% ofpatients showed a higher number of erectile episodes during Night 2—duration of single episodes: 96% of patients single episodes were notedto last longer during Night 2—overall duration of episodes: 94% ofpatients also overall duration of erectile episodes was noted to begreater during Night 2 versus Night 3—duration of maximum rigid-ity phases: 90% of patients the phases of maximum rigidity were notedto last longer during Night 2.

Conclusion: The results of this preliminary study seem to support theusefulness of administering a sedative hypnotic in patients candidatesfor NPT test. Improving the quality of sleep it is possible to reducefalse positive results.

MP-05-138

Does postejaculatory early voiding cause nonbacterialprostatitis?Atan, A.1; Basar, M. M.2; Tuncel, A.1; Aslan, Y.11Numune Hospital, Third Department of Urology, Ankara, Turkey;2Kirikkale University, Urology, Turkey

Objective: Postejaculatory early voiding may lead to prostatic inflam-mation due to leakage to prostate tissue via still open prostatic ductsduring urine passage from prostatic urethra. We evaluated whethervoiding immediately after ejaculation has a role in nonbacterial prostatitis.Methods: The study involved 136 subjects. Physical examination,digital rectal examination, microscopic prostatic secretion assessmentand urine cultures after taking a detailed medical history were per-formed. Prostatic inflammation was considered as if there were morethan ten white cells per high power field in microscopic examinationof the prostatic secretions. Urine samples before and after prostaticmassage were collected for urine culture. The patients were dividedinto two groups. Group 1 included 96 patients who were suspectedprostatitis and had more than ten white cells per high power field inmicroscopic examination of their prostatic secretions. Group 2 con-sisted of 40 volunteer healthy men who had normal microscopic exam-ination of their prostatic secretion as a control group. Patients wereasked to their first voiding time after ejaculation (less than 60 minutesor later). The two groups were compared in terms of the patients’ age,and first voiding time after ejaculation.Results: The mean age was 38.0 ± 8.7 and 36.6 ± 1.2 years, respec-tively (p = 0.175) in Group 1 and controls. In Group 1 and 2, thenumber of the patients voided in the first sixty minutes after ejacula-tion were 56 (58.3%) and 9 (22.5%), respectively (p = 0.001). In Group1, lower urinary tract symptoms (n = 45, 47%) and sexual dysfunction(n = 81, 84.4%), lumbal pain (n = 34, 35.4%), perineal fullness (n =50, 52.1%), haemospermia (n = 20, 20.8%) and scrotal pain (n = 43,44.8%) were observed. No bacterial growth was detected in the urinecultures.Conclusion: Postejaculatory early voiding should be taken into con-sideration as an etiologic factor and also exacerbation of prostaticinflammation.

MP-05-139

The importance of and satisfaction with sex inEurope: Regional analysis of the Global Better Sex SurveyGiuliano, F.1; Juenemann, K.-P.2; Kirby, M.3; Levinson, I.4

1Hopital de Bicetre, Dept. of Urology CHU de B, Le Kremilin Bicetre, Cedex,France; 2Klinikum der Christian-Albrecht, Direktor der Klinik für Urolo-gie, Kiel, Germany; 3The Hertfordshire Primary Care, The HertfordshirePrimary Care, Herts, United Kingdom; 4Pfizer Inc, New York, USA

Objective: To determine factors important to men and women inEurope for a good sexual experience.Methods: The Global Better Sex Survey was a survey conducted in27 countries worldwide in 2005. The European region consisted ofFrance, Italy, Germany, Spain, Switzerland, and the United Kingdom.Results: Nearly all (≥90%) respondents (1251 men, 1252 women)rated aspects of sex (eg, intercourse, foreplay, ability to achieve orgasm,attraction to partner, etc) very important. However, across all coun-tries, 40%–82% of men and women were not fully satisfied with theirsex lives. Although nearly all (≥90%) respondents rated the ability toachieve and maintain an erection important, only 28%–49% of menwere very satisfied with their erection hardness, and 32%–59% ofwomen were very satisfied with their partner’s erection hardness.


J Sex Med 2007;4(suppl 2):128–151

1%–11% of men reported using a prescription medication for erectiledysfunction (ED). However, 62%–80% of men not taking a prescrip-tion medication for ED said they would be willing to do so to improvetheir erections if they thought they had ED; 41%–87% of womenwould support that decision. 10%–38% of men and 6%–28% ofwomen reported that they are highly or very highly interested inimproving their sexual experience (ie, have better sex). ED medicationimproved the hardness of erections, reliability in achieving an erec-tion, duration of erections, and pleasure from sexual activity. A strongcorrelation existed between erection hardness and satisfaction with sexlife, love and romance, and overall health.Conclusion: For men and women in Europe, sex is very important,and there is a strong link between satisfaction with erection hardnessand satisfaction with sex life, love/romance, and overall health. Themajority of men would take a prescription medication to improve theirerections; a similar proportion of women support this decision.Policy of full disclosure: Consultant/Advisor : Johnson & Johnson,Pfizer, Lilly-Icos Meeting Participant/Lecturer Sanofi-Aventis,Johnson & Johnson, Pfizer, Lilly-Icos Scientific Study/Trial : Johnson& Johnson, Pfizer, Lilly-Icos, Bayer, Glaxo-Smithkline, Jerini, Icos,Novo-Nordisk, Roche, Solvay Pharmaceuticals.

MP-05-140

Severe obstructive sleep apnea syndrome is associatedwith female sexual dysfunctionDelibas, M.1; Ucar, Z. Z.2

1I.zmir, Turkey; 2Dr. Suat Seren Chest Disease T, Sleep Center, I

.zmir, Turkey

Objective: The association between obstructive sleep apnea syndrome(OSAS) and erectile dysfunction has been demonstrated in malepatients. The studies regarding the impact of OSAS on female sexualdysfunction (FSD) is limited. We aimed to assess the associationbetween OSAS and FSD.Methods: In this prospective study beginning from January 2005, allwomen suspected with OSAS and who would undergo a full-night in-laboratory polysomnography examination in Dr. Suat Seren ChestDisease Hospital Sleep Center, were asked to answer female sexualfunction index (FSFI) questionnaire. Postmenopausal women, womenwithout regular partner and women that did not want to answer FSFIwere excluded. Twentynine women were included in the study. Thepatients were grouped as mild, moderate, and severe OSAS accordingto the level of respiratory disturbance index (RDI) and women withhabitual snoring were regarded as control group.Results: The mean age was 43.24 +/− 8.28 years. Six of them had mild,7 of them had moderate and 9 of them had severe OSAS and 7 of themwere in the control group. The mean ages of the groups were foundhomogeneous with ANOVA. When all data were used for parametricanalysis arousal, lubrication, orgasm and satisfaction domains werecorrelated with RDI, Epworth score, minimum oxyhemoglobin satu-ration (Sa02) and time spent below oxyhemoglobin saturation below90% either positively or negatively. With nonparametric analysis onlysevere OSAS group demonstrate significant correlation between pre-viously defined variables. Also in severe OSAS group the scores ofarousal, lubrication and orgasm domains were found significantlylesser than all other groups with ANOVA.Conclusion: Though these preliminary results demonstrate a signifi-cant relation between severe OSAS and FSD, the effect of continuouspositive airway pressure (CPAP) treatment on FSD which is ongoingpart of the study would enhance these findings.

MP-05-141

Public-awareness does not promote a shortening ofthe delay in first seeking medical help for erectiledysfunction (ED) in the PDE5-is era. Preliminaryresults at single major tertiary academic centreSalonia, A.1; Pellucchi, F.1; Castillejos Molina, R. M.1; Briganti, A.1; Doha,F.1; Gallina, A.1; Zanni, G.1; Suardi, N.1; Rigatti, P.1; Montorsi, F.1

1IRCCS San Raffaele, Urologia, Milan, Italy


J Sex Med 2007;4(suppl 2):128–151

Objective: To assess whether there is a shortening of the time betweenonset of the disorder and first seeking for medical help for ED at theSexual Medicine Centre in a major tertiary academic unit.Methods: From July 2000 to August 2006, 471 patients newly diag-nosed for ED as a primary disorder and seeking medical help for thefirst time were consecutively visited by a single urologist at our out-patient clinic. Patients were comprehensively evaluated with a medicaland sexual history, specifically assessing the duration of ED andwhether they were aware of oral pills for ED. The Kruskal-Wallis (K-W) test assessed the delay between ED onset and first request ofmedical help across this 6-year frame shift. A Spearman’s test was usedfor univariate correlation analysis.Results: All exclusions resulted in a convenience sample of 322(68.4%) (mean ± SD age: 51.8 ± 13.3 years; range: 19–86) evaluablepatients. Mean delay between ED onset and seeking for first medicalhelp: 31.8 ± 36.6 months (median: 12 months; range: 1–180 months).Ninety-five percent (306/322) of these patients were aware of oraltreatments for ED. The K-W test showed: a similar (P = 0.59) age at1st visit for ED throughout time and it did not show a significant (P= 0.60) shortening of the delay between onset of ED and first seekingfor medical help in the current cohort of patients. Delay in seekingmedical help was positively correlated with patient’s age (r = 0.165; P= 0.0031; 95% CI: = 0.06, 0.27).Conclusion: These results show that there is still a significant delaybetween ED onset and first seeking for medical help, regardless of thepublic-awareness on ED and the existence of effective treatment forthe disorder.

MP-05-142

Time effect on potency in post-radical cystectomypatients: Subjective and objective evaluationHekal, E.1; Mesbah, A.1; El-Bahnasawy, M.1; El-Assmy, A.1; Abdel-Latif, M.1; Shaaban, A.1

1Urology and Nephrology Center, Urology, Mansoura, Egypt

Objective: To study the effect of time on EF in post-radical cystec-tomy patients.Methods: Between March 2003 and March 2005, a prospective studyover 45 potent males with organ confined bladder cancer weremanaged by radical cystectomy (21 by NS technique, 24 by classic non NS technique) & diversion, in Mansoura center. The preopera-tive IIEF and penile duplex ultrasound were assessed. The patientswere followedup at 2,6,12 months regularly regarding the same parameters.Results: Among patients with NS cystectomy (78.8%) were potentpostoperative, 12 with spontaneous complete tumescence (57.8%) and5 with partial tumescence on PDE-5 as erectogenic aid (21%), while4 need intracorporeal PGE1 injection.In contrast none of the non NSgroup showed spontaneous erection and all of them needed PG aserectogenic aid (87.5%) except 3 maintained on PDE-5.The compar-

ison between pre-operative IIEF domains with postoperative scoringshowed that the EF and overall satisfaction domains deteriorated butgradually improved with time in the NS group with a significant valuethan other parameters regarding the surgery group and the follow-upperiod. Corresponding Doppler findings were comparable in PSValong the course of follow up, while EDV was significantly deterio-rated in both groups, with gradual improving in NS cases, which wasmore evident at 12 months of the surgery.Conclusion: The regain of EF was better in NS cases on subjective& objective bases, in comparison to non NS cystectomies.The arterialflow was not affect in both groups; however the main change was invenous occlusive function which improved in NS cases within the firstyear of follow up, rapidly & progressively.

MP-05-143

How to improve the quality of life at male populationover 50 years old with erectile dysfunctionPorav-Hodade, D.1; Crisan, N.1; Feciche, B.1; Mihaly, Z. A.1; Coman, I.1

1Clinical Municipal Hospital, Urology, Cluj-Napoca, Romania

Objective: To identify the modality to improve the quality of life in amale population over 50 years by early detection of erectile dysfunc-tion during a screening which take place simultaneous with the a pro-static cancer screening and by initiation of a 5 PDE inh patient adaptedtreatment.Methods: We have organized a study, CLuj-Napoca PrOStaticCancER Screening (CLOSER) Program, between March 2005 untilmiddle of August 2006 in order to detect the patients with prostaticcancer in early stage. Next to standard tests for prostatic cancer screening, patients completed optionally the International Index ofErectile Function (IIEF). For those who completed IIEF tests, a 5weeks treatment was initiated in randomized, patient depended order,with tadalafil, vardenafil, sildenafil–one weeks for each drug and 2washout weeks. After this period patients continued with the 5 phos-phodiesterase inhibitor (5 PDE inh) which they considered thatimprove overall satisfaction–Sexual Encounter Profile, diary questionSEP5.Results: From a totally of 5031 men over 50 years-mean age 62,4-who enter in this prostatic cancer screening, 3672 were willing to speakabout their sexual problems, but only 3219 of them have completedthe IIEF test. Severe erectile dysfunction was presented at 526 patients,moderate erectile dysfunction was presented at 832 patients, mild erec-tile dysfunction was presented at 1413 patients and 448 patients hadno erectile dysfunction. A totally of 2614 patients entered in the initial5 weeks treatment period. Mean change from baseline of SEP5 afterthis period was 48,9 (p < 0,05). A totally of 1875 continued the treat-ment after the initial period, 61% of them preferred a long acting 5-PDE inh.Conclusion: Prostatic cancer screening is a helpful tool for an earlydetection of the erectile dysfunction and the initiation of a simple,patient adapted, 5 PDE inh treatment improve quality of life.

UNMODERATED POSTER PRESENTATION ABSTRACTS

Conclusion: Combination therapy has a better result because of alower dose of PGE1 with minimal penile pain.

PP-01-146

Alfuzosin pharmacotherapy for primary prematureejaculationBhatia, V.1

1Specialized Medical Care Hospi, Urology & Andrology, Al Ain, United ArabEmirates

Objective: This placebo (PLA) controlled double blind study evalu-ated the efficacy of Alfuzosin (ALF) in the management of primarypremature ejaculation (PPE).Methods: Patient population comprised 82 males,mean age 29years.Patients had stable female sexual partners and complained ofintravaginal latency time (IELT) of less than 120 secs during more than50% of attempted sexual intercourse.The mean IELT was 40 secs.Routine clinical and laboratory evaluation did not reveal any factorpredisposing to PE. Patients were informed about the study but thenature of medications was concealed. Each patient received a PLA(multivitamin capsule)daily for one month followed by no treatmentfor one month followed by ALF daily for one month.Results: The factors evaluated included- A) IELT in the last 3 sexualintercourses, B) sexual satisfaction graded I, II and III (fair, good andexcellent), C) period of onset of improvement in IELT, D) period ofmaintainance of improvement in IELT at 4 weeks of stopping therapy,E) side effects. The mean IELT with ALF at 4 weeks was 160 secs ascompared to 64 secs with PLA. The sexual satisfaction grading withALF was grade II (66%) and grade III (34%) while with PLA was gradeI (58%) and grade II (42%). The mean period of onset of improve-ment in IELT was at the end of three weeks with ALF while no suchpattern was observed with PLA. At the end of 4 weeks of stopping thetreatment 44% and 16% patients continued to have improvement withALF and PLA respectively. The side effects were higher with ALF-headache and asthenia (5%).Conclusion: ALF apears to be more effective than PLA in the man-agement of PPE. This potential benefit may be advantageous int hemanagement of LUTS due to BPH and often associated PE.

PP-01-147

Factors influencing preference for tadalafil andsildenafil citrate (sildenafil) in a crossover studytreating erectile dysfunction in men naïve tophosphodiesterase 5 inhibitor therapyEardley, I.1; Montorsi, F.2; Chan, M.3; Loughney, K.4; Vail, G. M.5;Beardsworth, A.51Leeds General Infirmary, Wetherby, United Kingdom; 2University VitaSalute San Raffaele, Division of Urology, Milan, Italy; 3Eli Lilly Canada,Inc., Statistics and Information Sci, Toronto, Canada; 4ICOS Corporation,— Bothell, WA, USA; 5Eli Lilly and Company, Lilly Research Laboratories,Indianapolis, IN, USA

Objective: In a recent, randomized, open-label, optimized-dose,crossover study treating erectile dysfunction (ED) in patients naäve tophosphodiesterase 5 inhibitors (N = 291), most patients preferredtreatment with tadalafil (206,71%) compared with sildenafil (85, 29%)(Eardley et al, 2006.BJU Int;96:1323). The purpose of these post hocanalyses were to identify factors influencing patient preference.Methods: Men were randomized to sildenafil (12 weeks) followed bytadalafil (12 weeks) or vice-versa (8 week dose optimization; 4 weekassessment). Patients completing both 12 week periods chose whichtreatment to continue during an 8 week extension. We examined base-

152

J Sex Med 2007;4(suppl 2):152–202

PP-01 Pharmacology

PP-01-144

Does treatment with sildenafil improve quality ofsexual life in a group of patients without sexualdysfunction? Interim analysisGruenwald, I.1; Massarwa, O.11Rambam Medical Center, Neurourology Unit, Haifa, Israel

Objective: In clinical practice we encounter sexually-active males thathave satisfying sexual function but still request a PDE5i. We aimed toevaluate the true effect of Viagra 50 mg on the quality of sexual life(QSF) in this group of patients.Methods: This is an ongoing prospective, placebo-controlled, double-blind crossover study. Included were naive sexually-active males. Themain inclusion criterion was an IIEF-ED Domain score (IIEF-EDDS)above 22. The study included 4 visits in which QSF questionnaires(SEARS, QVS, IIEF and EDITS) were filled and 6 tablets of Viagra50 mg or placebo were randomly provided in visits 1,3 in a crossovermanner. An interim-analysis was performed in the first 34 subjects. Forstatistical analysis, we performed paired-tests between Viagra treatedvs. placebo.Results: Average age was 53.5, mean IIEF-EDDS score was 25. Wefound significant differences between the Viagra vs. placebo groups inthe QVS (4.11 vs. 3.79, p = 0.022), EDITS (23.35 vs. 28.6, p = 0.009),and SEARS (56.1 vs. 51.1, P = 0.009) questionnaire respectively.Specifically, individuals receiving Viagra reported a longer duration ofsexual intercourse, more than one erection (per sexual activity), ashorter interval between erections, a better erectile quality and delayedejaculation. Social life and self esteem question scores were signifi-cantly higher in the Viagra group (p = 0.013 and p = 0.007 respec-tively). We did not find significant differences between the groups inthe total IIEF, the IIEF-EDDS nor in the frequency of sexual activity.Conclusion: Treatment with sildenafil may be beneficial to subjectsthat usually do not complain of ED and that are content with theirsexual life. There is need to characterize this group in more detail andto sub-categorize those that may enhance their QSF with the use ofViagra.Policy of full disclosure: This study was performed with an unre-stricted grant from pfizer.

PP-01-145

Treatment of post radical prostatectomy (PRP) sexualdysfunction with combined therapy of sildenafil andintracavernosal alprostadil (pge1)Vlachiotis, J.1; Petsis, D.2; Perlepes, G.3; Zozas, N.2; Tsidavis, A.2

1Ekali—Athens, Greece; 2Metaxa Cancer Hospital, Urology, Pireaus, Greece;3Metaxa Cancer hospital, Urology, Ekali—Athens, Greece

Objective: 15 men, 52–73 y.o. who underwent nerve sparing radicalprostatectomy were enrolled in the study. Of the 15 patients, 4 startedon 50 mg sildenafil daily alone and the rest 11 started with 5 µg intra-cavernosal PGE1 two times per week combined with 50 mg sildenafildaily. Sexual function was evaluated with international index of erec-tile function questionnaire.Methods: We evaluated the erectile function at intervals of 3, 6, 9,and 12 months.Results: In the 11 patients using intracorporal PGE1, 5 continuedwith 5 µg PGE1, 3 decreased to 3 µg and 3 increased to 8 µg PGE1.11 patients were sexually active, 7 (65%) with combination therapy and4 (36%) with injection alone. The 4 patients on sildenafil alone hadimpotence.

Unmoderated Poster Presentation Abstracts 153

J Sex Med 2007;4(suppl 2):152–202

line factors (age, race, ED etiology/duration, BMI, smoking status,alcohol consumption, vital signs, comorbid conditions, InternationalIndex of Erectile Function (IIEF) Domains, Psychological and Inter-personal Relationship Scales (PAIRS) Domains, Sexual EncounterProfile (SEP; questions 1–5) scores) and study factors (therapysequence, dosage, differences in postbaseline IIEF or PAIRS Domainsor SEP scores, differences in number/timing of attempts or differencesin side effect severity [overall patient perception, scale 0–10]). Nosingle factor appeared to explain the observed patient preference,therefore preference was modeled using stepwise logistic regression.Results: No baseline factors significantly influenced preference.Factors associated with increased preference for tadalafil included alarger reduction in the PAIRS Time Concerns Domain, patient dosagechoice of tadalafil 20 mg/sildenafil <= 50 mg, larger IIEF IntercourseSatisfaction Domain improvements, less severe side effects, moresexual attempts over 4 weeks, and higher SEP4 scores (satisfaction with erection hardness) during the tadalafil versus sildenafil treatmentphase.Conclusion: No baseline factors were identified as significantly asso-ciated with preference for tadalafil or sildenafil. Study factors signifi-cantly associated with an increased preference for tadalafil includedpatient differences in time concerns, dosage choice, intercourse satis-faction, side effect severity, number of sexual attempts, and satisfactionwith erection hardness. Funded by Lilly ICOS LLC.Policy of full disclosure: Investigator for Lilly ICOS, Bayer, Pfizer,Schering, Ipsen.

PP-01-148

Tadalafil improves psychological aspects of sexual life in patients formerly treated by short-acting ED medicationKoskimaki, J.1; Leinonen, M.2; Cameron, A.3; Saloranta, P.4; Leinonen, E. S.5;Leononin, M.6; Cameron, A.7; Saloranta, P.8; Leononin, E. S.9

1Tampere university Hospital, Urological Department, Finland; 2Kista,Sweden; 3Indianapolis, USA; 4Kuopio, Finland; 5Vantaa, Finland; 64PharmaAB, — Kista, Sweden; 7Lilly Research Laboratories, Health Outcomes, Indi-anapolis, IN, USA; 8The Kuopio Health Center, Eteläinen alue, Finland;9Eli Lilly Finland, Clinical Research and Development, Vantaa, Finland

Objective: Studies on erectile dysfunction (ED) traditionally examineerectile function endpoints. Sexual relationships comprise also psy-chological interpersonal aspects. We investigated whether switchingfrom another oral ED medication to tadalafil improves psychosocialoutcomes and interpersonal aspects in sexual relationships.Methods: 202 Finnish men aged >18 years successfully treated withoral ED prescription medication (tadalafil excluded) voluntarilyentered this multicenter, open-label, one-arm, 3-month study. Uponenrollment, patients discontinued previous therapy (Visit 1). After aone-week washout, tadalafil 10 or 20 mg on demand (dose determinedby investigator) was started. The dose could be changed twice duringthe study. We used the Psychological and Interpersonal RelationshipScales (PAIRS) to examine the effect of previous treatments at base-line (Visit 1) and the effect of tadalafil at 3 months. The analysisincluded patients having >=1 intercourse attempts during the preced-ing 4 weeks before both time points. PAIRS comprises Spontaneity,Sexual Self-Confidence, and Time Concerns domains that includequestions regarding the relationship between the patient and partner.Responses range from 1 (strongly disagree) to 4 (strongly agree).Results: Of 202 enrolled, 184 men were included in the analysis and completed PAIRS both at baseline and 3 months. All domains ofPAIRS improved clinically and statistically significantly: increase in theSpontaneity domain from 3.06 to 3.12 (p < 0.05) and Self-Confidencedomain from 2.22 to 2.74 (p < 0.001). The Time Concerns domaindecreased (improved) from 2.56 to 2.22 (p < 0.001) compared to base-line. There were three serious adverse events, none related to medication.Conclusion: In this study, switching to tadalafil improved spontane-ity and sexual self-confidence and reduced time concerns in menhaving previously used and responded to other oral prescription med-ication for ED.

Policy of full disclosure: Paid lecturer for Astellas, Astra-Zeneca,Bayer, Eli Lilly and Pfizer. Paid investigator for Astra-Zeneca, Bayer,Hormos Medical, Eli Lilly and Pfizer.

PP-01-149

The efficacy and safety of tadalafil 10 mg and 20 mgin Japanese men with erectile dysfunction (ED) and acomparison of tadalafil doses in Japanese men withsevere EDKimoto, Y.1; Nagao, K.2; Marumo, K.3; Tsujimura, A.4; Ishii, N.2; Fujimoto, K.5;Imaoka, T.5; Stothard, D.6; Watts, S.6; McGill, J.6; Kamidono, S.7

1Spinal Injuries Center, Department of Urology, Iizuka, Japan; 2Toho Uni-versity School of Medi, Department of Urology, Ota-ku, Tokyo, Japan; 3TokyoDental College, Ichikawa, Department of Urology, Ichikawa, Chiba, Japan;4Osaka University Graduate Scho, Department of Urology, Suita-city,Osaka, Japan; 5Lilly Research Laboratories, Japan Clinical Research, Chuo-klu, Kobe, Japan; 6Indianapolis, IN, USA; 7Chuo-ku, Kobe, Japan

Objective: Investigate the efficacy and safety of tadalafil in Japanesemen with ED, compare 10 and 20 mg tadalafil doses in Japanese menwith severe ED, and substantiate the Japanese results.Methods: This multicenter, randomized, double-blind, placebo-con-trolled, 12-week study enrolled 343 Japanese men with ED, stratifiedby ED severity, then randomly assigned to placebo, 5 mg,10 mg or 20mg tadalafil. Coprimary outcomes were International Index of Erec-tile Function Erectile Function (IIEF EF) domain score, percentageof “yes” responses to Sexual Encounter Profile (SEP) Diary Questions2 (penetration) and 3 (intercourse), and tolerability. Outcomes for the5 mg dose were not primary endpoints and are not shown. A prespec-ified subgroup analysis also was conducted comparing the efficacy andtolerability of tadalafil 10 and 20 mg among patients with severe EDto explore the benefit of higher doses of tadalafil in clinical practice.Because of the small number of men with severe ED in the Japanesestudy, we analyzed pooled data post hoc from men with severe EDenrolled in the only other similarly-designed tadalafil clinical trials (3placebo-controlled trials; 3PCT) to substantiate the Japanese results.Results: 302 patients (88%) completed the Japanese study. The mostcommonly reported (>5%) treatment-emergent adverse events(TEAE) were headache, nasopharyngitis, flushing, and hot flush. Onepatient discontinued due to adverse event (ureteral stone). For patientswith severe ED in the Japanese study, there was no significant differ-ence between tadalafil groups in the frequency of TEAE. For patientswith severe ED in the 3PCTs, there was a significant differencebetween tadalafil groups in the frequency of dyspepsia (5.3% vs.14.3%, P = 0.040).Conclusion: Tadalafil is efficacious and well tolerated in Japanese menwith ED. For patients with severe ED, tadalafil 20 mg may showgreater improvement in erectile function compared with 10 mg.Policy of full disclosure: Paid consultant and study investigator forEli Lilly, and study investigator for Pfizer.

154 Unmoderated Poster Presentation Abstracts

J Sex Med 2007;4(suppl 2):152–202

PP-01-150

Treatment patterns over 6 months with PDE5inhibitors in the erectile dysfunction observationalstudy (EDOS)Beardsworth, A.1; Martin-Morales, A.2; von Keitz, A.3; Hatzichristou, D.4;Riley, A.51Eli Lilly and Company, Lilly Research Laboratories, Indianapolis, IN, USA;2Hospital Carlos Haya, Servicio de Urologia, Malaga, Spain; 3UrologischePraxis, Marburg, Germany; 4Papageorgiou Gen’l Hosp. of Th, Dept.Urology, Thessaloniki-N, Efkarpia, Greece; 5Lancashire Post-Grad. Sch. of,Univ. of Central Lancashire, Preston, United Kingdom

Objective: To observe patterns of continued treatment with tadalafil,sildenafil citrate (sildenafil), and vardenafil HCl (vardenafil) over 6months in a naturalistic setting.Methods: EDOS observed men ≥18 years with ED who initiated EDtherapy or changed their current therapy as part of their routine,normal health care. The observational nature of EDOS allowedpatients to change treatment any time during the 6-month study.Investigators were encouraged, but not required, to fill 50% of theirenrollment allocation with patients prescribed tadalafil; however, anyavailable ED treatment was permitted. Data collection occurred atbaseline (treatment visit when patient agreed to participate in thestudy) and after 3 and 6 months (± 1 month) of observation.Results: Of the 8047 enrolled patients at 904 sites across 9 Europeancountries, 7560 (94%) were prescribed an inhibitor of PDE5 at base-line. There was no significant difference in baseline characteristics ofpatients prescribed tadalafil, sildenafil, or vardenafil. Most patients,64%, were treatment naäve. Mean baseline erectile function domainscore was 13, mean age was 56 years, and 76% of patients had ED oforganic or mixed etiology. At 3 and 6 months, more patients contin-ued therapy with tadalafil than with sildenafil or vardenafil (P < 0.001),and more patients switched from sildenafil and vardenafil than fromtadalafil (P < 0.001). Of the patients who continued on one inhibitorof PDE5 for the first 3 months, the percentage on the same therapyfor 6 months was 81.5% for tadalafil, 68.7% for sildenafil, and 67.5%for vardenafil (P < 0.001).Conclusion: In this observational study, patients prescribed tadalafilat baseline were less likely to switch to another PDE5 inhibitor thanthose prescribed sildenafil or vardenafil for the treatment of ED.Policy of full disclosure: Dr. Martin-Morales is an advisor for LillyICOS LLC.

those sexual attempts that led to completion of intercourse, in menwith ED treated with tadalafil, and to determine if men treated withboth tadalafil and sildenafil citrate reported differences in these measures.Methods: Data were pooled from 17 randomized, double-blind,placebo-controlled, 12-week studies (N = 3345 men) assessing the effi-cacy and tolerability of tadalafil 10 and 20 mg against placebo. SexualEncounter Profile (SEP) diaries were completed after each intercourseattempt and overall mean per-patient percentages for satisfaction withhardness (SEP4) and overall satisfaction (SEP5) were determined.Additionally, SEP4 and SEP5 results were assessed particularly forthose attempts that led to successful intercourse completion (SEP3 yesattempts). SEP4 and SEP5 data from a separate, randomized, open-labeled, cross-over, flexible-dose, 12-week study comparing sildenafilcitrate (25/50/100 mg) with tadalafil (10/20 mg), enrolling 367 menwith ED but naäve to PDE5 inhibitor therapy, also were evaluated forcomparison (Eardley I, et al. BJU Intl 2005;96:1323–32).Results: (see table).Conclusion: Men who took tadalafil 10 and 20 mg were significantlymore satisfied with the hardness of their erection and the overall sexualexperience than men who took placebo. When only successful inter-course attempts were assessed, men taking tadalafil continued to besignificantly more satisfied with the hardness of their erection and theoverall sexual experience than men taking placebo. In the comparativestudy, men reported no significant difference in their satisfaction witherection hardness between tadalafil and sildenafil, but did report sig-nificantly greater overall satisfaction with the sexual experience whiletaking tadalafil versus sildenafil. When only successful intercourseattempts were assessed, there was no significant difference between thetwo PDE5 inhibitors.Policy of full disclosure: Bayer/GSK/Shering-Plough-Consul-tant/Advisor, Lecturer, Investigator, Scientific Study/Trial; LillyICOS-Consultant/Advisor, Lecturer, Investigator, Scientific StudyMentor-Consultant/Advisor, Investigator; Pfizer-Lecturer, ScientificStudy/Trial.

PP-01-151

Satisfaction with erection hardness and overall sexualexperience in men with erectile dysfunction (ED)treated with tadalafilHellstrom, W.1; Moncada, I.2; Ralph, D. J.3; Mirone, V.4; Sotomayor, M.5;Stothard, D.6; Watts, S.6; Beardsworth, A.7

1Tulane U Health Sciences Ctr, Dept of Urology, New Orleans, LA, USA;2Hospital Gregorio Maranon, Urology, Madrid, Spain; 3Institute of Urology, Urology, London, United Kingdom; 4University of Naples “FedericoII”, Urology, Italy; 5Instituto Nacional de Ciencias, Medicas y Nutricion—Urology, Mexico, DF, Mexico; 6Indianapolis, IN, USA; 7Windlesham,Surrey, United Kingdom

Objective: The objective of this analysis was to assess satisfaction withhardness of erection and overall sexual experience, particularly for

PP-01-152

Evaluation of the treatment results and adaptation totreatment in the PDE5 inhibitor therapy amongerectile dysfunction patientsCimen, S.1; Demir, O.1; Aslan, G.1; Esen, A.11Dokuz Eylul University, Urology, I

.zmir, Turkey

Objective: Phosphodiesterase type 5 (PDE5) inhibitor therapy is anefficacious treatment for erectile dysfunction. PDE5 inhibitors supplypenile erection by inhibiting the hydrolysis of cGMP and thereforerelaxing the corpus cavernosum. In this study, retrospective evaluationof the patients who admitted to our clinic with the complaint of erec-tile dysfunction and whom were recommended on PDE5 inhibitortreatment in terms of follow-up results and patient satisfaction wereaimed.Methods: The patients were called by phone and after informingabout the study and taking the informed consent, patient satisfactionwith the treatment, purposes of withdrawal, treatment alterations andpartner satisfaction were investigated.Results: Interviews were made with 345 patients, whom accepted toenroll in the study and the mean patient age was 56 ± 11.2 years. 66.4%


J Sex Med 2007;4(suppl 2):152–202

of the patients were learned to be satisfied with the treatment. It wasdetermined that 10.7% of the patients did never use the medicationand 50% could not continue because of high treatment cost. It wasrecognized that 50.2% of the patients whom are not satisfied with thetreatment tried another PDE5 inhibitor. The success rate of the treat-ment was found to be higher in the followed-up group than the groupout of follow-up.Conclusion: Therapy with PDE5 inhibitors is an effective means oferectile dysfunction treatment. The importance of doctor-patientcommunication must be considered, and the patient must be advicedfor adaptation to follow-up program. High treatment costs should bere-evaluated by considering the negative psychosocial effects of erec-tile dysfunction and the patient population who cannot afford thetreatment costs.

PP-01-153

Erectile dysfunction and anxiety: The role ofescitalopram. A preliminary studyCorretti, G.1; Baldi, I.21Livorno, Italy; 2IRCSS “Stella Maris”, Childhood and Adolescent Neuro,Pisa, Italy

Objective: Erectile Dysfunction (ED) and anxiety are closely related.A high comorbidity between ED and Panic Disorder (PD) wasobserved. Psychical and psychological symptoms always interfere withthe approach, course and goal in treatment of ED patients. Frequentlythese symptoms decrease compliance, too. In this study we considerthe response to escitalopram, a new selective serotonin reuptakeinhibitor (SSRI), in patients affected by ED and PD.Methods: We consider 11 consecutive patients affected by ED andPD. None of them is consuming SSRI, benzodiazepine or other psy-choactive drugs. The patients are evaluated with IIEF15 and ASEX(Arizona Sexual Experience Scale) and they are treated with escitalo-pram. Six of them were previously unsuccessfully treated with Phos-phodiesterase type 5 inhibitors (PDE5i). The sexual evaluation isrepeted after 1, 2 and 3 mounths of treatment with escitalopram.Results: The entire group complete the study. All patients, includingthe PDE5i not-respondant, show a significant increase in IIEF15 andASEX, since the first mounth of treatment, in particular in sexualdesire and sexual satisfaction. We don’t observe any side effect esci-talopram related.Conclusion: Escitalopram results an efficacy choose in treatment ofpatients affected by ED and PD, with an consistent increase in sexualfunction and satisfaction. A missed evaluation of psychopathologicalsymptoms involves the course and prognosys of a sexual dysfunction.Further studies on wider populations are necessary to confirm ourobservations.

PP-01-154

Long-term administration of udenafil, PDE type 5inhibitor, helps to preserve erectile function in ratsexposed to alcoholAhn, G. J.1; Sin, J. H.1; Kang, K. K.1; Ahn, B. O.1; Yoo, M.1

1Dong-a pharmaceuticals, Preclinical division, Yong-in, Kyoung-gi, Republicof Korea

Objective: A couple of studies demonstrated that acute in vitro expo-sure of corpus cavernosum (CC) to ethanol decreased its relaxationresponses to field and pharmacological stimulation. The present studywas designed not only to determine whether chronic exposure toethanol induces the changes in erectile function and protein expres-sion of CC but also to suggest its modulation effects by concomitantPDE 5 inhibition.Methods: Adult SD rats (220 ∼ 250 g) were divided into a controlgroup (n = 10, fed a tap water + vehicle), ethanol group (n = 10, ethanol+ vehicle, 5% (v/v) ethanol in tap water and increased the ethanol con-centration up to 30% at 6th week) and ethanol + udenafil group (n =10, ethanol + udenafil 20 mg/kg oral administration). After 6 weeks,intracoporal pressure (ICP) was measured then immunoblots for

alpha-actin, CD-31, collagen type 4 were performed using peniletissues.Results: The rats in ethanol group exhibited significantly loweredmaximum ICP and area under the curve (AUC). Furthermore, alpha-actin, CD-31 and collagen type 4 protein expressions also markedlydiminished in CC. Concomitant administration of udenafil intensifiederectile response and restored the protein expressions.Conclusion: These findings of present study imply that chronic expo-sure to ethanol is a possible deteriorative factor for inducing erectiledysfunction (ED) and exhausting the key protein in CC. Additionally,udenafil treatment is proven helpful to maintain erectile function andendothelial cell and smooth muscle in CC.

PP-01-155

Effectiveness and satisfaction with tadalafil in patientschanging PDE5 inhibitor treatment: Results from theDETECT studyRoumeguere, T.1; Arver, S.2; Eliasson, T.3; Belger, M.4; Schmitt, H.51Erasme Hospital, Urology, Brussels, Belgium; 2Karolinska Hospital,Endocrinology, Sweden; 3Umea Hospital, Urology, Sweden; 4ELI LILLY,Statistics, Erl Wood, United Kingdom; 5ELI LILLY, Urology, Brussels,Belgium

Objective: To determine effectiveness and satisfaction with 6 monthstadalafil treatment in patients changing PDE5i treatment.Methods: The DETECT study is a prospective 12 months Europeanobservational study in ED patients initiating or changing treatment totadalafil. 191 patients out of 1900 took a PDE5i treatment in the 4weeks prior to enrolment (73% sildenafil, 15% vardenafil, 7% both,5% others). 151 patients (79%) completed data forms after 6 months(IIEF EF scores and EDITS scores at 1 and 6 months).Results: Main reasons for changing treatment at enrolment were:Duration of action(29%),lack of efficacy(25%),unwantedeffects(9%),slow onset(9%),lack of confidence(5%), cost(5%). 13patients reported not using tadalafil at 6 months: 4 reported no longerhaving ED and 7 switched to another PDE5i. 91% indicated tadalafiluse after 6 months. Changes in ED severity and satisfaction isdescribed in the table.

N = 138 Baseline One month Six months Mean IEF EF 18.5(6.7) 25.3(5.2) 24.9(5.8)

score(SD)ED severity: –Severe 17% 3% 4%

–Moderate 20% 3% 4%–Mild 51% 35% 35%–Normal 13% 59% 56%

Total EDITS score 80.1(14.6) 80.9(17.1)

Satisfaction (EDITS: very/somewhat satisfied)—Treatment overall 86% 84%—Treatment met expectations 77% 76%—How quickly treatment works 86% 90%—How long treatment lasts 88% 87%—Confidence to engage in sexual activity 91% 90%—How satisfied is your partner 85% 82%—Hardness of erections versus before ED 55% 71%Mean number of 6.0(4.5) 7.4(5.6) 7.7(5.4) sexual attempts in last 4 weeks(SD).

Conclusion: Patients changing treatment from another PDE5i totadalafil had improvement in ED severity with a high satisfaction andtreatment continuation rate after 6 months.Policy of full disclosure: UNRESTRICTED GRANT FROM ELILILLY.


J Sex Med 2007;4(suppl 2):152–202

PP-01-156

The Real–Life Safety and Efficacy of Vardenafil(REALISE) Study—Results from BelgiumRoumeguere, T.1; Claes, H.2; Van Poppel, H.2; Schulman, C.1; Handel, H.3

1Erasme Hospital, Urology, Brussels, Belgium; 2Univ. Clin. Gasthuisberg,Urology, Leuwen, Belgium; 3Bayer Medical, Leverkusen, Germany

Objective: To determine safety, efficacy and patient acceptance of var-denafil 5, 10 and 20 mg in a real-life setting.Methods: REALISE is a prospective observational study evaluatingthe use of vardenafil for ED in routine practice. Data collected by 903physicians in Belgium between February 2004 and April 2005 wasdone. Safety and efficacy data under day life conditions were acquiredby interviews and diaries.Results: Data from 1,851 patients with a mean age of 57.8 (SD 10.3)years were analyzed. ED severity was mild, moderate and severe in14,7%, 54,5% and 23,9% respectively. About one third (35.9%) hadreceived another ED treatment prior to using vardenafil. At the initialvisit vardenafil 10 mg was the most frequently prescribed dose(72.5%). Dose changes during the course of the study occur only in21%. Overall tolerability was rated satisfying/very satisfying in 95.5%.There were 113 patients (6.10%) with adverse drug reactions (ADRs).The most frequently reported were headache (2.49%), flushing(1.40%) and nasal congestion (0.59%). In 93.7% of patients erectionsimproved (GAQ), and improvement occurred already after the first(70.7%) or second tablet (87.0% cumulative). Overall efficacy wasrated satisfying/very satisfying in 92.7%. In total, 70.7% of pretreatedpatients preferred vardenafil compared to their previous treatment and 86.6% wanted to continue vardenafil treatment. Data from 1,087patient diaries showed, that regarding all attempts penetration waspossible in 93.6%, and in 82.9% erections were maintained longenough to complete intercourse. Erections were considered to be sat-isfying/very satisfying in 86.0% of all attempts.Conclusion: In this non-interventional study of 1,851 Belgianpatients, vardenafil showed very good safety and efficacy which is con-sistent with data reported from other open-label studies.Policy of full disclosure: UNRESTRICTED GRANT FROMBAYER.

PP-01-157

The influence of vardenafil on quality sexual life in aging men with erectile dysfunction and diabetes mellitusHuk, J.1; Fryczkowski, M.1; Kaletka, Z.1; Szwedowski, M.11Silesian Madical University, Urology, Zabrze, Poland

Objective: In Poland are 1.5 mln men above 35 years old with erec-tile dysfunction (ED).Methods: Wardenafil 20 mg were evaluated in randomized studies in150 men with ED: 50 with diabetes mellitus type 1—group 1 and 50with type 2—group 2 and 50 without diabetes—group 3. The menwere evaluated in two age groups: A—40–50 and B—51–65 years old.Diagnosis was based on andrological, sonographic and examination.Laboratory investigation included: FSH, LH, T, HbA1C, E2, SHBG,DHEA, IGF-1. Efficacy was measured by: The questionnaires- IIEFand SEP.Results: The questionnaire IIEF—before the treatment was ingr.1–7.8 gr.2–10.2, gr.3–7.5 points and after was respectively 15.9,17.2, 23.9 points. The answered after administration 20 mg wardenafilto SEP question 2 and 3 was respectively: gr.1–62.3%, 51.4%,gr.2–66.8%, 54.6%, gr.3–85.6%, 69.2%. The efficacy of wardenafilafter 60 minutes was: gr.1–75%, gr.2–69%, gr.3–81%. The influenceof wardenafil on erectile dysfunction in age group was: A–71% (gr.1),74% (gr.2) and 93% (gr.3) and in B was: 67%, 72%, 85%. Improve-ment of ED indenpendently of age, and time after administration of20 mg wardenafil was in gr.1–68%, in gr.2–72%, and in gr.3–86%.Conclusion: 1. Wardenafil significantly improve erection and enablethe successfully attempted intercourse in 70% men with diabetes mel-litus independently of degree glicemia and age of men. 2. In above

78% patients independently on present and type of diabetes mellitusimprove of erection and satisfactory intercourse were observed after60 minutes. 3. Improvement of the erection and successfully inter-course for both partners are compared in two age groups was signifi-cantly higher (89%) in men without diabetes mellitus.

PP-01-158

Attitudes of patients and physicians to the use ofvardenafil in the Belgian populationClaes, H.1; Roumeguère, T.2; van Poppel, H.3; Schulman, C.1; Landen, H.3

1UZ Gasthuisberg, Dept. of Urology, Leuven, Belgium; 2Univ. Clin. Erasme,Urology, Bruxelles, Belgium; 3Bayer, Health Care, Leverkusen, Germany

Objective: In order to provide further insight into the sexual ecologyof PDE-5 users in Belgium, we performed a prospective, non-inter-ventional, multicenter, post-marketing study (the Real-Life Safety andEfficacy of Vardenafil (REALISE) Study).Methods: From February 2004 till April 2005, 1851 patients wereincluded by 903 physician’s, who prescribed vardenafil. Data wereacquired by interviews and diaries.Results: 95% of the patients were older than 40 years of age (meanage 57.8, SD 10.3). 71.3% had a BMI of >25 kg/m2. Alcohol con-sumption was present in 77%. 55.8% were smokers and 71.6% hadnot enough physical activity. 14.7% were categorized as mild, 54.5%as moderate and 23.9% as severe ED. The severity of ED increasedwith age. The average use was 1 tablet/week and diminished with age.38.4% were able to have intercourse within 30 min. Being unable tomaintain an erection during intercourse is the most important reasonfor PDE-5 treatment. Only in men over 70 y does penetration becomethe main problem. 30.62% had previously used another PDE-5 treat-ment before, but preferred vardenafil. The reasons were mainlybecause of a new drug trial (>50%), although efficacy was also men-tioned in 34.9% of sildenafil users and in 40.6% of tadalafil users.Overall efficacy was rated satisfying/very satisfying in 92.7% of allpatients and this result was obtained after the first (70.7%), second(87.0% cumulative), third (94.7% cumulative) or fourth (97.5% cumu-lative) tablet.Conclusion: Not being able to maintain an erection during inter-course is the most frequent reason for PDE-5 treatment and in orderto achieve an appropriate result with PDE-5 treatment, we had toadvise our patients to try at least 4 tablets.Policy of full disclosure: This study was supported by a grant ofBayer NV.

PP-01-159

Sample analysis of patients in whom phosphodiesterasetype—5 inhibitors treatment failed or wascontraindicatedAlkhayal, S.1; Lehmann, V.1; Thomas, P.1

1Royal Sussex County Hospital, Urology, Brighton, United Kingdom

Objective: Certain patients fail to respond to Phosphodiesterasetype—5 inhibitors (PDE5-I) treatment or is contraindicated. Alterna-tive treatment in the form of penile Prostaglandin injections, intrau-rethral prostaglandins (Muse) or vacuum constriction devices are oftenthen prescribed. Patient and partner satisfaction with these treatmentsis reviewed.Methods: 20 patients in whom PDE5-I treatment have either failedor was contraindicated were sent a questionnaire to evaluate their erec-tile function and sexual satisfaction as well as their partners’ satisfac-tion in response to using other prescribed treatments. The IIEF-5questionnaire as well as sexual satisfaction scores were recorded andcase notes were reviewed in regards to co-morbidities and indications.Results: 8 patients responded to the questionnaire, average age 63years (49–74). Average IIEF-5 score whilst using their treatment was10, range (3–25) and sexual satisfaction score of 1.6, range (1–5). 3patients failed to respond to PDE5-I treatment while for the other 5this treatment was contraindicated. 5 patients were using a vacuumconstriction device; none of whom was satisfied with the result, nor


J Sex Med 2007;4(suppl 2):152–202

their partners. 2 patients were using Muse, one of whom was satisfiedwith the treatment while the other reported dissatisfaction, as well asboth partners. Only one patient was using penile injections and wassatisfied with the result along with his partner. Blistering of the fore-skin was reported by one patient using the pump while another patientreported mild penile pain after injection.Conclusion: Alternative therapy to PDE5-I often fails to satisfypatients and their partners. Those who fail PDE5-I treatment needfurther assessment along with their partners. Sexual counselling shouldbe provided and expectations should be reviewed before other optionsbeing offered.

PP-01-160

Efficacy and safety of sildenafil citrate in managementof erectile dysfunction following radical retropubicprostatectomyBrodak, M.1; Navratil, P.2; Pacovsky, J.21University Hospital H.Kralove, Urology, Hradec Kralove, Czech Republic;2University Hospital H.Kralove, Urology, Hradec Králové, Czech Republic

Objective: Radical prostatectomy is common cause of erectile dys-function. Great improvement have occurred with using nerve sparingtechnique described by Walsh since 1980. Another important step wasintroducing sildenafil citrate in treatment of erectile dysfunction in1998 in the United States and in 1999 in Czech Republic. The aim ofour study is an analysis of sildenafil citrate in management of erectiledysfunction after radical prostatectomy.Methods: Of 162 men who underwent radical prostatectomy between2000–2004, 48 were prescribed sildenafil at their request. Medicationwas initiated at 50 mg, and if this was ineffective, the dose wasincreased to 100 mg. Patients underwent bilateral nerve sparing radicalprostatectomy and were sexually active before surgery. These patientswere interviewed using IIEF-5 questionnaire and questioned foradverse events.Results: Thirty-nine of the 48 patients were eligible for the evalua-tion of the efficacy of sildenafil and completed IIEF-5 questionnaires.Of the 39 patients 22 (54%) responded to the drug. Mean IIEF-5 scoreincreased from 4,4 to 14,4 (P < 0,001). No serious adverse events wererecorded; the most common mild adverse events were headache in 2patients.Conclusion: Most important prognostic factors for recovery of sexualpotency are number of spared neurovascular bundles, age and sexualactivity before surgery. Sildenafil citrate is effective and well toleratedin management of erectile dysfunction after radical prostatectomy.Non-responders of this treatment could be treated another methodsespecially intracavernous treatment.

PP-01-161

Plasma levels of von Willebrand factor are loweredafter treatment with 25 mg of sildenafil dailyKonstantinopoulos, A.1; Raptis, S.2; Gyftopoulos, K.2; Giannitsas, K.2;Spathas, D.3; Perimenis, P.21University Hospital of Patras, Urology, Greece; 2University Hospital ofPatras, Urology, Greece; 3Uiversity of Patras, Molecular Biology, Greece

Objective: Von Willebrand factor (vWf) is a multimeric glycoproteinsynthesised by endothelial cells and megacaryocytes, the progenitorcell forms of platelets. High plasma levels of vWf are considered asindicators of endothelial dysfunction. As endothelial dysfunction isconsidered to play a major causal role in many pathologies associatedwith erectile dysfunction, we sought to assess the impact of dailyadministration of sildenafil on the levels of vWf in plasma.Methods: Eight patients with a (mean ± SD) age of 57 ± 5 years, withcarcinoma of the prostate were treated with radical retropubic prosta-tectomy and as a standard post-surgery treatment in our department,they received sildenafil 25 mg daily. The levels of vWf in plasma weremeasured preoperatively and after 30 days of sildenafil daily dosing.Results: Among the 8 subjects, pre-treatment levels of vWf (935 ±419 mU/ml, mean ± SD) were significantly higher than post-treatment

levels (679 ± 191.1 mU/ml), Wilcoxon signed ranks test, p = 0.036.Preopertively, one patient reported severe erectile dysfunction (IIEF5score = 7) while the rest had mild or no erectile dysfunction, with anIIEF5 score ≥21.Conclusion: Although the direct pharmacological target of sildenafil,as well as the other PDE5Is, is not vWf or other molecular markersof endothelial dysfunction, there seems to be an impact of daily admin-istration of PDE5Is on the levels of vWf. Further clinical studies areneeded in order to investigate whether the PDE5Is’ effect on indicesof endothelial dysfunction, such as vWf, is consistent with clinicalimprovement of sexual dysfunction.

PP-01-162

Sildenafil reduces pudendal artery vascular resistancein the anaesthetised dogWayman, C.1; Hornby, S.1; Burden, A.1; Edmunds, N.1; Casey, J.11Pfizer Global R&D, Disc Biology, Sandwich, United Kingdom

Objective: Inadequate penile arterial blood inflow is acknowledged tobe a major cause of erectile dysfunction. The pudendal artery repre-sents 70% of total resistance of the penile vasculature (Manabe 2000)and agents that reduce this resistance will promote penile flow-mediated vasodilation and improve quality of erection.Methods: Experiments were in compliance with UK legislation andsubject to ethical review. Adult dogs (n = 4) were terminally anes-thetised with chloralose/urethane and instrumented for pudendalartery blood flow and intracavernosal pressure (ICP). Pudendal pulsewidth and pudendal vascular resistance were calculated. Penile erec-tion was elicited by submaximal electrical stimulation of the cavernosalnerve (2–4 Hz, 20 v, 2 ms for 60 sec). Clinically relevant plasma con-centrations of sildenafil were infused intravenously (20–133 nM).Results: Electrical nerve stimulation significantly (P < 0.05) increasedpudendal flow by 253% (to 1602 ± 325 ml/min) and erection hardness(ICPrise; 29.7 ± 6.3 mmHg; ICPAUC 23.9 ± 3.4). Pudendal arterypulse width was increased significantly (P < 0.05, paired) during elec-trical stimulation, and remained elevated post-stimulation for ∼3 mins(prestim-92.6 ± 27 mmHg, stim-112.2 ± 25.8 mmHg, poststim-153.3± 29.1 mmHg). Sildenafil significantly (P < 0.05) reduced basal puden-dal vascular resistance (69.0+8.0% of predose). Sildenafil increasednerve-stimulated ICP by a further 88.6% (ICPrise; 56.0 ± 15.7 mmHg;ICPauc 39.6 ± 6.2) and pudendal flow by 152.3% (to 4049 ±1182 ml/min) compared to control increases. Sildenafil increased pre-stimulation, stimulation and post-stimulation pulse-widths by circa60% respectively verses time-matched vehicle controls.Conclusion: Sildenafil reduces pudendal artery vascular resistance, ie.increases elasticity, suggesting that sildenafil could overcome the “arte-rial stiffness” associated with many ED causalities eg aging, diabetes.Sildenafil also enhances stimulated increases in pudendal flow therebyimproving erection hardness by increasing flow-mediated vasodilation.This data demonstrates a novel role for nitrergic neurotransmissionand PDE5 in the control of pudendal artery compliance and bloodflow.Policy of full disclosure: Pfizer Global Research and Development.

PP-01-163

Pharmacokinetic-pharmacodynamic (PKPD) datademonstrates different erectogenic response-plasmaexposure relationships for sildenafil, tadalafil,vardenafil, UK-343,664 & UK-357,903Wayman, C.1; Hornby, S.2; Price, M.1; Foster, L.1; Carter, A.1

1Pfizer Global R&D, Disc Biology, Sandwich, United Kingdom

Objective: Release of nitric oxide and increases in intracellular cGMPunderlie penile erection. The biological activity of cGMP is termi-nated by phosphodiesterase type 5 (PDE5). Insufficiencies in thispathway underlie the pathophysiology of erectile dysfunction (ED).The aim of this study was to compare the translational pharmacologyof five PDE5 inhibitors.


J Sex Med 2007;4(suppl 2):152–202

Methods: Experiments were in compliance with UK legislation andsubject to local ethical review. IC50 and ED50 values were determinedfor sildenafil, tadalafil, vardenafil, UK-343,664 and UK-357,903. IC50s(concentration required to inhibit 50% of the hydrolysis of [3H]cGMPin a scintillation proximity assay) were determined using PDE5 purifiedfrom canine corpus cavernosum. Adult dogs (12–16 kg) were terminallyanesthetised and instrumented for intracavernosal pressure (ICP, Carter,1998). PDE5 inhibitors were intravenously infused and steady stateunbound plasma exposures determined (Walker, 1999). Penile erectionwas elicited by intracavernosal injection of sodium nitroprusside (3–6 ug). ED50 values were calculated (dose level producing 50% of themaximum possible potentiation of the SNP-induced increase in ICP).Data is expressed as geometric mean with 95% confidence intervals.Results: See Table.Conclusion: PKPD analysis reveals differences between the fivePDE5 inhibitors tested. Only sildenafil demonstrated an equivalenttranslation of enzyme potency to erection improving plasma expo-sures. The other PDE5 inhibitors required approximately 3 times theplasma exposure, relative to IC50, to produce comparable erectogenicefficacy as sildenafil. Intracellular drug levels, penile oxygenation orbiochemical interactions with PDE5 may explain these differences.Policy of full disclosure: Pfizer Global Research & Development.

PP-01-165

The Real-Life Safety and Efficacy of Vardenafil(REALISE)—An international post-marketingsurveillance study: Pooled results from 11 European countriesZumbe, J.1; van Ahlen, H.2; Kopa, Z.3; Trinkler, F.4; Landen, H.5

1Klinik für Urologie, Klinikum Leverkusen, Germany; 2KlinikumOsnabruck GmbH, Klinik fur Urologie und Kinder, Germany; 3KlinikumOsnabrück, Germany; 4Urologisches Zentrum, Zollikon, Switzerland; 5BayerHealthcare AG, Bayer Vital GmbH, Leverkusen, Germany

Objective: To determine safety, efficacy and patient acceptance of var-denafil 5, 10 and 20 mg in real-life use.Methods: Prospective, worldwide, post-marketing surveillance study.Data collected in 11 European countries between March 2003 andApril 2005. Subjects with erectile dysfunction prescribed vardenafil inroutine practice were followed for 2 months. Efficacy was measuredunder daily life conditions. Data were acquired by interviews and in 9countries additionally by patient diaries. Safety was determined byreporting adverse events (AEs). Subjects who took at least one tabletand had follow-up data were valid for analysis.Results: Data from 54,140 subjects (mean age = 57.4 ± 10.2 years)were analysed. Vardenafil 10 mg was the most frequently prescribeddose at initial visit (70.6%); for 76.8% of patients there was no doseadjustment. In 94.3% of subjects erections improved and improvementoccurred after the first/second tablet in 73.1%/88.2%. In 93.1% ofsubjects overall efficacy was rated satisfying/very satisfying. Additionaldata were available from 30,721 patient diaries. In these subjects pen-etration was possible in 94.7% of all attempts; in 86.3% of attemptserections were maintained long enough to complete intercourse. Erec-tions were considered satisfying/very satisfying in 88.2% of attempts.Finally, 87.1% of all subjects stated that they would like to continuevardenafil treatment. Incidence of AEs was 2.14%; incidence of drug-related AEs was 1.97%. Most frequently reported AEs were headache(0.95%) and flushing (0.37%), symptoms associated with the pharma-cological action of PD5 inhibitors.Conclusion: In this large pool of patients from Europe, vardenafil washighly effective in >90% of men, with high rates of SEP2 and SEP3success. Vardenafil was generally safe and very well tolerated. Thesedata are consistent with other open-label trials.Policy of full disclosure: Dr’s Zumbé, Ahlen, Kopa and Trinkler arespeakers and consultants for Bayer Healthcare, Pfizer, and Lilly ICOS.Harald Landen is an employee of Bayer Healthcare.

PP-01-166

A comparison of vardenafil and sildenafil: Diary-recorded outcomes in men with erectiledysfunction and cardiovascular risk factorsRubio-Aurioles, E.1; Porst, H.2; Eardley, I.3; Goldstein, I.4

1Mexico; 2Private Practice, Urology, Hamburg, Germany; 3Pyra Depart-ment of Urology, St. James University Hospital, Leeds, United Kingdom;4Private Practice, Urology, Milton, USA

Objective: To compare diary-recorded outcomes with vardenafilversus sildenafil, in men with erectile dysfunction.Methods: This was a pooled analysis of two randomised, double-blind, crossover studies, one performed in the USA and one in Europeand Mexico. Both studies comprised two 4-week periods of treatmentwith either vardenafil 20 mg or sildenafil 100 mg, separated by a 1-week washout period. Study participants were men aged ≥18 years withED for >6 months according to NIH criteria and risk factors for car-diovascular disease (diabetes mellitus, hypertension and/or hyper-lipidaemia). All participants also had to be in a stable, heterosexualrelationship (>6 months). The primary endpoint of the study was treat-ment preference. Fifteen diary questions were also answered during

PP-01-164

Results of the use of vardenafil in “non-demand”regimenVinarov, A.1; Akhvlediani, N.1

1Moscow Medical Academy, Dept. of Urology, Russia

Objective: Determination of the presence and persistence of a thera-peutic effect in patients with erectile dysfunction during prolonged andregular intake of phosphodiesterase-5 inhibitor—vardenafil in “non-demand” regimen.Methods: The Urology Clinic of Sechenov Moscow MedicalAcademy has conducted a study in which 32 patients aged 22–48 years(mean age 35.7 ± 6.8 years) participated. In the study there wereenrolled males with erectile dysfunction which was confirmed on ques-tioning using the International Index of Erectile Function (IIEF) scale.For 1 month the subjects daily received PDE-5 inhibitor—vardenafilat a dose 10 mg before going to bed in “non-demand” regimen.Repeated the IIEF scale questioning was conducted 1 and 2 monthsafter the beginning of the study. In addition, the results of penisDopplerography performed on indicated control days were correlated.Results: On analyzing the results of the IIEF scale questioning 1month after the beginning of vardenafil administration, a significantincrease of the index characterizing erection from 17.8 ± 4.5 to 23.7 ±5.3 scores (p < 0.01) was determined. Thirty days after PDE-5inhibitor therapy completion a significant decrease of the given param-eter up to 21.9 ± 5.6 (p < 0.01) was observed. At the same time, thedescribed value remained significantly better than the initial one (p <0.01). Similar dynamics was noted in respect of objective indices ofpenile hemodynamics. A peak systolic rate in the cavernous arteriesbefore treatment, as well as 1 and 2 months after the beginning of var-denafil administration, was 23.8 ± 4.7, 27.9 ± 4.9 and 26.2 ± 4.5 cm/s,respectively (p < 0.01).Conclusion: Daily administration of vardenafil in the “non-demand”regimen results in significant and relatively persistent improvement ofthe erectile function and arterial perfusion of the penis.


J Sex Med 2007;4(suppl 2):152–202

the study, including the Sexual Encounter Profile (SEP) questions 2and 3.Results: A total of 1,057 men were randomised to treatment. Of 12diary questions, 9 indicated a better response to vardenafil treatmentversus sildenafil (nominal significance, p < 0.05). These were: SEP2(LS mean positive response with vardenafil: 83.9%, compared with82.3% for sildenafil); SEP3 (74.4% vs 71.6%); satisfied with hardness’(55.7% vs 52.7%); satisfied with sexual experience (64.9% vs 61.0%);‘how hard was erection’ (LS mean score with vardenafil: 2.18, com-pared with 2.13 for sildenafil); ‘maintain erection’ (3.11 vs 3.02); ‘erec-tion stayed hard’ (3.33 vs 3.24); ‘satisfied with length’ (3.37 vs 3.27);and ‘satisfied with girth’ (3.36 vs 3.27). The remaining 3 questionsshowed a trend in favour of vardenafil (‘some erection’, ‘ejaculate’, and‘satisfied with sensitivity’).Conclusion: Diary-recorded outcomes demonstrated that vardenafilwas superior to sildenafil (nominal significance) in 9/12 questions,including SEP2 and SEP3, satisfaction with sexual experience, erec-tion hardness and maintenance of erection.Policy of full disclosure: Dr. Rubio-Aurioles is a speaker and consultant for Bayer Healthcare, Lilly ICOS LLC, and Johnson & Johnson/Janssen-Cilag and receives grant support from BayerHealthcare, Lilly ICOS, and Johnson & Johnson. Mr. Eardley and Prof. Porst are both speakers and consultants for Bayer Health-care, Pfizer, and Lilly ICOS. Dr. Goldstein is a lecturer and consult-ant for Bayer, Pfizer, Lilly ICOS, Auxillium, Mentor, and SurfaceLogix.

PP-01-167

In a clinical setting using VSS, men with ED mayachieve a second erection with vardenafilRosen, R.1; McMurray, J.2; Bangerter, K.3; Mazzu, A.41New England Research Institute, Clinical Research, Watertown, USA;2Medical Affiliated Research, Urology, Huntsville, AL, USA; 3Bayer Health-Care, Biometry, West Haven, USA; 4Bayer HealthCare, Clinical Pharma-cology, West Haven, USA

Objective: To investigate the ability of men with erectile dysfunction(ED) to achieve a second erection following initial ejaculation, upontreatment with vardenafil.Methods: Men with ED >6 months were randomised to receivedouble-blind treatment with vardenafil 10 mg, 20 mg or placebo.Study medication was administered in an office environment; 1 hourlater, recipients underwent visual sexual stimulation (VSS) with vibro-tactile stimulation (VTS) until ejaculation. There were four subse-quent 15-minute sessions of VSS, at 30 minutes and 1, 2 and 4 hourspost-ejaculation. Successful erection was defined as ≥55% rigidity for≥3 minutes as measured by RigiScan® (base of penis). This was a 2-stage pilot study; results from the subsequent at-home stage arereported independently.Results: 46 men participated (vardenafil 10 mg, n = 16; 20 mg, n = 14;placebo, n = 16). Following an initial erection and ejaculation, suc-cessful base erection was achieved upon VSS at 30 minutes post-ejaculation by 69% of men receiving vardenafil 10 mg, 79% of thosereceiving 20 mg and 31% of those receiving placebo. Considering allVSS sessions, mean total duration of penile base erection was 31.4minutes in the vardenafil 10 mg group, 42.7 minutes in the 20 mggroup, and 16.3 minutes for placebo.Conclusion: As detected by RigiScan, vardenafil 20 mg enabled 79%of men with ED to achieve a second erection within 45 minutes ofinitial erection and ejaculation. Vardenafil was associated with longerduration of erection than placebo during four post-ejaculation sessionsof VSS; a dose response was observed.Policy of full disclosure: Dr Rosen and Dr McMurray are bothspeakers and consultants for Bayer Healthcare, Pfizer, and Lilly ICOS. Dr Bangerter and Dr Mazzu are both employees of BayerHealthcare.

PP-01-168

Erection hardness correlates positively with score onthe quality of erection questionnaire (qeq): A double-blind, placebo-controlled multinational trial offlexible-dose Viagra® (Sildenafil Citrate)Depko, A.1; Kadlioglu, A.2; Grohmann, W.3; Levinson, I.4; Sun, F.4; Collins, S.4

1Warszawa, Poland; 2Istanbul Universitesi, Department of Urology, Capa,Istanbul, Turkey; 3Praxis, Munich, Germany; 4Pfizer Inc, New York, USA

Objective: The validated, easy-to-use, 6-item Quality of ErectionQuestionnaire (QEQ) solely, specifically, and comprehensively evalu-ates patient satisfaction with the quality of erections. To further vali-date the QEQ, correlations were sought with erection hardness in menbeing treated for erectile dysfunction (ED).Methods: At 25 European Union and South American centers, menwith ED, documented by a score of ≤25 on the Erectile Functiondomain of the International Index of Erectile Function, received flex-ible-dose Viagra (sildenafil citrate 25, 50, or 100 mg, PRN) for 6 weeksin a randomized, double-blind, placebo-controlled (DBPC) trial. Erec-tion hardness was graded by the patient at the occasion of sexual stim-ulation using the Erection Hardness Grading Scale and was assessedas the percentage of occasions with grade 3 (hard enough for penetra-tion but not completely hard) or grade 4 (completely hard) erections.The denominator was occasions of medication use.Results: Mean (range) age was 45 (18–55) years and ED duration was2 (< 1–21) years. At baseline, grade 3 or 4 erections were achieved on46% and 45% of occasions in men subsequently randomized toplacebo (n = 153) and Viagra (n = 154), respectively. This increased to57 ± 3% and 85 ± 3%, respectively, during DBPC treatment (P <0.0001 between groups, estimated as least squares [LS] means ± SEfrom an analysis of covariance model). QEQ scores (transformed ontoa 1–100 scale) were 37.3 and 33.6, respectively, at baseline, andincreased by 6.9 ± 2.2 and 41.1 ± 2.5 points (LS means ± SE), respec-tively, at the end of DBPC treatment (P < 0.0001). Change in erec-tion hardness correlated positively with change in QEQ score (Pearsoncorrelation coefficient = 0.57).Conclusion: Erection hardness increases in men treated with Viagrafor ED, and correlates positively with quality of erection assessed withthe QEQ.Policy of full disclosure: Pfizer, Inc Investigator.

PP-01-169

Improvement of erectile function and fertility withPrelox. A placebo-controlled, double-blind, cross-over studyStanislavov, R.1; Nikolova, V.1; Rohdewald, P.21Medical University Sofia, Obstetrics & Gynecology, Bulgaria; 2Universityof Münster, Pharmaceutical Chemistry, Germany

Objective: Aging of men is associated with decrease of sexual func-tions, which has a great impact on quality of life of men. Simultane-ously, quantity and quality of sperm production is fading. Open clinicaltrials have shown an enhancement of erectile function in 80% of menwith mild to moderate erectile dysfunction after combined treatmentwith L-arginine aspartate and Pycnogenol, whereas treatment with L-arginine aspartate alone had little effect. Previously infertile menshowed better results in seminological investigations after treatmentwith testosterone, L-arginine aspartate and Pycnogenol. To substanti-ate these findings, a controlled trial was initiated.Methods: In a randomized, placebo-controlled, double-blind, cross-over study with 50 men showing symptoms of mild to moderate erec-tile dysfunction, patients reported sexual function from diaries usingthe International Index of Erectile Function Questionnaire after treat-ment with Prelox, a combination of L-arginine aspartate and Pyc-nogenol (Maritime pine bark extract). Testosterone levels and activityof endothelial nitric oxide synthase were monitored and fertility statuswas evaluated after seminological analysis.


J Sex Med 2007;4(suppl 2):152–202

Results: Treatment with Prelox increased endothelial nitric oxide syn-thase activity in sperms and testosterone levels. Erectile function andsexual wellness were highly significantly improved. The seminologicalparameters indicated an enhanced quality of sperms. All patients com-pleted the study, no unwanted effects were reported.Conclusion: This controlled study confirmed previous findings fromopen clinical trials that Prelox improves erectile function and fertilityin patients with mild to moderate erectile dysfunction.Policy of full disclosure: Investigation was sponsored by HorphagResearch Ltd. UK.

PP-01-170

Efficacy of sildenafil still maintained after 3 years oftreatment despite a 2-month treatment pauseCarrier, S.1; Morales, A.2; Defoy, I.3

1McGill University, Department of Urology, Montreal, Canada; 2QueensUniversity, Centre for Advanced Urological, Kingston, Canada; 3Kirkland,Canada

Objective: To assess the efficacy of chronic use of sildenafil taken ona prn basis for 3 years, despite a 2-month wash-out period.Methods: Patients were eligible for this post-hoc analysis if they hadbeen initially randomized to sildenafil and had successfully completedthe series of open-label extensions leading to three years of sildenafiluse. A wash-out period occurred between the second and third yearextensions, for an average duration of 2 months. Efficacy was assessedusing the IIEF, event-log diaries, and the Erectile Distress Scale.Results: For all 225 patients, results were available at months 0, 3, 25(after the 2-month wash-out period) and 36. Scores for all IIEF ques-tions and domains were significantly improved after the initial 3months of treatment (p < 0.0001 for all IIEF questions and domains).At month 25, IIEF scores went down to near baseline values, but theefficacy of sildenafil was restored after an additional 12 months oftreatment, with IIEF scores returning to month 3 values. When strat-ified by ED severity at baseline, similar IIEF results were found, withthe exception of month 25 values being lower than baseline for all EDcategories except the severe one. A large proportion (46–73%, depend-ing on ED severity at baseline) of men returned to a normal IIEF-EFscore after 3 and 36 months of sildenafil treatment. A higher percent-age of men felt their erection problems were “none/a little of the time”a worry in their life at month 36. The proportion of successful inter-course attempts was increased at month 3 and was further improvedat month 36, going from 72% to 84%, respectively (p < 0.0001).Conclusion: Overall, the efficacy of sildenafil was maintained over 36months of treatment, despite a 2-month wash-out period.Policy of full disclosure: S. Carrier: Investigator and advisory boardmember of: Pfizer Canada, Eli Lilly Canada, Bayer Canada andJanssen-Ortho Canada.

PP-01-171

Sildenafil improves depressive symptoms of men withED and untreated depression not otherwise specifiedDugre, H.1; Kennedy, S.2; D’Angelo, P.3; Sunderland, M.3; Defoy, I.4

1Centre Hospitalier de l’Université, Hopital St-Luc, Montreal, Canada;2University Health Network, Department of Psychiatry, Toronto, Canada;3Pfizer Canada Inc, Medical Division, Kirkland, Canada; 4Kirkland,Canada

Objective: To assess the effect of sildenafil in men with ED anduntreated depressive symptoms meeting the DSM-IV criteria for dys-thymia or depression not otherwise specified, including minor depres-sive disorder but excluding any form of major depressive disorder orpsychotic disorder.Methods: This was a multi-centre, 6-week double-blind, randomized,placebo-controlled Canadian study in men with ED and baseline BDIII scores of 14 to 28. Erectile function was assessed using the IIEF, theGAQ, and event-log diaries; depressive symptoms using the BDI II;

and QoL using the Patient Reported Erectile Function Assessment(PREFA).Results: The ITT population consisted of 185 men. BDI II scores atbaseline were 18.3 for the placebo group and 18.0 for the sildenafilgroup, improving to 13.6 and 9.5 after 6 weeks of treatment, respec-tively (p = 0.0001). At baseline, mean score of the IIEF-EF was 11.8.At the end of the study, sildenafil-treated men had a mean IIEF-EFscore of 22.2 vs. 14.4 for placebo (p < 0.0001). All other IIEF domainsand questions were also significantly improved by sildenafil. The pro-portion of successful intercourse attempts at the end of the study was77% for the sildenafil group vs. 40% for the placebo group (p <0.0001). A large proportion (77%) of men found that sildenafilimproved their erections, as opposed to only 26% of those on placebo.At the end of the study, 70% of men found that sildenafil enabled themto obtain an erection that allowed them to engage in satisfactory sexualintercourse “most times” or “always/almost always”, vs. 30% forplacebo. QoL was also significantly improved by sildenafil (p < 0.0001vs. placebo).Conclusion: In this patient population, sildenafil was improveddepressive symptoms, erectile function, as well as QoL.Policy of full disclosure: H. Dugre: Consultant for: Bayer Canada,Eli Lilly Canada, Organon Canada, Pfizer Canada.

PP-01-172

Treatment satisfaction with sildenafil in a Canadianreal-life settingCarrier, S.1; Brock, G.2; Casey, R.3; Tarride, J.-E.4; D’Angelo, P.5; Elliott, S.6; Dugre, H.7; Rousseau, C.8; Defoy, I.9

1McGill University, Department of Urology, Montreal, Canada; 2St.Joseph’s Healthcare, Department of Urology, London, Canada; 3The MaleHealth Centres, The Male Health Centres, Oakville, Canada; 4McMasterUniversity, St. Joseph’s Hospital, Hamilton, Canada; 5Pfizer Canada Inc,Medical Division, Kirkland, Canada; 6Vancouver General Hospital, Centrefor Sexual Medicine, Canada; 7Centre Hospitalier de l’Université, HopitalSt-Luc, Montreal, Canada; 8Pfizer Canada Inc, Outcomes Research, Kirk-land, Canada; 9Kirkland, Canada

Objective: To examine the efficacy and treatment satisfaction withsildenafil in a real-life setting in Canada.Methods: This was a 6-month prospective study with sildenafil-naävemen with erectile dysfunction (ED). Data were collected throughpatient self-administered questionnaires, such as the SHIM and theEDITS.Results: The ITT population consisted of 2573 men from 231 sitesacross Canada. Mean age was 55 years. In approximately 50% of cases,sexual partners were involved in the men’s decision to consult a physi-cian for ED. At baseline, the mean SHIM score was 11.9, and was significantly improved to 18.0 after 3 months of sildenafil use (p <0.0001), with a further increase to 18.7 at month 6. 33% of patientshad a SHIM score above 21 (no ED) after 3 months of treatment withsildenafil and this proportion was maintained through month 6. TheSHIM scores were slightly higher in younger patients (50 years-old orless) at all time points. At months 3 and 6, 83% of patients were sat-isfied with their sildenafil treatment (EDITS ≥ 50). Satisfaction withsildenafil treatment (EDITS index) was influenced by ED severity (p< 0.0001) and age (p = 0.0031), but not by the involvement of the sexualpartner in the decision to consult for ED. At baseline, patients reportedan average of 2 sexual intercourse episodes over the past 2 weeks. After3 months of sildenafil use, this was significantly increased to a reported3 episodes over the past 2 weeks (p < 0.0001). On average, patientsreported using 2 sildenafil tablets over the past 2 weeks at both months3 and 6.Conclusion: Efficacy of sildenafil and patient satisfaction with silde-nafil treatment were demonstrated in a Canadian real-life setting. Satisfaction and efficacy were maintained through 6 months of use,suggesting no attenuation over time.Policy of full disclosure: S. Carrier: Investigator and advisory boardmember of: Pfizer Canada, Eli Lilly Canada, Bayer Canada andJanssen-Ortho Canada.


J Sex Med 2007;4(suppl 2):152–202

PP-01-173

Men with erectile dysfunction may achieve a seconderection with vardenafil, in a home settingRosen, R.1; McMurray, J.2; Bangerter, K.3; Mazzu, A.41New England Research Institute, Clinical Research, Watertown, USA;2Medical Affiliated Research Ce, Clinical Research, Huntsville, USA; 3BayerHealthCare, Biometry, West Haven, USA; 4Bayer HealthCare, ClinicalPharmacology, West Haven, USA

Objective: To investigate the ability of men with erectile dysfunction(ED) to achieve a second erection sufficient for intercourse followinginitial intercourse, upon treatment with vardenafil.Methods: Men with ED >6 months were randomised to receivedouble-blind treatment with vardenafil 10 mg, 20 mg or placebo. In a2-stage study, following an initial dose of study medication adminis-tered in an office environment (first stage), patients were given threedoses for use at home on separate days (second stage). In the homesetting, patients attempted a second erection and intercourse, follow-ing initial intercourse and ejaculation. Effect was recorded by diary,according to SEP2 and SEP3.Results: 46 men participated in this stage of the study (vardenafil 10 mg, n = 16; 20 mg, n = 14; placebo, n = 16). Initial intercourse andejaculation were completed by 91% of men in the vardenafil 10 mggroup, 98% in the vardenafil 20 mg group, and 73% in the placebogroup. SEP2 success was achieved within the following 6 hours on82%, 93% and 46% of attempts in the three groups, respectively. Cor-respondingly, SEP3 success rates were 74%, 83% and 34%. Drug-related adverse events were reported by 19% and 29% of men in thevardenafil 10 mg and 20 mg groups, and 6% in the placebo group. Noadverse events were considered serious or clinically significant.Conclusion: Vardenafil 20 mg enabled a second erection and secondintercourse in >80% of men with ED, within 6 hours of initial inter-course and ejaculation.Policy of full disclosure: Dr Rosen and Dr McMurray are bothspeakers and consultants for Bayer Healthcare, Pfizer, and Lilly ICOS.Dr Bangerter and Dr Mazzu are both employees of Bayer Healthcare.

PP-01-174

The in-vivo and in-vitro effects of vardenafil oncorpus cavernosal smooth muscle relaxation indiabetic rabbitsLau, D.1; Thompson, C.1; Mikhailidis, D.1; Mumtaz, F.21Royal Free Hospital, Clinical Biochemistry, London, United Kingdom;2Chase Farm Hospital, Urology, London, United Kingdom

Objective: Diabetes mellitus is associated with impaired cavernosalsmooth muscle relaxation (CSMR) due to diminished cGMP produc-tion. Vardenafil, a PDE type 5 inhibitor, enhances cGMP accumula-tion. The aim of this study was to assess the in-vivo and in-vitro effectsof Vardenafil on diabetic rabbit CSMR.Methods: Control and diabetic animals were given either acid water(n = 4 in each group) or vardenafil (3 mg/kg, n = 4 in each group) todrink for 4 weeks. CSMR were obtained in response to electrical fieldstimulation (EFS) (0.5–16 Hz) and sodium nitroprusside (SNP) (3 ×10–9–10–6 M), on pre-contracted tissue in the absence and presenceof vardenafil (10–8 M) in both groups.Results: SNP and EFS induced CSMR in diabetic rabbits given acidwater was significantly (ANOVA; P < 0.0001) impaired when com-pared with controls. The in-vitro addition of Vardenafil significantly(p < 0.0001) enhanced SNP and EFS induced CSMR in diabeticanimals given acid water. SNP and EFS induced CSMR in diabeticanimals given Vardenafil for 4 weeks was significantly (p = 0.0004)increased compared to diabetic rabbits given acid water. The in-vitroaddition of Vardenafil also significantly (p < 0.0001) enhanced theCSMR taken from diabetic animals given Vardenafil for 4 weeks.Conclusion: The present findings suggest that both in-vivo and in-vitro administration of Vardenafil enhances diabetic CSMR. Thesefindings further reinforce the use of Vardenafil for the treatment ofdiabetes induced erectile dysfunction.Policy of full disclosure: Study funded by Bayer.

PP-01-175

Effectiveness and patient satisfaction with 6 monthstadalafil treatment: Results from the DETECT studyVerheyden, B.1; Roumeguere, T.2; Bitton, A.3; Roos, E.4; Belger, M.5; Schmitt, H.61UZ Antwerpen, Urology, Edegem, Belgium; 2Erasme Hopital, Urology,Brussels, Belgium; 3Private Urological Practice, Geneva, Switzerland;4Antonius Hospital, Urology, Sneek, Netherlands; 5Eli Lilly, Statistics, ErlWood, United Kingdom; 6Eli Lilly, Brussels, Belgium

Objective: Objectives: To determine effectiveness of tadalafil andpatient satisfaction after 6 months treatmentMethods: Design and Methods: The DETECT study is a prospec-tive 12 months European multi-centre observational study in patientswith erectile dysfunction (ED) initiating or changing treatment totadalafil. 236 sites from 8 countries enrolled 1900 eligible patients.Data were available from 1716 patients (90%) and 1582 (83%) after 1and 6 months. A multivariate regression analysis showed differentbaseline patient characteristics were not associated with missing datacollection forms. 1406 (89%) patients at 6 months reported tadalafiluse. IIEF (at each visit) and EDITS questionnaire(after 1 and 6months) were analysed for these patients.Results: 1406 patients indicating tadalafil use at 6 months

Baseline 1 month 6 monthsMean IIEF EF score(sd) 14,0 (7.3) 24,0 (6.1) 24,9 (6,0) ED severity(IIEF EF score):x

—Severe (1–10) 25% 6% 4% —Moderate (11–16) 25% 6% 4% —Mild (17–25) 35% 39% 33% —Normal (26–30) 5% 50% 58%

Mean number of sexual attempts in last 4 weeks(sd) 5.0(4.2) 7.1(4.4)7.3(4.5) Total EDITS satisfaction score 81.0(14.8) 82.(16.0) Satisfac-tion(EDITS: very/somewhat satisfied) with: -Treatment overall 86%89% -Treatment met expectations 75% 80% -How quickly treatmentworks 87% 90% -How long treatment lasts 87% 89% -Confidence toengage 91% 91% in sexual activity -How satisfied is your partner 81%83% -Hardness of erections 60% 69% versus before EDConclusion: Conclusions: 89% of patients reported continued use oftadalafil after 6 months. There was high and continued improvementin effectiveness and satisfaction in these patients.Policy of full disclosure: this study has been performed under anunlimited grant of Eli Lilly.


J Sex Med 2007;4(suppl 2):152–202

PP-02 Risk Factors, Hormones and Epidemiology

PP-02-176

Effects of hyperbaric oxygen therapy (HOT) on totaltestosterone (TT) blood serum concentrationPassavanti, G.1; Pizzuti, V.1; Carlucci, M.2; Brauzzi, M.3; Tanasi, P.3;Pagni, R.3; Norgini, E.3; Paolini, R.1; Aloisi, A.21Misericordia Hospital, Urology, Grosseto, Italy; 2University of Siena, Phys-iology, Italy; 3Misericordia Hospital, HOT, Grosseto, Italy

Objective: Testosterone has modulating effects on inflammatory and healing processes. We tried to verify whether HOT could modifyTT blood serum concentration in patients treated for differentpathologies.Methods: 14 patients, age 23–72(av.46,62 yrs), were treated with 1 hr.session HOT at a rate of 4 to 23 sessions. Conditions included: 4leg fractures, 2leg compound fractures, 2osteonecroses, 3diabetic footlesions, 1firearm injury, 1complicated arthroprosthesis, 1skin-diverembolism. TT assay was carried out just before start of therapy andthe day after completion. We have evaluated TT blood serum con-centration in six health volunteers before and after 10 session HOT.Results: TT preHOT ranged between 1.65 and 8.44 ng/ml (3.54 +/−1.68) while TT post HOT ranged between 3.3 and 9.98 ng/ml (5.15+/− 1.93), resulting in a significantly different TT pre/post therapy(z:3.2). 12 patients fully recovered and 2(diabetic foot patients) showeda marked improvement. TT preHOT in volunteers ranged between5.18 and 6.04 (av.5.48 ng/ml), while TT postHOT ranged between 5.2and 8.22 (av.6.42 ng/ml) resulting in a slighty, but significantly differ-ent TT pre/post therapy (z:2.09).Conclusion: From the above data we could assume HOT increasesblood serum concentration of TT. Such fact opens new questions andthe need of further studies to investigate the causes of the increase andits therapeutic significance. It is well known how TT is a modulatorof phlogosis mediators and healing processes, it is therefore possiblethat its increased concentration is one of the mechanisms throughwhich HOT’s therapeutic effect can be explained. TT slighty increasesin volunteers easily because his production is very flexible; it can bespeculated that stress could trigger a marked reduction of TT inunhealthy controls. Consequently HOT therapeutic effect couldtrigger significant rise of TT production.

PP-02-177

Erectile dysfunction severity might be associated withpoor cardiovascular prognosis in diabetic menJusto, D.1; Uri, I.2; Arbel, Y.1; Swartzon, M.1; Galor, S.2; Heruti, R.3

1Sourasky Medical Center, Internal Medicine D, Tel-Aviv, Israel; 2IsraelDefense Force, Medical Corps, Tel-Aviv, Israel; 3Reuth Medical Center,Sexual Rehabilitation Clinic, Tel-Aviv, Israel

Objective: Although erectile dysfunction (ED) might be associatedwith coronary heart disease (CHD), there is no evidence it predictspoor cardiovascular prognosis. On the other hand, an abnormal heartrate profile during exercise stress testing predicts poor cardiovascularprognosis in high risk patients, such as diabetic men, even in theabsence of CHD. In order to study if ED predicts poor cardiovascu-lar prognostic in high risk patients, we examined the associationbetween ED severity, exercise capacity during exercise stress testing,and heart rate decrease after exercise stress testing in diabetic men withno CHD.Methods: A retrospective study. The medical charts of diabetic menwith vascular ED from a single sex clinic were reviewed, as well as themedical charts of body mass index- and age-matched diabetic menwithout ED going through routine check-ups. All men underwentroutine treadmill stress testing according to the Bruce protocol inorder to characterize heart rate profile during exercise. The SexualHealth Inventory for Men questionnaire (SHIM) was used to charac-terize ED.Results: Included were 18 diabetic men with ED (SHIM scores 5–20)and 18 diabetic men without ED (SHIM scores 22–25), 40 years of

age or older. None of the men had signs of coronary insufficiencyduring exercise treadmill stress testing. Although the two groups didnot statistically differ with respect to the mean age, the mean bodymass index, the prevalence of cardiovascular risk factors, and the meanexercise treadmill stress testing findings, the SHIM questionnairescores were significantly associated with low metabolic equivalents (r= 0.51, p = 0.03) and delayed heart rate recovery during the first twominutes after exercise (r = 0.55, p = 0.018) only among the diabeticmen with ED.Conclusion: ED severity might be associated with poor cardiovascu-lar prognosis in adult diabetic men with no CHD.

PP-02-178

The prevalence of erectile dysfunction and its riskfactors among nearly 10,000 men ages 25–55 yearsJusto, D.1; Shochat, T.2; Galor, S.2; Heruti, R.3

1Sourasky Medical Center, Internal Medicine D, Tel-Aviv, Israel; 2IsraelDefense Force, Medical Corps, Tel-Aviv, Israel; 3Reuth Medical Center,Sexual Rehabilitation Clinic, Tel-Aviv, Israel

Objective: Although the prevalence of erectile dysfunction (ED) andits risk factors in middle-aged and elderly men is well studied, theprevalence of ED and its risk factors in younger men varies greatlyfrom one small-scale study to another. We investigated the prevalenceof ED and its risk factors in nearly 10,000 men ages 25–55 years.Methods: All the military personnel in the Israel Defense Force gothrough routine health check-ups at the Staff Periodic ExaminationCenter (SPEC) every 3–5 years. The Sexual Health Inventory for Menquestionnaire (SHIM) was introduced to these men in order to detectED.Results: During 2001–2005, an overall of 19,131 men, ages 34.0 ± 7.1years, went through routine health check-ups at the SPEC. More thanhalf of these men (n = 9956, 52%) completed the SHIM questionnaire.There was no significant difference between men who completed theSHIM questionnaire and men who did not in terms of mean age, meanbody mass index, education level, and the prevalence of cardiovascu-lar risk factors. One man out of four (25.2%) suffered from ED (SHIMquestionnaire scores ≤21). The prevalence of ED was 21.8% amongmen ages ≤40 years. The prevalence of ED was associated with age (p< 0.0001). The prevalence of ED was higher among diabetic men com-pared with non-diabetic men (p < 0.0001).Conclusion: ED is prevalent among men ages 25–55 years, and evenamong men ages 25–40 years. Early diabetes mellitus might be asso-ciated with ED. Screening for ED is feasible in the setting of routinehealth check-ups.

PP-02-179

The effect of coronary artery bypass surgery onerectile function and related quality of lifeHotston, M.1; Jones, R.1; Angelini, G.2; Jeremy, J.2; Persad, R.1

1Bristol Royal Infirmary, Urology, United Kingdom; 2Bristol Royal Infir-mary, Bristol Heart Institute, United Kingdom

Objective: Ischaemic heart disease (IHD) and erectile dysfunction(ED) commonly coexist due to their shared aetiology. The effect ofcoronary revascularisation on erectile function however remains unre-ported. This study aimed to measure erectile function and the rela-tionship between ED and quality of life (QoL) before and aftercoronary artery bypass graft (CABG) surgery. Patient expectations onthe impact of surgery, perceptions of safety, exposure to medical advice,were investigated.Methods: Male patients undergoing CABG surgery completed thefollowing questionnaires before and 3 months after surgery (n = 132pre-CABG, n = 92 post-CABG): SF36 Health Survey, Seattle AnginaQuestionnaire (SAQ), International Index of Erectile Function (IIEF),specific questionnaire on safety, advice, expectations.Results: Erectile function, along with angina-specific and globalquality of life (QOL), scores improved following surgery (p < 0.05).


J Sex Med 2007;4(suppl 2):152–202

The number of patients reporting sexual activity increased (55% to69%, p < 0.05). Physical factors previously limiting sex life, particu-larly IHD symptoms, reduced post-operatively (22% to 4%, p <0.061). ED affected all patients’ QoL, less severely postoperatively.63% expected that CABG surgery would improve erection quality, but17% felt that this occurred postoperatively. 40% preoperativelybelieved intercourse was safe (37% were unsure), while most were reas-sured postoperatively. A significant proportion of patients (37% pre-op, 59% post-op) felt medical advice regarding sexual activity wasinadequate. 46% before and 63% following surgery were interested inreceiving ED therapy.Conclusion: ED is common in patients undergoing CABG surgery.However, coronary revascularisation leads to an improvement in sexualactivity, erectile function and ED-related quality of life in a significantproportion of men. Patients have high unrealistic expectations on theeffects of surgery on their symptoms, leading to inevitable disappoint-ment. Uncertainty on safety of intercourse preoperatively and discon-tent with medical advice related to sexual activity are apparent. Morethorough counselling on these issues is therefore advised.

PP-02-180

Early rehabilitation and nerve sparing cystectomy. Is there any value?Hekal, E.1; Mesbah, A.1; El-Bahnasawy, M.1; El-Assmy, A.1; Abdel-Latif, M.1; Shaaban, A.1

1Urology and Nephrology Center, Urology, Mansoura, Egypt

Objective: assess the value of early rehabilitation in postNS radicalcystectomy patients, evaluating by IIEFquestionnaire&penile Dopplerultrasound.Methods: prospective study between March 2003 and March 2005 wascarried out, the study included 21 potent males with organ confinedbladder cancer who were managed by NS radical cystectomy& dive-sion in Mansoura center. All patients were encouraged to resumesexual activity as early as the first two postoperative months. On fol-lowup the patients were classified according to their compliant to ourinstructions into:early rehabilitation group: those who retained spon-taneous postoperative EF successfully or who used an erectogenic aidto resume their sexual activity early. Late rehabilitation group noncompliant patients, who missed follow up and came reporting no sexualactivity in the first6 months. After the first month the EF state of thepatients was assessed provisionally as: Complete regain of spontaneousEF, mild tumescence unsatisfactory to intercourse or complete loss ofEF. The latter two groups were given (PDE-5 I;50 mg) on demandbasis, to be increased to 100 mg after failed 50 mg response. Total 8doses were tried before considering its failure and shift to intracorpo-real PGE 1 injection.12 cases of them were early rehabilitated&9 caseswith late rehabilitation. The preoperative IIEF domains&duplex ultra-sound were assessed, the patients were followedup 2,6,12 months reg-ularly regarding the same parameters.Results: preoperative IIEF were assessed and compared with postop-erative scoring. The EF and overall domains had improving figureswith a significant value than other parameters regarding the followupperiod. Corresponding Doppler findings were comparable in PSValong the course of followup, while the EDV was significantly improv-ing along the time of followup, which was more evident at 12 monthsof the surgery in early rehabilitation group.Conclusion: Early rehabilitation provides good, rapid recovery of EFin patients were managed by NS radical cystectomy

PP-02-181

The realtionship between chronic obstructivepulmonary disease and erectile dysfunction: A comparative studyUsta, M. F.1; Ozbudak, O.2; Cilli, A.2; Guntekin, E.1; Koksal, T.1; Ozdemir, T.21Akdeniz University, Urology, Antalya, Turkey; 2Akdeniz University, Pul-monary Disease, Antalya, Turkey

Objective: Chronic obstructive pulmonary disease (COPD) is a com-monly encountered chronic disease. Although there are some infor-mation about the association between COPD and erectile dysfunction(ED), comparative studies investigating the exact relationship betweenCOPD and ED are lacking. In the present study we investigated therelationship between COPD and ED and assessed if the severity ofCOPD had en impact on erectile function.Methods: A total of 41 consecutive patients with COPD (Group-1)and 27 consecutive healthy volunteers (Group-2) were included in thatprospective, comparative study. All patients underwent routine physi-cal examination and pulmonary assessment with spirometry parame-ters and completed the 5-item version of the International Index ofErectile Function (IIEF-5). Additionally, COPD patients were alsoevaluated with arterial blood sampling and the severity of COPD wasclassified using the Global Initiative for Chronic Obstructive LungDisease criteriaResults: Mean patient age was 65 ± 8.2 and 49 ± 7 for group-1 andgroup-2, respectively (p < 0.05). No patient in the study groups hadany co-morbidity (except than smoking) related to ED. IIEF-5 scoreswere significantly lower in group-1 than in group-2 (p < 0.05). Fur-thermore statistical analyses showed that there was a strong correla-tion between COPD and ED severity for group-1 (p < 0.05).Conclusion: It has previously been reported that there is a possiblerelationship between ED and COPD. However, that relationshipremains still obscure. This comparative study broader our under-standing about the association between COPD and ED and suggestthat and erectile function should assessed in all patients with COPD.

PP-02-182

ED: A cue for wider health risk assessments?Hurn, W.1; Rutherford, D.2; Etherington, R.3; Aslet, P.4; Griffiths, V.5

1Bristol Royal Infirmary, Urology, United Kingdom; 2Ayr Hospital, Urology,United Kingdom; 3Royal United Hospital, Urology, Bath, United Kingdom;4North Hampshire Hospital, Urology, Basingstoke, United Kingdom; 5City Hospital, G U Medicine, Nottingham, United Kingdom

Objective: 1 To examine random serum total-cholesterol levels in menreferred from primary to secondary care specialist clinics for assess-ment of erectile dysfunction (ED) 2 To identify potential risk of hyperlipidaemia.Methods: This was a multicentre, prospective, observational pilotstudy conducted between March and May 2005, of men followingGeneral Practitioner (GP) referral for assessment of ED. Men previ-ously diagnosed with hyperlipidaemia, or those with exposure to lipidlowering drugs were excluded. All others were offered caplliary sam-pling for serum total-cholesterol, using the Roach Accutrend GCmonitor. Validated audit forms were completed for all new patientsreferred to the five UK centres participating. Patients with a total-cholosterol level >5.2 mmol/L (1) were referred back to their GP forfasting lipid analysis prior to receiving treatment for ED.Results: * 195 patients (21–79 years) consented to total-cholsterolsampling and met the study criteria * Mean total-cholesterol value was5.15 mmol/L (2.6–9.9 + 0.11 SEM) * 94 patients (48%) had a highertotal-cholesterol level than recommended national treatable levels (1)* 54/94 (57.5%) had not consulted their GP for any other conditionin the last 12 months.Conclusion: Our initial findings across 5 centres, indicate almost halfof those presenting with ED have a previously unidentified risk factor.Given this surprising observation, we believe this is a missed oppor-tunity to identify a treatable risk factor at an early stage. Accordingly,inclusion of cholesterol screening in UK national guidelines for ED(2) may be helpful in this respect, and would provide consistency withcurrent EuropeanAssociation of Urology (EAU) guidelines (3).


J Sex Med 2007;4(suppl 2):152–202

PP-02-183

Preliminary results of post radical prostatectomy(PRP) penile lengthVlachiotis, J.1; Petsis, D.2; Perlepes, G.3; Spiliopoulos, K.2; Tsidavis, A.2

1Ekali—Athens, Greece; 2Metaxa Cancer Hospital, Urology, Pireaus, Greece;3Metaxa, Urology, Pireaus, Greece

Objective: 45 men, 50–75 y.o., who underwent nerve sparing RP wereincluded in the study. The aim of our study was to evaluate the penileshortening PPR and the time that it happened.Methods: We measured the penile length at flaccid status (from pubisto corona sulcus) preoperatively and 18 days postop. 3,6,9,12 monthspostoperatively.Results: We noticed a continue 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 and the mechanism is theurethra shortening after the operation or denervation fibrosis one yearafter the operation. We have to informed our patients for a possibilityof penile shortening after a RP.

PP-02-184

Sexual function in rats with testicular dysgenesisKarakitsios, K.1; Kawamura, H.1; Pardalidis, N.1; Grameniatis, E.1; Baltogiannis, D.1; Sofikitis, N.1

1Ioannina University, Urology, Greece

Objective: We evaluated the sexual function of rats with testicular dysgenesis (TD).Methods: A model of TD was created in male newborn Wistar ratsby administering phthalates to pregnant female Wistar rats from the13th gestational day up to the day of birth. The sexual function wasevaluated in a group of 20 TD-rats (group A; 3-month-old) and agroup of same age control rats (group B; n = 20). We assessed for eachmale rat the ejaculatory latency (EL; period necessary for the occur-rence of the first ejaculation in a mating test with a female rat in estrus),the post ejaculatory interval (PEI; period from the first ejaculation tothe next intromission), and the numbers of erections and yawns afterstimulation of the male rat with apomorphine.Results: The numbers of erections and yawns were statistically signifi-cant larger in group B than in group A. The EL and the PEI were sig-nificantly shorter in group B than in group A. Peripheral serumtestosterone levels were significantly smaller in group A than in group B.Conclusion: Rats with TD due to exposure to a toxicological agentduring endometrial life demonstrate sexual dysfunction probably dueto their lower peripheral testosterone levels.

PP-02-185

The padam and expression of genes of severalproliferation factorsPechersky, A.1; Loran, O.2; Pechersky, V.3; Vonsky, M.4; Mittenberg, A.4;Semiglazov, V.51St. Petersburg Medical Academy, Department of Surgery, St. Petersburg,Russia; 2Medical Academy of Post-Gradua, Urology, Moscow, Russia;3Academy of Physical Education, Problem Laboratory, St. Petersburg, Russia;4Institute of Cytology, Sector of Biomedical Technolog, St. Petersburg, Russia; 5Research Institute of Oncology, Director, St. Petersburg, Russia

Objective: The likelihood of the development of oncological pathol-ogy increases significantly among men after 40 years of age (Napalkov,1989); from this period men have less testosterone circulating in theirblood. This phenomenon is called Partial Androgen Deficiency ofAgeing Men (PADAM) (Gray et al., 1991). The reduction in the testos-terone level leads to increased mitotic activity, a breakdown in the reg-ulation of the cell cycle, and also inhibits the beginning of apoptosis(Pechersky et al., 2003).

Methods: In this study 12 patients with partial androgen deficiencywere analyzed. The age of these patients ranged from 56 to 72 yearsold. The patients were given 40 mg of andriol (testosterone unde-canoate) once each morning. All patients were put into one group, forwhich the research results were compared before and one month afterthe beginning of androgen-replacement therapy.Results: A month after the beginning of androgen-replacementtherapy the patients showed a decreased expression of bFGF genes (onaverage by 4.9 times), ER (on average by 11.5 times), bcl-2 (on averageby 4.5 times) and an increased expression of the insulin gene (onaverage by 26 times) as compared with the original values before thestudy began.Conclusion: Normalization of testosterone production by usingandrogen-replacement therapy leads to a decrease in proliferativeactivity, to the restoration of regulation of the cell cycle, and to a reduc-tion in insulin resistance among men of older age groups.

PP-02-186

The padam and regulation of the pulse mode ofincretion of some hormonesPechersky, A.1; Semiglazov, V.2; Loran, O.3; Karpischenko, A.4; Pechersky, V.5; Mazurov, V.6

1St. Petersburg Medical Academy, Department of Surgery, St. Petersburg,Russia; 2Research Institute of Oncology, Director, St. Petersburg, Russia;3Medical Academy of Post-Gradua, Urology, St. Petersburg, Russia; 4Military Medical Academy, Clinical Biochemistry, St. Petersburg, Russia;5Academy of Physical Education, Problem Laboratory, St. Petersburg, Russia;6Medical Academy of Post-Gradua, Therapy, St. Petersburg, Russia

Objective: After 40 years of age, men have a reduction in the amountof testosterone circulating in their blood. The mechanisms of hypo-thalamic-pituitary regulation are broken down, including the mecha-nisms for the pulse mode of incretion.Methods: In this study 9 patients with partial androgen deficiencywere analyzed. The age of these patients ranged from 42 to 74 yearsold. The patients were given 40 mg of andriol (testosterone unde-canoate) once each morning. All patients were put into one group, forwhich the research results were compared before and one month afterthe beginning of androgen-replacement therapy. In order to make thediagnoses of the breakdown in the rhythm of incretion, levels of LH,FSH, and STH, as well as of testosterone, cortisol, and insulin weremeasured by taking five samples from the serum. The samples weretaken once every 20 minutes (in a period of time that covered the wholeaverage period of their impulse incretion).Results: A month after the beginning of androgen-replacementtherapy the patients showed an increase in the amplitude of fluctua-tions of LH (on average by 52.2%), FSH (on average by 126.7%),STH (on average by 81.0%), testosterone (on average by 69.0%), cor-tisol (on average by 45.5%) and insulin (on average by 76.2%) as com-pared with the original values before the study began (relative toaverage values).Conclusion: The reduction in testosterone production as men getolder leads to a change from a pulse mode to a tonic mode of incre-tion of a number of hormones, as well as to a breakdown in the regu-lation of the cell cycle and an increase in mitotic activity. The inversedevelopment of these changes can be seen among men of older agegroups with PADAM who have been given androgen-replacementtherapy.

PP-02-187

Correlation of aortic stiffness with severity of erectile dysfunctionIoakimidis, N.1; Vlachopoulos, C.1; Rokkas, K.1; Tsokanis, A.1; Alexopoulos, N.1; Fassoulakis, C.1; Askitis, A.1; Stefanadis, C.11Hippokration Hospital, 1st Department of Cardiology, Athens, Greece

Objective: Accumulating evidence suggests that erectile dysfunction(ED) may be an early manifestation of generalized vascular disease.Aortic stiffness is an independent marker and prognosticator of car-


J Sex Med 2007;4(suppl 2):152–202

diovascular risk. The association of aortic stiffness with severity of EDhas not been defined.Methods: A total of 173 men (mean age 59 ± 9 yrs) affected by non-psychogenic and non-hormonal erectile dysfunction for more than 6months were studied. All participants were invited to complete a 5-item form of the International Index of Erectile Function (SHIM-5)which is a validated and widely applied method for the evaluation ofED. Carotid-femoral pulse wave velocity (PWV) was measured as anindex of aortic stiffness using an automated non-invasive device (Com-plior®). Higher values of carotid-femoral PWV indicate stiffer aortaand vice versa.Results: There was a stepwise increase in carotid-femoral PWV frommild ED (SHIM-5 score 17–21), to mild-moderate (11–16) and mod-erate ED (8–10) and to severe ED (7 or less), (p < 0.001, figure). Inunivariate analysis, a negative correlation between carotid-femoralPWV and SHIM-5 score was observed (r = −0.37, p < 0.001). More-over, in a separate backward elimination multiple regression model,carotid-femoral PWV was significantly associated with SHIM-5 score(b = −0.223, P = 0.006), after controlling for age, body-mass index,mean pressure, total cholesterol, triglycerides, C-reactive protein,hypertension, diabetes, intensity of smoking (pack-years), antihyper-tensive agents and statines (adjusted R2 of model: 0.41).Conclusion: ED is associated with impaired aortic elastic properties.This finding provides further evidence for the potential link betweenED and cardiovascular risk.

Results: Bladder weight was significantly higher in PBOO groupsthan control and sham-operated rabbits (figure 1). Contractionresponses induced by KCl and phenylephrine were significantlyenhanced in both sham-operated and PBOO groups than controls(figure 2 and 3). However, there has been no statistically significantdifference in all KCl, phenylephrine and doxazosin responses betweensham-operated and PBOO groups in both 2- and 4-week duration.Conclusion: Rabbit model of PBOO, described for the studies thatexamining the bladder responses is useful for creating bladder outletobstruction. However, this model is not suitable for the investigationof outlet obstruction-related erectile dysfunction. * Chang, S., Hypo-lite, J. A., Zderic, S. A., Wein, A. J., Chacko, S., DiSanto, M. E.:Enhanced force generation by corpus cavernosum smooth muscle inrabbits with partial bladder outlet obstruction. J Urol; 167: 2636, 2002.

PP-02-188

Contraction and relaxation response of rabbit corpuscavernosum to partial bladder outlet obstruction: A direct comparison of 2- and 4-weekDemir, O.1; Esen, E. C.2; Murat, N.3; Aslan, G.1; Gidener, S.4

1Dokuz Eylul University, Urology, Izmir, Turkey; 2I.zmir Science High

School, Science, Turkey; 3Dokuz Eylul University, Advanced ProfessionalSchool, I

.zmir, Turkey; 4Dokuz Eylul University, Pharmacology, I

.zmir,

Turkey

Objective: It has been well established that erectile dysfunction is acommon incident in patients with benign prostate hyperplasia. Animalmodels have been described to investigate the relationship betweenbladder obstruction and erectile dysfunction.* In order to examine ifpartial bladder outlet obstruction (PBOO) induces any change in thecontraction and relaxation response of corpus cavernosum smoothmuscle (CCSM) of the penis in the rabbit model.Methods: Partial bladder obstruction was produced in rabbits as pre-viously described.* After 2 and 4 weeks follow up, control, sham-oper-ated (2- and 4-week duration) and partial bladder outlet obstructed (2-and 4-week obstruction duration) rabbits were sacrificed and theirbladder weight was determined. Then CCSM tissue was obtained.Contraction responses induced by 124 mM KCl, phenylephrine (10–6to 10–4 mM) and relaxation responses induced by doxazosin (10–7 to10–5) of CCSM of rabbits were determined. The obtained contractionand relaxation responses of all groups were compared.


J Sex Med 2007;4(suppl 2):152–202

PP-02-189

Patient preferences in treatment of erectiledysfunction after cryoablation of prostate for prostate cancerLobik, L.1; Hassan, M.2; Shumalinsky, D.2; Kesari, D.2; Paz, A.2; Kravchick, S.2; Cytron, S.21Rehovot, Israel; 2Barzilai Medical Center, Urology, Ashkelon, Israel

Objective: Erectile dysfunction (ED) is a major side effect ofcryosurgery for prostate cancer. ED is still a main factor affectedquality of life (QOL) of these patients. We evaluated patient prefer-ences of different modalities for the treatment of ED after cryoabla-tion of prostate.Methods: 70 patients underwent 72 cryoablation procedures between2001 and 2005. 63 patients chose this form of therapy as primary treat-ment and 7 patients underwent salvage procedure after failed radio-therapy. 24 patients (34%) received androgen deprivation at least 3month before cryosurgery. Sexual function before and after the treat-ment was evaluated by simple questionnaires. Patient’s preferences ofdifferent modalities for ED treatment were evaluated.Results: Mean follow up was 23 months (6–55). 34 patients (48%)were potent and sexually active before treatment. All of the patientswere impotent after the treatment. 53 patients (45 potent and 8 impo-tent before treatment) were interested in sexual rehabilitation. No oneof them has continued hormonal therapy after the procedure. Sponta-neous partial erections were reported by 7 patients, although only twoof them had erection sufficient for intercourse. The initial choice inthe majority of patients (44 of 53, 83%) were phosphodiesterase type5 (PDE 5) inhibitors, however drop out rate in this group was 80%during the 6 months because of the lack of effectivity. Intracavernousinjections were chosen initially by only 5 patients, but finally 41patients (77%) have continued this method. Vacuum-pump device was chosen by 4 patients, no one have continued the usage of vacuummore than 4 months. 3 (6%) patients underwent insertion of penileprosthesis.Conclusion: Intracavernous injections of vasoactive drugs is prefer-able treatment option in patients with ED after cryoablation ofprostate. Patient’s education before and during the treatment encour-ages them to choose ED treatment, including those who were impo-tent before treatment.

PP-02-190

Erectile dysfunction obesity and metabolicsyndrome—A multicenter studyGekas, A.1; Konstantinidis, C.2; Kartsaklis, P.1; Palaiodimos, I.1;Andreadakis, S.1; Kalogeropoulos, N.1; Baltogiannis, D.3; Sofikitis, N.3

1General Hospital of Patras, Urology Department, Greece; 2National Insti-tution of Rehabil., Urology Department, Athens, Greece; 3University Hospi-tal of Ioannina, Urology Department, Ioannina, Greece

Objective: Erectile dysfunction (ED) is the inability of a man to attainand/or to maintain a penile erection sufficient for sexual activity. Thepresence of metabolic syndrome (MS) is defined as 3 of the followingcriteria are present: 1) the waist circumference greater than 102 cm, 2)the fasting blood glucose greater than 110 mg/dL, 3) the systolic bloodpressure greater than 130 mmHg and diastolic pressure greater than85 mmHg, 4) the serum TG levels greater than 150 mg/dL and 5) theHDL cholesterol levels less than 40 mg/dL. Our aim is to investigatethe prevalence of MS in obese patients with ED.Methods: A retrospective study was performed between April2004–April 2006. The elective criteria were: 1) the presence of organicED diagnosed and investigated with the Triplex of corpora cavernosausing vasoactive drug injection and evaluated by the IIEF-5 question-naire, 2) obesity (BMI ≥30 kg/m2) and 3) the absence of previous pelvictrauma or operation. There were 74 men matching with the criteriaabove. Their age was 42–67 years old (mean age 55.2 years). Therewere blood tests and blood pressure measurements in all the patients.Results: Metabolic Syndrome was detected in 68 (91.9%) of the 74patients of our study group. Waist circumference was higher than 102

cm in all patients. The blood glucose was >110 mg/dL in 66 (89.2%)patients. Hypertension was detected in 64 patients (86.5%). Therewere high levels of serum TG (≥150 mg/dL) in 60 patients (81.1%).The HDL cholesterol levels were <40 mg/dL in 64 patients (86.5%).Conclusion: The prevalence of MS in obese patients with organic EDis very high. Apart from that the components of MS are already wellknown risk factors for ED.

PP-02-191

Premature ejaculation treated with sildenafil. A multicenter studyAndreadakis, S.1; Konstantinidis, C.2; Kartsaklis, P.1; Palaiodimos, I.1;Gekas, A.1; Delakas, D.3

1General Hospital of Patras, Urology Department, Greece; 2National Insti-tution of Rehabil., Urology Department, Athens, Greece; 3General Hospital“Asclepio”, Urology Department, Athens, Greece

Objective: Premature ejaculation (PE) is the most common form ofmale sexual dysfunction, with an estimated prevalence of up to 40%.For the treatment, SSRI’s are extensively used, which have moderateefficacy, relatively more side effects and high recurrence rate, whenphosphodiesterase type V (sildenafil) seem to have good efficacy andfew side-effects. The aim was to evaluate the efficacy of sildenafil toincrease the time to ejaculation and to improve the overall sexual sat-isfaction with regard to improving ejaculatory control, and decreasingthe post ejaculatory erectile refractory time in men with PE.Methods: From September 2004 until June 2006, 29 men, 22–54 yearsold with diagnosed primary PE entered the study. They all had life-time PE, intravaginal ejaculatory latency time (IELT) <1 min, normalStamey-Mears test and no erectile dysfunction. The evaluation wasperformed by measuring the IELT and responses to the Index of Pre-mature Ejaculation (IPE) questionnaire. The IELT was assessed bystop watch method. The duration of the treatment was 8 weeks, withrecommendation for having sexual contact at least 2 times/week. Silde-nafil dose was 50 mg taken 60 minutes before intercourse.Results: The IELT was 0.75 +/− 0.24 minutes before treatment, and3.63 +/− 0.55 minutes after treatment. Regarding sexual satisfaction,patients reported improved overall sexual satisfaction scores (3.1 +/−0.2 vs. 2.4 +/− 0.2) on the IPE, increased ejaculatory control (2.1 +/−0.3 vs. 1.2 +/− 0.2), and had a decreased postejaculatory erectile refrac-tory time (3.2 +/− 0.7 vs. 9.7 +/− 2.8 minutes).Conclusion: During our clinical trial, the treatment with sildenafilappears to prolong IELT in men with primary premature ejaculation.Sildenafil seemed to increase the perception of ejaculatory control, andoverall sexual satisfaction.

PP-02-192

Microvascular complications and diabetic neuropathyare more important risk factors for diabetic erectiledysfunction, than macrovascular disturbancesKamenov, Z.1; Christov, V.1; Yankova, T.11Clinic of Endocrinology, Medical University, Sofia, Bulgaria

Objective: Macro- and microvascular pathogenic diabetic factors con-tribute to the higher prevalence and severity of erectile dysfunction(ED) in diabetic men. The aim of the study was to evaluate the impor-tance of macro- and microangiopathic diabetic complications as riskfactors for ED.Methods: In this cross-sectional study were included 150 consecutivediabetic men with mean age ±SD 53.0 ± 12.5 years, DM 1/2 = 39/111and diabetes duration of 4.9 ± 3.8 years. Data from the clinical recordsabout macroangiopathy: arterial hypertension (AH), coronary artery-and cerebral vascular disease (CAD/CVD), dyslipidemia and microan-giopathy: nephropathy, retinopathy, symptoms and set diagnosis ofdiabetic neuropathy (DN) was analyzed. ED was diagnosed with aquestionnaire, based on the answer to the question about having erec-tile problems.Results: ED was present in 44.7% of men with significant depend-ence on age and DM duration. The prevalence of AH (p < 0.05) and


J Sex Med 2007;4(suppl 2):152–202

CAD/CVD (p < 0.05) was higher in the ED-group, but the differencesin nephropathy (p < 0.01), retinopathy (p < 0.001), presence of symp-toms (p < 0.001) or set diagnosis (p < 0.001) DN were more signifi-cant. After adjustment for age, only the duration of diabetes OR(CI;p)—1.054 (1.010–1.099; p < 0.05), retinopathy—5.512(2.469–12.305; p < 0.001), symptoms of DN—2.428 (1.138–5.179; p< 0.05) and diagnosis of DN—2.805 (1.406–5.597; p < 0.01) remainedas risk factors for ED. Vice versa the presence of ED increased the riskof having these microangiopathic complications.Conclusion: Microvascular complications and DN are more impor-tant risk factors for ED than macrovascular disturbances in diabetes.Diabetic ED is a special entity, where DN plays most important patho-genetic role.

PP-02-193

Combined reporting of functional and oncologicalresults following open radical prostatectomy using the‘Salomon-score’Joniau, S.1; Albersen, M.2; van Poppel, H.1

1University hospitals Leuven, Urology, Belgium; 2Antwerpen, Belgium

Objective: Since functional outcome becomes more important to(increasingly younger) patients, we think combined oncologic andfunctional reporting is valuable in the comparison of outcome of RRPbetween various centres. In 2003, Salomon et al. proposed a scoringsystem to jointly report cancer control and functional results follow-ing RRP. We aimed to evaluate the use of this scoring system in ourown experience.Methods: Between January 2001 and November 2004, 272 patientsunderwerwent nerve-sparing (NS) RRP at our institution; 45% uni-lateral or partial-bilateral, and 55% bilateral nerve-sparing. Eachpatient was attributed 0 or 4 points for the presence or absence of bio-chemical progression (PSA > 0.2 ng/ml), 0 or 2 points for the presenceor absence of urinary incontinence (any use of pads) and 0 or 1 pointfor the presence or absence of impotence (no erections firm enoughfor penetration). The sum of these points provides the Salomon-score.We compared the scores of our own institution to those published bySalomon et al.Results: The response rate was 71.7%. Patients reporting preopera-tive ED or incontinence were excluded; leaving 176 patients in thefinal analysis. Mean age was 59.45 years. At a minimum of 18 monthspostoperatively, 41% of patients were potent, 87% of patients reportedno pad use. Seven patients experienced biochemical progression.Salomon-scores are shown in the Table.Conclusion: This study is the first to evaluate the Salomon-score inreporting combined oncological and functional outcome after RRP. Itprovides an excellent way to present outcome of NS-RRP and facili-tates comparison of outcomes between various centres.

Methods: From September 2004 to April 2006, we evaluated 112 men(aged 34 to 78 years) in whom 2 months of PDE-5 Inhibitors therapyat the maximal recommended dose with at least four attempts at inter-course during the 2-month period had failed. Total testosterone levelswere measured at baseline and after 3 months. To assess sexual function:medical history, IIEF questionnaire, several general assessment ques-tions and a questionnaire completed by the patients’ partner were used.Results: Mean testosterone levels were observed to increase frombaseline to study end. The assessment after week 12 showed anincrease of the mean values of all the four domains of IIEF. Accord-ing to several general assessment questions, satisfaction and confidenceimproved. Partners found that erectile capacity had greatly improvedfrom baseline to study end. No adverse effects have been observed.There was no correlation between these results and the testosteronelevels at baseline.Conclusion: The result of this study supports the use of testosteronewith PDE-5 Inhibitors in men with low-normal and even normalserum testosterone levels in whom PDE-5 Inhibitors alone fail. Wesuggest that every man, who is not totally satisfied with PDE-5 treat-ment, could get a benefit out of a temporary adjuvant therapy withtestosterone.

PP-02-195

A comparison of NCEP-ATP-III and IDF metabolicsyndrome definitions with relation to metabolicsyndrome associated sexual dysfunctionCorona, G.1; Mannucci, E.2; Petrone, L.1; Lotti, F.1; Fisher, A. D.1; Schulman, C.3; Balercia, G.4; Forti, G.1; Maggi, M.1

1Andrology Unit, University of Florence, Italy; 2Diabetes Section GeriatricUni, University of Florence, Italy; 3University Clinics of Brussels, ErasmeHospital, Bruselles, Belgium; 4Endocrinology Unit, Polytechnic University ofMarc, Ancona, Italy

Objective: The aim of present study was to verify possible differencesin the prevalence of vasculogenic ED and hypogonadism comparingtwo distinct new definitions of metabolic syndrome (MetS), asNational Cholesterol Education Program-Third Adult TreatmentPanel (NCEP-ATPIII) and International diabetes Federation (IDF) inpatients with sexual dysfunction.Methods: Several hormonal, biochemical and instrumental (peniledoppler ultrasound) parameters were studied. ANDROTEST Struc-tured Interview was also applied. This a 12-item, recently validated,inventories, which assesses the degree of androgenization in male.Results: In a consecutive series of 1086 patients the prevalence ofMetS was 32.0% and 44.7% according to NCEP-ATPIII and IDF cri-teria, respectively. After adjustment for confounding factors onlyNCEP-ATPIII was significantly associated with dynamic PGE-1 stim-ulated penile flow (Vpmax, B = −7.7+/−3.8; p < 0.05). Patients withMetS defined according to both criteria reported lower total and freetestosterone levels, higher prevalence of hypogonadism, and higherANDROTEST score. However, when IDF, but not NCEP-ATPIII,criteria were fulfilled, the prevalence of hypogonadism was signifi-cantly lower than that observed in patients fulfilling both criteria(15.6% vs. 34.8% respectively; p < 0.00001). Conversely, those fulfill-ing NCEP-ATP-III, but not IDF, criteria did not show a significantdifferent prevalence of hypogonadism than those positive for both setsof criteria (30.8% vs. 34.8%; p = NS).Conclusion: In patients with ED, NCEP-ATPII criteria seem to bea better predictor of hypogonadism and impaired penile blood flowthan IDF.Policy of full disclosure: This paper was supported from uncondi-tioned grant from Pfizer, Rome, Italy.

PP-02-194

Testosterone and erectile function in hypogonadalmen unresponsive to PDE-5 Inhibitors: Results froman open-label uncontrolled studyClaes, H.1; van Poppel, H.1

1UZ Gasthuisberg, Dept. of Urology, Leuven, Belgium

Objective: To evaluate whether combination therapy with testos-terone {transdermal (Andractim®) or intramuscular (Sustanon®)} andPDE-5 Inhibitors is effective in achieving adequate potency in subjectswith low-normal and even normal serum testosterone levels in whomPDE-5 Inhibitors alone have failed.


J Sex Med 2007;4(suppl 2):152–202

PP-02-196

An androgen-dependent pde5 activity in bladdermight contribute to LUTSFilippi, S.1; Morelli, A.2; Sandner, P.3; Fibbi, B.2; Mancina, R.2; Marini, M.4; Gacci, M.5; Vignozzi, L.2; Vannelli, G. B.4; Carini, M.5; Forti, G.2; Maggi, M.2

1University of Florence, Pharmacology, Italy; 2University of Florence, Clin-ical Physiopathology, Italy; 3Bayer Health Care, Pharma Research EU, Wup-pertal, Germany; 4University of Florence, Anatomy, Histology and Forensi,Italy; 5University of Florence, Urology, Italy

Objective: BPH is the most common disease in male aging, often asso-ciated to Erectile Dysfunction (ED). PDE5 inhibitors (PDE5i) ame-liorates LUTS in patient with ED and BPH. We studied their actionin rat and human bladder.Methods: We studied PDE5 expression and activity in human bladderand effects of PDE5i using in vitro (human and rat) and in vivo (ratbladder outlet obstruction, BOO) models.Results: In bladder, we found high PDE5 mRNA expression and anintense PDE5 immunolocalization in the vascular endothelium andsmooth muscle cells. PDE5i vardenafil, sildenafil and tadalafil, blocked70% of total cGMP catabolizing activity in human bladder homo-genates. Vardenafil exhibited the highest IC50 (0.3 nM). In rat, theNO-donor sodium nitroprusside (SNP) marginally relaxed carbachol-precontracted bladder strips, while vardenafil (100 nM) stronglypotentiated its activity to the level of the PDE-resistant cGMP ana-logue SP-8-Br-PET-cGMPS. Accordingly, in human bladder stromalcells the anti-proliferative activity of SNP was potentiated by varde-nafil up to the PDE-resistant cGMP analogue. We found that surgi-cal castration in the rat decreased, and T supplementation restored,PDE5 mRNA (Real-time RT-PCR) and enzymatic activity. Accord-ingly, bladder strips from castrated rats were more sensitive to SNPinduced-relaxation than control or T-replaced rat strips, while in pres-ence of vardenafil, all the groups showed the same SNP sensitivity. Toelucidate whether vardenafil affects in vivo bladder activity, the ratBOO model was used. Chronic treatment with 10 mg/kg/d vardenafildid not influence bladder hypertrophy but significantly reduced (47%,p < 0.05 vs. placebo) non-voiding contractions in the rat to tamsulosinlevel (51%).Conclusion: Overall, these results demonstrate that PDE5 in thebladder regulates smooth muscle tone, strongly limiting theNO/cGMP signalling, and that vardenafil, by blocking PDE5, mightrepresent a possible therapeutic option for bladder dysfunction.

PP-02-197

The role of sexual dysfunctions in inducing the use ofdrug in males: Preliminary resultsLa Pera, G.1; Peris, F.1; Carderi, A.1; Marianantoni, Z.1; Livi, S.2; Macchia, T.31San Camillo-Forlanini Hospital, Urology, Roma, Italy; 2Faculty Psicology,Psychometry, Roma, Italy; 3Italian Health Institute, Drug, Roma, Italy

Objective: The aim of this study is to evaluate the role of sexual dys-functions in inducing the use of drug in males.Methods: 75 male patients between 18 and 35 years of age (mean age30.24 +/− 4.98 SD), from 6 drug abuse rehabilitation centers, wererecruited. They were given a validated questionnaire analyzing retro-spectively family background, toxicological characteristics (first druguse, type of drugs, etc), sexual experiences (date of first sexual inter-course, sexual preference etc) sexual function (desire, erection and ejac-ulation). The questions focused on recollections of sexual experiencesbefore the subjects started taking drugs. For the validation and com-prehensiveness of the questionnaire a set of items obtained with sixfocus groups discussions were preparedResults: 67% of the subjects stated that their initial drug use did notstem from a sexual dysfunction, while 33% affirmed that a sexual dys-function had influenced their initial use of drugs. In particular, 57.1%of these subjects affirmed that their sexual dysfunctions had influencedthem a little, 28.7% that they had influenced them a lot while 14.2%

stated that they had been a decisive factor. More than 50% of the wholesample used drug to improve sexual performances and in particular todelay the ejaculatory reflex.Conclusion: These data show that there is an association betweeninitial drug use and sexual disorders supporting therefore the “La Peratheory” in which sexual dysfunctions play an important role in induc-ing young males to substance abuse and addiction. Although duringthe interviews the subjects clearly stated that they became addicted justbecause a sexual disorder, it is still necessary a longitudinal study todemonstrate a cause-effect relationship between sexual disorders andsubsequent addiction.

PP-02-198

Sexual dysfunction in obese patientsKadioglu, P.1; Ozgil Yetkin, D.2; Serap Yalin, A.2; Onem, K.3; Kadioglu, A.3

1Cerrahpasa medical faculty, Endocrinology and diabetes, Istanbul, Turkey;2Istanbul University Cerrahpasa, Endocrinology and diabetes, Turkey; 3Istanbul University, Urology, Turkey

Objective: The prevalence of obesity has increased dramatically overthe past years. Although the health risks associated with obesity arewell documented, the prevalence and related factors of female sexualdysfunction in obesity are limited. The aim of this study is to investi-gate sexual dysfunction (SD) in obese female patients.Methods: Fifty-seven obese women (mean age: 36.45 ± 5.06 SD) and12 age matched voluntary healthy hospital staff as control group wereevaluated with detailed medical and sexual history including FemaleSexual Functioning Index Questionnaire (FSFI) and Beck’s DepressionInventory (BDI). Educational attainment level and income were alsoasked. Serum levels of prolactin, dehydroepiandrosterone sulfate, freetestosterone, total testosterone, androstenedion, 17α hydroxyproges-terone, estradiol, were measured.Results: The mean serum levels of hormones in obese patients were notdifferent from control group. Sexual dysfunction was diagnosed in 30 of57 patients (52,6%), while 3 of healthy women (25%) have been foundto have sexual dysfunction (p = 0.12). Although median total FSFI scoresin obese patients (26,2 [IQR: 19.5–29.4]) was lower compared to healthycontrols (28.9 [IQR: 23.55–31.8]), the difference was statisticallyinsignificant (p = 0.11). In edition to total scores, all of the domains werealso similar in both groups. Educational attainment and income levelwas higher in control group (p = 0.001 and p = 0.009, respectively).Median BDI score was 1 [IQR: 0–3.75], in control group whereas obesepatients’ score was 13 [IQR: 8.5 ± 17], (p < 0.0001). We determined nocorrelation between hormone levels and total FSFI score. Only BDI wasnegatively correlated with FSFI total score (p < 0.0001, r:-0.6).Conclusion: We determined sexual dysfunction in %52,6 of obesefemale patients. Demographic characteristics, such as educationalattainment and income, and the existence of depression are relatedfactors with female sexual function.

PP-02-199

Outcomes of testosteron therapy in impotent patientswith metabolic syndrom and hypogonadismCakan, M.1; Demirel, F.2; Topcuoglu, M.2; Altug, U.21Ankara, Turkey; 2SB Ankara, Urology, Turkey

Objective: The metabolic syndrome (MS), characterized by centralobesity, insulin dysregulation, abnormal lipids and borderline hyper-tension. Observational data suggest that MS is strongly associated withhypogonadism in men. Androgens are critical for maintaining penilestructure and function and androgen deficiency alters the function ofthe corporal veno-occlusive mechanism. In current study we aimed topresent the effect of transdermal testosterone gel treatment on impo-tent patients with MS and hypogonadism.Methods: A total of 8 impotent patients with metabolic syndrome andlow testosterone level were included in the study. The mean age was58.3 years (49–65 years). Patients were evaluated with a completehistory, physical examination, sex hormones, and metabolic profiles.The metabolic syndrome was defined by the National Cholesterol


J Sex Med 2007;4(suppl 2):152–202

Education Program’s Adult Treatment Panel III criteria. The baselineand post-treatment erectile functions were assessed using an Interna-tional Index for Erectile Function (IIEF) questionnaire. The patientsunderwent treatment with 50 mg transdermal testosterone gel (Testo-gel) per day for 3 months.Results: Testosterone levels were increased to normal values in allpatients after the treatment. Three (37.5%) of the patients reportedsignificant improvement in erectile function and are currently underfollow-up. These patients also noted improvement in sexual desiredomain (International Index of Erectile Function [IIEF] scoresincreased from 3 ± 0.5 to 7 ± 0.4) and erectile function domain (IIEFscores increased from 10 ± 4 to 19 ± 3). No significant drug-relatedside effect was observed.Conclusion: Treatment with transdermal testosterone gel seems toimprove erectile function in some hypogonadal patients with metabolicsyndrome. However, our study had limited number of patients andfurther prospective randomized studies including more patients shouldbe performed to further defining the role of testosterone treatment forimpotent patients with hypogonadism and metabolic syndrome.

PP-02-200

Stable testosterone levels achieved with subcutaneoustestosterone injectionsGreenspan, M.1

1McMaster University, Urology, Hamilton, Canada

Objective: Intramuscular testosterone injections have been a pre-ferred technique for androgen replacement, but wide variations intestosterone levels are often seen. Subcutaneous (SC) testosteroneinjection is a novel approach with unknown physiological effects. We,therefore, investigated the sustainability of stable testosterone levelsusing SC therapy.Methods: Between May 2005 and May 2006 a small pilot study involv-ing 10 patients with LOH was conducted. Patients self-injected 100mgs of testosterone enanthate (TE) weekly into the anterior abdomi-nal wall. All patients had been stable on TE 200 mgs IM for greaterthan 1 year. T levels were measured immediately before and 24 hoursafter injection during weeks 1,2,3 and 4 and 96 hours after injectionweeks 6 and 8. PSA, CBC, and T levels were measured at weeks 12,24, 36 and 48. A subgroup of 25 patients have also been started on SCT, with follow-up between 3 and 12 months.Results: At study initiation in the pilot group T level was 19.14 +/−3.48 nmol/L (normal range 10–36), hemoglobin 15.8 +/− 1.3 g/dl,hematocrit 0.47 +/− 0.02, and PSA 1.05 +/− 0.65 ng/ml. During thefirst 4 weeks, there was a steady increase in T levels to 23.9 +/−9.15 nmol/L. After 8 and 12 weeks post-injection T was 25.77 +/−7.67 nmol/L. Stable levels of T, CBC and PSA continue to be observedat 12 months in the pilot group and similar findings are noted in thesubgroup.Conclusion: Once weekly SC injection of TE appears to achieve sus-tainable and stable levels of T. This technique offers many fewer physi-cian visits, thus lower costs. However, the longterm clinical andphysiological effects of this therapy need futher evaluation.

PP-02-201

Sexual problems in Romanian active male populationCalomfirescu, N.1; Fiica, S.1; Belinski, C.1; Gaita, D.2; Bucuras, D. L.3;Cambosie, A.4; Mota, M.5; Bulai, A.1; AMSR Study Group1Central Emergency Military, Hospital—Urology, Bucharest, Romania;2Central Emergency Military, Hospital—Urology, Timisoara, Romania; 3Sp.Clinic Jud., Timisoara, Romania; 4Centrul Nat. de Acupunctura, siHomopatie, Bucharest, Romania; 5Univ. de Medicina si, Farmacie Craiova,Romania

Objective: “The sexuality of Romanian active population” is the firstresearches accomplished in Romania in this field, initiated by theRomanian Association for Sexual Medicine (AMSR). The objectives:1. Informing and communication 2. The sexual life of the active people

3. The erectile dysfunction and treatment 4. Social- demographicalprofilesMethods: • The research has been accomplished on a sample of 1240people between 15 and 55 years old • The research is based on a quan-titative methodology, statistically significant • Three groups: youth(15–25), young (26–45), adults (46–55).Results: General information and sexual topics: • The men are morelooking for information • The main communication partners in sexualtopics is the sexual partner • The most known sexual affections areAIDS and syphilis • The pills and the condoms are the most used con-traception methods Regarding the sexual life: • Sexual life begin is 16years for the urban people and 17 years for rural people • The mostimportant sexual life characteristics are self-satisfaction and the partnersatisfaction • The average number of sexual acts is about 12–13 permonth • 56% of the men have had a single stable sexual partner.Pathology and treatment: • 9% from the men have precocious ejaculation in average for 5–6 months • 38% from the men have prob-lems with the ejaculation • 13% from the men who have erectile prob-lems has tried a treatment • One third from the men who haveproblems declares they want a drug with a long period of operation • The most known medicament for erectile dysfunction is sildenafil.Conclusion: This study is very important because it helps us to havea global image about sexuality of Romanian active men, in order tofind a better way for communication, education and treatment.

PP-02-202

Testosterone gel associated to tadalafil in the therapyof diabetic patients affected by erectile deficitSpera, E.1; Scarfini, M.1; Vannozzi, E.1; De Carolis, A.1

1University Tor Vergata, Urology Policlinico Casilino, Rome, Italy

Objective: To evaluate the benefit of association of testosterone geland tadalafil in the diabetic patients affected by erectile deficit.Methods: 24 patients affected by diabetes mellitus type 2 and agebetween 42 and 65 years were enrolled in this study. Urologic evalu-tation, iief test, blood samples (emocromo, psa testosterone, prolac-tine, lh, fsh) werw cheked in all patients at the beginning and at theend of the study. All enrolled patients had evidence of hard erectiledeficit and sieric testosterone lower then 3 mc/l. patieents were dividedin 3 groups. In group 1 we gave only tadalafil (1 tablet every 3 daysfor 2 months) in group 2 add to tadalafil we prescribed testosteronegel 50 mg every day for 2 months). in group 3 we only gave dailytestosterone for 2 months.Results: An emprovement of ed was observed in 5/8 patients of groupone, in 8/8 of group 2 and only 2/8 patients of group 3. The only sideeffects were muscle pain in only 1 patient of group 1 and slight rise ofematocrito in 2 patients of group 2 an 1 of group 3.Conclusion: Even if the study was performed in a small number of patients our data suggest an advantage in the association of thestosterone gel and tadalafil in the ed therapy of diabetic patients.

PP-02-203

The recovery of sexual function in patients withprostate cancer, obtaining antiandrogen therapy: Use of vacuum devices and FDE-5 inhibitorsRomanyuk, M.1; Gorpinchenko, I.1; Shamraev, S.11Institute of Urology, Sexology and Andrology Dpt, Kiev, Ukraine

Objective: This randomized prospective study was made to estimatethe efficacy and safety of methods of treatment of sexual disorders inpatients obtaining antiandogen therapy due to prostate cancer:vacuumdevices and FDE-5 inhibitors.Methods: 76 patients with hystologically proved prostate cancer tookpart. All of them obtained antiandrogen therapy due to prostate cancer.Mean age was 63.4 years (from 52.3 to 72.5). All patients had normalsexual function before antiandrogen treatment (evaluated by IIEF-15scale and penile colour-doppler ultrasound). After 3 month of cancer


J Sex Med 2007;4(suppl 2):152–202

therapy patients were divided in 3 homogeneous groups. Group 1 (26patients, mean age—62.5 ± 3.4) used vacuum devices 15 minutes dailyfor 2 month, group 2 (28 patients, mean age—64.1 ± 4.2) besidesvacuum therapy obtained 50 mg of Sildenafil 3 times a week, group 3(22 patients, mean age—65,0 ± 3,1) did not get any treatment for sexualdisorders. After treatment erectile function was assessed and comparedin all three groups.Results: After treatment the mean IIEF-15 score in group 1 was 43.3± 2.5, in group 2–59.3 ± 2.7, in group 3–16 ± 4,1. Mean penile peaksystolic velocity after stimulation was: group 1–28,6 mm/sec, group2–34.3 mm/sec, in group 3–18,2 mm/sec. 14 patients (54%) fromgroup 1 and 21 (75%) from group 2 noticed recovering of spontaneousand adequate erections, and in group 3 there were only 6 (27%) suchpatients.Conclusion: We can say, that antiandrogen therapy decreases erectilefunction in prostate cancer men. But this impact can be corrected byvascular therapy. Use of vacuum devices is one of good methods, butmore efficacy can be achieved while using combination of vacuum andFDE-5 inhibitors.

PP-02-204

Early therapy following nerve sparingradicalprostatectomy (RP): Improvement withcombination alprostadil + oral sildenafilBitelli, M.1; Zucchi, A.2; Virgili, G.3; Spera, E.3; Pietrantuono, M.4; Valitutti, M.5; Vespasiani, G.3

1Urology, Rome, Italy; 2 University of Perugia, Urology, Italy; 3Tor VergataUniversity, Urology, Rome, Italy; 4Cassino Hospital, Urology, Italy; 5AureliaHospital, Urology, Rome, Italy

Objective: The time lapse of recovery of erectile function after nerve sparing radical prostatectomy is still under debate. Severalpathophysiologies are postulated for postoperative erectile functionrehabilitation.Methods: 26 sexual active patients suffering from local prostate cancerwere operated by uni- or bilateral nerve-sparing radical prostatectomywere enrolled in our study and divided “random” in 2 groups: a) i.c.ALPROSTADIL (10 mcg/2 week) + ORAL SILDENAFIL (100 mg3/week), b) ORAL SILDENAFIL (100 MG 3/week). Rehabilitationtherapy started day 7 after catheter removal. Erectile function was eval-uated with International Index of Erectile Function (SHIM) ques-tionnaire at regular intervals (before RP and at 3,6,9 months).Results: In Group A 4/13 pts increased PGE1 dose (max 20 mcg) after1st step (3 months), 2/13 decreased PGE1 dose (2,5 and 5 mcg), 1 ptsstopped IC therapy for penile discomfort and dropped out of the study,6 pts continued 10 mcg PGE1. 2/13 pts of Group B dropped out thestudy, 2/13 decreased Sildenafil 100 mg to 50 mg, 9/13 continued 100 mg therapy. The return of spontaneous partial erections occurredin 7/26 (26.9%) patients at 9 months. At the end of the study 23/26pts were sexually active, 6 (26%) with injection alone, 8 with combi-nation therapy (34%), 9 (39%) with Sildenafil only (7 pts Group A, 2Group B). IIEF at 3,6,9 months showed an early improvement in 10/13of group A and 2/13 group B.Conclusion: Early combination therapy following RP promotessexual activity and an earlier return of natural erections, particularlycombination therapy with sildenafil + PGE1.

PP-02-205

Sexual factors and prostate cancerLonghi, E.1; Salonia, A.1; Columbo, R.1; Briganti, A.1; Rigatti, P.1; Montorsi, F.1

1IRCCS San Raffaele, Dept. of Urology, Milano, Italy

Objective: The aim of this study was to investigate sexual health issuesin patients with prostate cancer (pCa).Methods: We evaluated 130 patients (aged <70 years) with a diagno-sis of the pCa and who have been complaining of ED for at least 5years. Patients were administered a set of validated questionnaires,

including: IIEF, the Hamilton Depression Evaluation Scale (HAM-D),The Self-Esteem Rosenberg Questionnaire (Italian version of theRSES), the Center for Epidemiological Survey Depression Scale(Italian version of the CES-D), the Intra-Psychic and with others Rela-tion Questionnaire (DSI-R). After having completed the above mentioned indexes, patients underwent a check-up interview and 3subsequent psycho-sexological interviews.Results: Overall, the current psychometric assessment underlinedhow newly diagnosed pCa patients may not reveal any data regardingtheir oncologic disease during a psycho-sexual interview. On the con-trary, the study retrace the positive association with marital status andthe negative correlation with the number of femal sexual partners.There are several reports of positive associations with veneral diseaseand with high-risk behaviour. In the 15% of the cases, there are anincreased risk of prostate cancer after some period of reduced sexualactivity. It is possible that infrequent ejaculation could increase the riskof pCa because of the stagnation of carcinogenic secretions in the pro-static acini. Moreover, ED, circulating levels of testosterone within thenormal range (stronger in older men and men with advanced disease).Conclusion: During the evaluation of pCa patients it is important toexamine the association between lifestyle factors, and psycho-sexualparameters and being diagnosed as a oncologic patient. One of the psy-chological factors that strongly affects sexual functioning is the imagea person has of his or her own sexual organs and the meanings attrib-uted to these parts of the body.

PP-02-206

In vitro effects of androgens on cyclic AMP and cyclicGMP levels in isolated human cavernous arteries(HCA) and corpus cavernosum (HCC)Waldkirch, E.1; Ueckert, S.1; Bruns, C.1; Schultheiss, D.1; Sohn, M.2; Jonas, U.1; Andersson, K.-E.3; Stief, C. G.4; Hedlund, P.31MHH/ Hannover Medical School, Urology, Germany; 2St. Markus Acad-emic Hospital, Urology, Frankfurt, Germany; 3Lund University Hospital,Clinical and Experimental Pharmacology, Sweden; 4Academic HospitalGrosshadern, Urology, Munich, Germany

Objective: Coronary heart disease and erectile dysfunction (ED) sharethe same risk factors such as arterial hypertension, diabetes mellitusand the metabolic syndrome. The metabolic syndrome increases therisk for hypogonadism. Genomic effects of androgens on smoothmuscle physiology are evident. Androgens relax vascular and nonvas-cular smooth musculature in vitro. This nongenomic effect might bemediated by a change of cAMP and cGMP levels. Therefore we eval-uated the influence of androgens on cAMP and cGMP levels in penileerectile tissue.Methods: Isolated segments of HCA and HCC were exposed toincreasing concentrations of testosterone (T) and dihydrotestosterone(DHT) (0.1 to 10 mikroM). The dose-dependent accumulation ofcAMP and cGMP was determined by means of radioimmunoassays.Responses of the tissue to T and DHT were compared to baselinelevels of unstimulated specimens. Forskolin (F) and sodium nitroprus-side (SNP) served as reference compounds.Results: SNP and F significantly stimulated the accumulation ofcGMP and cAMP in tissue preparations of HCA and HCC. SNP morethan doubled cGMP levels. cAMP levels were increased 20-fold after exposure to forskolin. No significant differences were recordedbetween the vascular and nonvascular tissue specimens. We did notdetect a significant effect of T and DHT on cGMP and cAMP tissuelevels.Conclusion: Hypogonadism is considered a component of the meta-bolic syndrome, which itself increases the risk of cardiovascular dis-eases, endothelial dysfunction and ED. Nongenomic effects of T andDHT on the tonus regulation of smooth musculature seem to belimited. Our results could not confirm earlier findings that nonge-nomic effects of T and DHT are mediated by changes in cAMP orcGMP tissue levels. It has been suggested that nongenomic effects ofandrogens might involve potassium channel stimulation in singlemyocytes.


J Sex Med 2007;4(suppl 2):152–202

PP-02-207

The erectile dysfunction in the alcohol drinking withlow, medium and high riscDachille, G.1; Giovanni, V.1; Cardo, G.1; Maselli, F.1; Erinnio, M.1;Ludovico, G. M.1

1Monopoli-Bari, Urology, Italy

Objective: The aim of this study was to improve the knowlage and totret the erectile disfunction with in the alchol intake down, and heavyrisch but not in the chronic alcoholics.Methods: From May 2004 to May 2005, we have evaluated 225patients by andrological ambulatory screening in the San Giorgio Hos-pital in the Monopoli-Bari. Only 90 patients with an everage 56 years(range 22–77 years) have been included in the study All the 90 patientswere studied with penile ultarsound Doppler in the basal and dynamiclevel after injection of 10 microgr of the prostaglandin(PGE1) and tothe baseline with IIEF (International Index Erectile Dysfunction) andC.A.G.E. blind (cut down, annoyed, guilt, eye opened).Results: In 43 patients light drinkers, 11 had only the abstinence ofthe alcohol drinking, 16 abstinence and therapy with sildenafil. In thesecond group of 47 patients heavy drinkers 15 had only abstinence ofalcohol drinking, 16 therapy with sildenafil 50 mg and alcohol absti-nence and 16 only sildeafil therapy. In the group of the drinkers thedown risk 30 patients improved the condition of the erectile dysfunc-tion evaluated with IIEF items 1–15 and 15 questions, 10 with onlyabstinence, 12 with only abstinence, 12 with sildenafil 50 mg therapyand abstinence and 8 with only therapy 50 mg. In the group of 47patients with heavy risk, 30 patients improved the condition of erec-tile dysfunction; 6 improved the erectile dysfunction with alcoholabstinence, 16 with sildenafil and abstinence, and 8 with only sildenafiltherapy.Conclusion: 16 patients improved the erectile function only in thetherapeutical plain with alcohol abstinence, the sildenafil therapy andabstinence in 28 cases, but in 16 patients with only sildenafil therapy.The abstinence is the treatment most used in the patients with downand heavy alcoholic risch.

PP-02-208

Is ED in patients with LUTS managed adequately inprimary care? An audit of the current practiceChitale, S.1; Collins, R.1; Hull, S.1; Irving, S.1

1Norflok &Norwich Univ Hospital, Urology, United Kingdom

Objective: Lower urinary tract symptoms (LUTS) and erectile dys-function (ED) are highly prevalent in aging men. A common patho-physiology is hypothesised to explain causal link. However, prevalenceof ED in patients with LUTS remains underdiagnosed. We auditedthe primary care approach to patients with LUTS & ED.Methods: 100 consecutive patients with LUTS attending the prostateassessment clinic (PAC) anonymously filled a locally developed, validated questionnaire and sexual health inventory for men (SHIM).Results: 54/100 (54%) admitted to ED. Age range was 39–86 yrs.45/68 (66%) ≥60 yrs. and 9/32 (28%) ≤60 yrs. had ED. 19/54 (35%)patients with ED failing to complete SHIM were excluded from thefinal analysis. Mean IPSS in LUTS +/− ED groups was 16 with sym-metrical distribution across mild, moderate, severe. In ED cases meanSHIM score was 9.3 with an inverse correlation between severity ofIPSS and SHIM. Only 13/54 (24%) mentioned ED to GP, only 2(15.4%) received treatment. 10/11 (90.9%) untreated were keen ontherapy. 29/41 (71%) stated definite reasons for inability to discuss EDwith GP. GPs enquired about ED in only 5/54 (9.2%). 35/41 (85.3%)non admitting patients had no therapy, 19/35 (54.3%) would like some.Overall 36/54 (66.6%) wanted their ED addressed.Conclusion: ≥50% of patients with LUTS admitted to ED. 66% were≥60 yrs. Patients with more severe LUTS had more severe ED. Over<3/4> of patients did not report ED. GPs enquired about ED in <10%patients. GPs offered no therapy to >80% patients. 67% LUTSpatients wanted treatment for ED. Hence, a more integrated approach

is desired in the management of LUTS & ED to address them com-prehensively in primary and secondary care.Policy of full disclosure: N/A.

PP-02-209

Frequency rate of erectile disfunction in patients witharterial hypertensionKan, I.1

1Msumd, Urology, Moscow, Russia

Objective: The objective of the current study is to determine the cor-relation of the arterial hypertension, the ischemic heart disease and theage with the development of ED.Methods: We conducted a complex examination of 268 patients withAH using the IIEF as a screening investigation method to reveal ED.Results: ED was revealed in 115 patients (42.9% with AH). 28 of themsuffered from concomitant ischemic heart disease (IHD). The exami-nation included duplex Doppler examination of cavernous arteries anda test with intracavernous injection of E1 prostaglandin. We deter-mined that the ED incidence increase correlated with the patients’ ageas follows. ED was revealed in 4.3% of patients aged 18–35, 17.3%aged 36–50, 49.7% aged 51–65 and in 81.6% patients older than 65.The results confirm weak negative connection between the data of thequestionnaires with the use of the IIEF and the patients’ age (k =−0.22), history of AH (k = −0.25), presence of the iIHD (k = −0.22)and the level of the systolic arterial pressure (k = −0.18). The data afterthe intracavernous injection correlated with the presence of the IHD(k = −0.26) and the level of the systolic arterial pressure (k = −0.25).The peak systolic speed of the blood flow in the cavernous arteryrevealed by Doppler after intracavernous PgE1 injection highly cor-related with the patients’ age (k = −0.44), presence of the IHD (k =−0.33) and the level of the systolic arterial pressure (k = −0.23); thoughthe peak diastolic speed correlated only with the presence of the IHD(k = −0.25).Conclusion: So, older age, presence of the IHD, the history of AHand systolic arterial pressure have a negative impact on the erectilefunction of male patients with hypertension.Policy of full disclosure: no.

PP-02-210

Sex hormones regulation in males with maldescendent testesLuchitskiy, V.11Institute of Urology AMSU, Andrology / Sexology, Kiyv, Ukraine

Objective: Maldescendent testes in 2% cases is only reasons of male’sinfertility. It is known that this anomaly occurs due to hormonal dis-balance in the intrauterine period and results in the decline of testos-terone production. The regulation of sex-hormones production on theaxis pituitary gland—testes was investigated in male teens and adults.Methods: Serum levels of testosterone (T), estradiol (E2), luteinizinghormone (LH) and follicle-stimulating hormone (FSH) were meas-ured at 72 patients in age from 11 to 27 years.Results: Bilateral maldescendence was observed at 48% patients, uni-lateral—at 52%. The signs of delayed pubertacy t were exposed at 77%patients. The reliable (P < 0.001) decline of middle levels of FSH wasmarked with patients in age 11–13 years, which in age 14–16 years was replaced by the decline of middle levels of LH. In all ages therewas the significant decline of middle levels of T on a background ofE2 increase. Evaluation of T/LH coefficient showed the reliabledecline of T production on LH unit in the initial periods of pubertyand in men with maldescendent testes. This fact testifies to the lowsensitivity of Leydig-cells to the central hormonal stimulation. Thelow LH-effect was confirmed by test with chorionic gonadotropinehormone (CGH), which showed 3 times elevation of serum T inpatients with T/LH coefficient >2 units.Conclusion: In teenagers with maldescendent testes in pathogenesisof delayed puberty is absent the FSH-effect, as initiating mechanism


J Sex Med 2007;4(suppl 2):152–202

of pubertacy, and the subsequent failure of synthesis of sex-hormonesresults in development of absolute and relative gypoandrogenic state,due to the low sensitivity of cages of Leydig-cells to LH stimulationand increase of E2 synthesis.

PP-02-211

Erectile Dysfunction and South Asians: Whatdetermines whether participants seek healthcare? An ethnography centred in Oxfordshire and Sri LankaEdwards, D.1

1White House Surgery, Chipping Norton Oxon, United Kingdom

Objective: ED is a marker for serious disease; many pivotal studiesincluding MMAS ‘had essentially no Asian participants’. South Asiansmake up 3% of UK population, they have a high incidence ofCVD/DM and would therefore expect to have an increased rate of ED.If one could diagnose such conditions earlier, preferred cross-culturaltreatment regimes could be instigated.Methods: Ethnographic fieldwork consisted of one-to-one semi-structured interviews, focus groups, ‘hanging around’ and personalreflection. This gave depth and richness to the fieldnotes, arguablysomething that quantitative research has difficulty approaching. Set-tings were Banbury mosques and many SriLankan sites from hospitalsto paddy fields.Results: Patient • All enthusiastic being asked about ED • Embarrass-ment • All trust the doctor, prefer to get treatment directly from doctornot pharmacy • Sex important at any age Couple • Can affect coupleinteraction • Accommodation often expected that parents sleep sepa-rately when the children sexually aware Healthcare delivery • Muchsocietal pressure not to have sex • Gender—men would prefer to seemale doctors • Privacy and confidentiality important • Doctors “don’thave the guts” to ask about ED • Complementary medicine issues.Conclusion: ED was a common problem that was considered of greatimportance to the patient whatever his age, intelligence, social class,religion, or ethnic origin. My participants were usually very keen onreceiving treatment up to any age, for what was perceived as a humil-iating shameful condition. In summary, when the participant had EDthe usual parameters that prevented help-seeking behaviour: shame,embarrassment, lack of knowledge and fear of side effects from med-ication, were magnified by the perception of healthcare delivery exert-ing control and regulation. By combining a mélange of patient,pluralistic health-care professional and physician support and educa-tion; ED can be addressed, and assessed without necessarily distress-ing or disrupting the cultural mores.

PP-02-212

Male Chlamydia self-testingBanks, I.1; Wilkins, D.2

1European Men’s Health Forum, Spa, Co. Down, United Kingdom; 2Men’sHealth Forum England, Public Health Policy and Resea, Brussels, Belgium

Objective: Chlamydia infection rates are increasing rapidly through-out Europe. It is a major cause of ectopic pregnancy, female infertil-ity while men are often asymptomatic. Testing in the UK, has beenprimarily female targeted. A partnership of the UK Department ofHealth, National Pharmaceutical Association, and the Mens HealthForum (England and Wales) established a Chlamydia self testing pro-gramme for young men with the objectives to: • Increase men’s aware-ness of Chlamydia • Promote the adoption of safer sexual practices • Encourage men to seek screening and treatment where appropriate.Methods: Phase 1: Research Group discussions with men agedbetween 18 and 25 to develop a greater understanding of their atti-tudes to sex and sexual health in general, and Chlamydia in particular.The knowledge gained used to develop accurately targeted health pro-motion materials. Phase 2: Programme Eight industrial workplaces,employing over 4,000 men, distributed health promotion materials(posters and leaflets) and free kits for Chlamydia “self-testing”. Neg-ative test results were notified directly to the individual by post. Thosemen testing positive were telephone contacted by a Sexual Health

Adviser. A local group of pharmacists issued the one-off antibiotictreatment without the man needing to see his GP or visit a GUMclinic.Results: 3,000 urine-testing kits were taken from the display boxesplaced in the workplaces. 401 urine specimens were submitted to thelab (13%) Ten people tested positive for Chlamydia. A minimum offive sexual trace contacts of those ten people were also tested andtreated.Conclusion: The workplace is a valuable venue for male sexual healthpromotion. The pharmacist can play a significant role in addressingChlamydia infection in men. Following the successful completion ofthis study a major UK pharmacy chain established a free self testingprogram.

PP-02-213

Ultrastructural characterization andimmunohistochemical study of expression of Ang1,Ang2 and Tie-2 in corpus cavernosum of erectiledysfunction-prone rat modelsVendeira, P.1; Santos, J.1; Cordeiro, A.1; Figueiredo, A.1; Godinho, F.1;Martins, I.1; Almeida, H.1; Neves, D.1

1Faculty of Medicine of Porto, Lab. Molecular Cell Biology, Portugal

Objective: Ageing, diabetes and hipogonadic states are recognized riskfactors for erectile dysfunction (ED) contributing together to vasculardamage of penile tissue. It is known that penile trabeculae of corpuscavernosum, smooth muscle, and endothelium, as well as, structuraland ultrastructural alterations in fibroelastic components may influ-ence an inadequate sinusoidal expansion. This may contribute to arte-rial flow and smooth muscle relaxing disorders which diminishesstiffness of erect penis. In this way, clarifying ultrastructural organiza-tion of corpus cavernosum, will improve knowledge about preventionand treatment of ED. We also proceeded to study of vascular growthfactors expression such as Ang 1 and its antagonist Ang2, and recep-tor Tie-2 in order to clarify its contribution for ED progression.Methods: Male Wistar rats were divided in experimental groups (n =6), aged (12, 18 and 24 months), orchidectomized (at 2 and sacrificedat 6 months), diabetics (streptozotocin 90 mg/kg ip injection at 2 andsacrificed at 6 months) and respective controls of 6 months. Rats weresacrificed by decapitation, penis fragments removed, fixed in glu-taraldehyde, processed to Epon inclusion and comparative ultrastruc-tural study was performed by transmission electron microscopy (Jeol100B). Immunohistochemical detection of Ang1, Ang2 and Tie-2 wasperformed employing appropriated antibodies (Santa Cruz Biotech-nology). We also proceeded to SDS-PAGE analysis and Western blot-ting detection of Ang1 and 2 in penis fractions of all experimentalgroups.Results: Ultrastructural study revealed endothelium, smooth muscu-lature and connective tissue in penile corpus cavernosum of all exper-imental groups. Aged, diabetic and orchidectomized rats presented analtered vascular organization with foam cells in corpus cavernosum.Immunohistochemistry revealed Ang1 and Ang2 expression mainly insmooth muscle cells and their receptor Tie-2 in endothelium.Conclusion: The presented results suggest that ageing, androgendepletion and diabetes contribute to ED progression by causing a dis-organization of cavernosum tissue. Supported by CGD/UP.

PP-02-214

Testosterone is the therapeutical bridge betweenmetabolic syndrome and erectile dysfunctionSaad, F.1; Yassin, A.2; Shabsigh, R.3; Traish, A.4; Kalinchenko, S.5; Eardley, I.6

1Schering AG, Berlin, and Gulf Medical College/UAE, Germany; 2Sege-berger Kliniken, Clinic of Urology & Andrology, Norderstedt, Germany;3Columbia University, Center for Human Sexuality, New York, USA;4Boston University, Urology Research, USA; 5Centre of Endocrinology,Centre of Endocinology, Moscow, Russia; 6St. James’ University Hospital,Urology Dept, Leeds, United Kingdom


J Sex Med 2007;4(suppl 2):152–202

Objective: To evaluate associations between erectile dysfunction(ED), the metabolic syndrome, and testosterone deficiency.Methods: Review of the current literature.Results: The Metabolic Syndrome is a complex of risk factors whichprogressively leads to the manifestation of diabetes mellitus type 2 andcardiovascular diseases. Erectile dysfunction may appear as the firstsymptom. Cross-sectional and longitudinal epidemiological studiesshow associations between testosterone levels and features of theMetabolic Syndrome. Low testosterone levels are more common inpatients with the Metabolic Syndrome, cardiovascular diseases, or dia-betes type 2 than in the normal population. Recent studies have shownthat the prevalence of hypogonadism in male patients with angina ordiabetes type 2 can be approximately 50%. Observations in prostatecancer patients receiving androgen deprivation therapy show anincreased risk of unfavourable changes in body composition, lipidpattern, and insulin resistance. Studies in obese men reveal that obesemen in good or impaired health have lower testosterone levels thannon-obese controls. Waist circumference as an indicator for visceralobesity is inversely associated with testosterone. The risk of obese mento develop the Metabolic Syndrome and consequently diabetes andcardiovascular diseases is significantly higher than in normal-weightcontrols. Studies in diabetic men demonstrate that many of the riskfactors for diabetes correlate negatively with testosterone levels.Several intervention studies in patients with visceral obesity, cardio-vascular diseases, and diabetes type 2 suggest that the normalisation oftestosterone levels reduces fat mass, increases lean body mass andshows an overall improvement of the risk factors for the MetabolicSyndrome and the consecutive diseases.Conclusion: Erectile dysfunction may be the first symptom drivingmen to seek medical help. It is therefore an opportunity but also aresponsibility for physicians seeing patients with erectile dysfunctionto look for concomitant risk factors and diseases.

PP-02-215

Two modern modes of testosterone treatmentcompared: Transdermal testosterone gel and injectablelong-acting testosterone undecanoateYassin, A.1; Haider, A.2; Saad, F.31Segeberger Kliniken, Clinic of Urology & Andrology, Norderstedt,Germany; 2Urology Office, Clinic for Urology, Bremerhaven, Germany;3Schering AG, Berlin, and Gulf Medical College/UAE, Germany

Objective: The introduction of transdermal testosterone gel andinjectable long-acting testosterone undecanoate in recent years hasbeen a major improvement in the treatment of androgen deficiency.Both fulfil largely criteria for adequate androgen treatment. This beingso, the questions arises: are there differences in the their profiles thatwould make one preferable over the other in certain patients and incertain clinical conditions?Methods: Fifty men previously treated with transdermal gel andhaving transitioned to injectable long-acting testosterone undecanoateare under study. The following data have been collected: age, baselinetestosterone before treatment, duration of treatment with testosteronegel, duration of treatment with injectable long-acting testosteroneundecanoate. Of each treatment modality the following variables havebeen and are being collected: body weight, waist circumference, lipidprofiles: total cholesterol, LDL, HDL, triglycerides, HbA1c as anindex of glycemic control. Prostate characteristics (volume and PSA),questionnaires regarding general health (Aging Male Symptoms’scale). The international index of erectile function (IIEF), the inter-national prostate symptoms score (IPSS) and patient satisfaction.Results: The study is nearing completion and results will be availableat the time of the meeting.

PP-02-216

Does intracavernous rehabilitation of erectile functionafter nerve-sparing radical prostatectomy improvepost-operative urinary stress-incontinence?Polito, M.1; Giannubilo, W.2; Leone, M.2; d’Anzeo, G.2; Muzzonigro, G.2

1OO.RR. Ancona, Urology, Italy; 2AO OO.RR., Urology, Ancona, Italy

Objective: to assess the value of sexual rehabilitation in improvingpost-prostatectomy urinary stress-incontinence.Methods: : 35 patients (median age 59 years) who underwent Nerve-Sparing-Radical Retropubic Prostatectomy in the year 2005. All thepatients had a tPSA <10 ng/ml, Gleason score <=6, no or mild erec-tile dysfunction according to pre-operative IIEF5, no hormonal pre-operative therapy. All the 35 patients had their catheter removed 6 daysafter operation. For the rehablitation, we used intracavernous injec-tion of PGE1 once a week, for 10 weeks, starting 10 days after theoperation, from 5 mcg to 20 mcg; after, we used long-term PDE-5inhibitors. We assessed urinary continence after 3 months of therapywith PAD test.Results: We observed no post-operative complications; 14 patients(40%) had trasfusions with their own blood (pre-deposit). All thepatients were <pT3, N0, M0, R0. The most important complaints withintracavernous therapy were: penile pain, deep perineal pain, some-times prolonged erections. After 3 months of therapy, all patientsreferred an improving in urinary stress incontinence. No one useddiapers, and, at the PAD test, they were all dry. At present day, nonpatients need further urinary rehabilitation.Conclusion: we observed that early penile rehabilitation after radicalprostatectomy can improve urinary stress incontinence, without anyother specific rehabilitation for incontinence. We hypothesized anincreased urethral and sfinteric tone, determined by intracavernoustherapy.

PP-02-217

Correlation between hemodinamic and clinical resultsof penile color Doppler ultrasound and risk factors forerectile dysfunctionBettocchi, C.1; Boezio, F.1; Stellacci, V.1; Lucarelli, G.1; Ditonno, P.1;Battaglia, M.1; Selvaggi, F. P.1

1Policlinico di Bari, Urologia I, Italy

Objective: Color doppler sonography of the cavernosal arteries hasreceived considerable attention since its description in 1985 by Lue.Color doppler analysis provides a useful and noninvasive means ofevaluating both morphologic and hemodynamic penile abnormalitiesin patients with erectile dysfunction. Purpose of this study is to eval-uate the correlation between the most common risk factors for erec-tile dysfunction and hemodynamic abnormalities and alterationsunderlined during penile color doppler ultrasound.Methods: From the January 1996 to December 2005 we examined1245 consecutive patients suffering from erectile dysfunction. All thepatients underewnt penile doppler ultrasound in basal and dynamicconditions and all the examinations were performed by mesurementsof the peak systolic velocity (PSV) and resistance index (RI) in basaland dynamic condition. From the patient’s past medical history weobtained the following risk factors for ED: diabetes, hypertension,heart desease, smoking, depression and anxiety.Results: 868 patients with a normal clinical evaluation present normalor borderline PSV (>35 cm/s) and RI (>0.90). Of 377 patients withpathological clinical evaluation, 247 (65%) present a normal PSV, 50(13%) a borderline PSV and 8 (2%) a pathological PSV; 62 (16%)present a normal RI, 127 (34%) a borderline RI and 20 (5%) a patho-logical RI. In this group 338 patients present one or more risk factorsfor ED.Conclusion: Color doppler sonography is important to evaluate theemodynamic parameters of the erectile dysfunction. Our data demon-strate the correlation between risk factors, age and clinical results ofpenile color doppler ultrasound.


J Sex Med 2007;4(suppl 2):152–202

PP-02-218

Testosterone gel therapy for LUTS in male patients: A treatment optionColombo, F.1; Guarneri, A.1; Romano, A. L.1; Inneo, E.1; Austoni, E.1

1San Giuseppe Hospital, Dept. of Urology, Milano, Italy

Objective: Low testosterone levels in the aging male may be associatedwith several symptoms negatively affecting quality of life and multipleorgan systems. This syndrome is better known as PADAM (PartialAndrogen Deficiency in the Aging Male). During the last few years thescientific community has focused more attention on aging male hypog-onadism, to improve quality of life to the ever growing elderly menpopulation. Male sexual dysfunction is often associated with lowerurinary tract symptoms (LUTS). All benign prostatic hypertrophy(BPH) treatment options affect sexuality and show an incidence ofdecreased libido and ED. This study intended to evaluate the role oftestosterone replacement therapy in patients over 60 years old, affectedby LUTS or ED and with border-line hormonal levels.Methods: From February through October 2005 we enrolled 18patients presenting with PADAM related symptoms and affected byBPH-related LUTS treated with 5alpha-blockers only. The treatmentprotocol established that all patient receive daily testosterone gel at thefixed dose of 50 mg, for 3 months. All patients were administered theAMSS questionnaire, as well as IPSS and IIEF-5. at the beginning andat the end of treatment. At the same timepoints, serum levels of testos-terone, SHBG, LH, FSH, PRL and PSA were measured in all patients.Results: Mean levels of testosterone at the end of treatment werenoted to be 13.8 nmol/L. Serum PSA remained substantially unvaried;an average 10-point improvement in AMSS was observed (from 30 to20) while the IIEF-5 score increased by 1.6 points only (from 17 to18,6). No significant differences in IPPS scores were observed at theend of treatment.Conclusion: The results of this preliminary study seem to support theusefulness of administering testosterone gel to a wider population.

PP-02-219

The quality of life, sexuality and cognitive functionsin patients diagnosed with PADAMNowosielski, K.1; Skrzypulec, V.1; Sipinski, A.2; Drosdzol, A.1

1Medical Universtity of Silesia, Sexology Department, Katowice, Poland;2Medical Universtity of Silesia, Department of Nursing and Midw, Tychy,Poland

Objective: The purpose of the study is to evaluate the quality of life,cognitive functions and sexuality of males over 45 with preliminarydiagnosis of Partial Androgen Deficiency in Aging Male (PADAM).Methods: The study was based on a questionnaire containing stan-dardized scales: WHO Quality of Life-BREF and Short GeneralHealth Questionnaire 12 for quality of life, Carrol Rating Scale fordepression, Sexuality Scale for sexuality, Trait Making Test Part B andMental State Examination (questions 2, 3, 4) to evaluate cognitivefunctions (memory and concentration). The inclusion criterion forinvestigated group was the Self-Esteem Test for PADAM score. Sta-tistical analysis was based on chi square, U Mann-Whitney test andlogistic regression in Statistica 6,0 computer software.Results: Among 76 males included in the study 50 were preliminarydiagnosed as having Partial Androgen Deficiency in Aging Maleaccording to Self-Esteem Scale for PADAM scores. The mean age ofrespondents was 57,48 ± 6,84 (range 46–76). The control and investi-gated group were homogenous in age and BMI. Quality of life andgeneral health was lover in PADAM group comparing to control.Sexual activity, sexual self-esteem was lower, memory and concentra-tion worse in investigated patients. Sexual depression level was higherin PADAM males. Level of sexual depression was significantly corre-lated with PADAM symptoms.Conclusion: PADAM has negative influence on sexuality, cognitivefunctions and quality of life. New methods of coping with andropausein aging males should be introduced to improve quality of life, sexuallife and cognitive functions.

PP-02-220

Histopathological proved prevention of post-prostatectomy cavernosal fibrosis with a 5PDE inhibitorIacona, F.1; Prezioso, D.; Somma, P.; Chierchia, S.; Galasso, R.; Di Martino, M.1University Federica II, Dept. Urology, Sect. Pathology, Naples, Italy

Objective: In a recent study we evidenced the progressive fibrotic cav-ernosal process in prostatectomized patients, with clear decrease ofelastic and smooth muscle fibers and increase of connective tissue (F.Iacono et al. J Urol. 173:1673–6.2005). Authors studied the efficacy ofsildenafil citrate to inhibit the fibrotic process evaluated on pre andpost prostatectomy cavernosal biopsy specimens.Methods: 21 patients (aging 54–70 y.o.) undergone to radical prosta-tectomy for prostatic cancer, have been treated with sildenafil citrateat the dosage of 50 mg, 3 times a week, for 2 months shortely aftersurgery. All the patients underwent to cavernous biopsy before theoperation and after 2 months of medical treatment. Formaline fixedtissue stained with Masson’s Trichrome method was evaluated byEureka Interface System (Menarini Diagnostic) with an analysis perarea and elastic fibers count was performed on 10–12 fields (X400) of5 seriate sections.Results: In all the patients, before and 2 months after the surgery andthe sildenafil treatment, the percentage of connective tissue in thecorpora cavernosa specimens was invariated, between 30 and 40% inthe per area analysis. Also the elastic fibrers count was invariated beforeand after treatment.Conclusion: In our previous study we evidenced the presence ofintensive cavernosal fibrosis in prostatectomized patients, due to thelocal hypoxia. Sildenafil, successfully used in the pulmonary fibrosis,due to a possible activity against the vasoconstrictive action of Endote-line 1, was effective to contrast the corpora fibrosis in this group ofpatients, for its strong vasodilatative action.


J Sex Med 2007;4(suppl 2):152–202

PP-03 Female Sexual Function and Dysfunction

PP-03-221

Correlation between FSFI scores and sexualdysfunction in male partners in a random sample ofregistered nurses: The Nurses Sexuality StudySand, M.1


Objective: To assess, in a random sample of female American Regis-tered Nurses the correlation between FSFI scores and the presence oferectile dysfunction (ED) or premature ejaculation (PE) in their malepartner.Methods: A random sample of 580 registered nurses was mailed a 58-item questionnaire in which the Female Sexual Function Index wasembedded. Two items addressed ED and PE. Differences betweengroups were tested using t-tests.Results: 133 responses were returned, of which 112 reported a currentmale partner. The proportion of women who reported sexual dys-function in their partner was 20.2% (PE) and 28.7% (ED) respectively.Women who reported ED in their partner were more likely to reportlower mean FSFI scores than women who did not (19.90 vs. 25.95, p< 0.001), while no such difference was noted in women who reportedPE compared with those who did not (24.07 vs 23.98, ns). Mean FSFIdomain scores in those women who reported ED in their male partnerwere significantly lower than those women who did not report ED,while Mean FSFI domain scores for those women who reported PEin their male partner were not statistically different from those whodid not report PE. (Table 1)Conclusion: Erectile dysfunction, but not premature ejaculation, wasassociated with significantly lower FSFI total and domain scores.Women presenting with sexual dysfunction who have a current malesexual partner should be asked about the presence of sexual dysfunc-tion in their partner.Policy of full disclosure: I am en amployee of BayerHealthcare,however this research was part of my PhD dissertaion and wasunfunded.

PP-03-222

Comparison of normative and menopausal women by the Brief Index of Sexual Functioning for Women (BISF-W)Kim, H.-Y.1; Huh, C.-Y.2; Bae, D.-H.3; Kang, J.-S.4; Kim, D.-H.5; Hong,S.-Y.6; Oh, S.-T.7; Lee, K.-H.8; Cho, S.-H.9; Kim, S.-R.10; Jung, M.-H.11

1College of Medicine, Kosin Uni, Dept. of Ob & Gyn., Busan, Republic ofKorea; 2College of Medicine, Kyunghee, Dept. of OB & GYN, Seoul, Repub-lic of Korea; 3College of Medicine, Soonchunh, Dept. of Ob & Gyn. Chunan,Republic of Korea; 4College of Medicine, Korea Uni, Dept. of Ob. & Gyn.,Seoul, Republic of Korea; 5College of Medicine, Chungang, Dept. of Ob &Gyn., Seoul, Republic of Korea; 6College of Medicine, Eulji Uni, Dept. of Ob& Gyn., Seoul, Republic of Korea; 7College of Medicine, Chonnam N, Dept. of Ob. & Gyn., Gwangju, Korea, Republic of; 8College of Medicine,Soonchunh, Dept. of Ob & Gyn., Bucheon, Republic of Korea; 9College ofMedicine, Hanyang U, Dept. of Ob & Gyn., Seoul, Republic of Korea;10College of Medicine, Hanyang U, Dept. of Ob & Gyn., Kuri, Republic ofKorea; 11College of Medicine, Kyunghee, Dept. of Ob & Gyn., Seoul, Repub-lic of Korea

Objective: The purpose of this study was to address whether there isan association between menopause status and various aspects of sexualfunctioning, and the relative contributions of menopause status andother variables to various aspects of sexual functioning by the BISF-W questionnaire among the Korean women.Methods: One hundred twenty-eight healthy women were classifiedas pre- and postmenopausal according to menstrual cycle characteris-tics. Women were nonrandomized to survey by BISF-W question-naire. Sexual functioning was measured in terms of dimensions D1(Thoughts/Desire), D2 (Arousal), D3 (Frequency of Sexual Activity),D4 (Receptivity/Initiation), D5 (Pleasure/Orgasm), D6 (RelationshipSatisfaction), D7 (Problems affecting Sexual Function), and compos-ite score.Results: Frequency of sexual arousal, physical contact, sexual desireand pleasure were significantly higher for the premenopausal women.Symptoms during sexual intercourse such as vaginal bleeding or irri-tation, pain, vaginal tightness, involuntary urination, headache, andvaginal infection was significantly greater for postmenopausal women.The dimensions D2 (Arousal), D3 (Frequency of Sexual Activity), D4(Receptivity/Initiation), D5 (Pleasure/Orgasm), D6 (Relationship Sat-isfaction), and the composite score decreased significantly for the post-menopausal women with D7 (Problems affecting Sexual Function) was significantly increase for the postmenopausal women. Pain duringintercourse among the dichotomous outcomes were unrelated tomenopausal status (p < 0.05). Q11 Reached orgasm and Q14 Othersymptom during sexual intercourse among the seven continuous werenegatively associated with menopause (p < 0.05).Conclusion: Menopause status is related to some, but not all, aspectsof sexual functioning. Menopause status has a smaller impact on sexualfunctioning than health or other factors.

PP-03-223

Association of Women’s FSFI Scores and sexualdysfunction in male partners in a sample of registerednurses: The Nurses Sexuality StudySand, M.1


Objective: To assess, in a sample of female American RegisteredNurses, the correlation between FSFI scores and reports of erectiledysfunction (ED) or premature ejaculation (PE) in their male partner.Methods: A random sample of 580 registered nurses was mailed a 58-item questionnaire in which the Female Sexual Function Index wasembedded. Two items addressed women’s reports of partner’s ED andPE. Differences between groups were tested using t-tests.Results: 133 responses were returned, of whom 112 reported a currentmale partner. The proportion of women who reported sexual dys-function in their partner was 20.2% (PE) and 28.7% (ED), respec-tively. Women who reported ED in their partner were more likely to


J Sex Med 2007;4(suppl 2):152–202

report lower FSFI scores than women who did not (20.39 vs. 25.59, p< 0.014), while no such difference was noted in women who reportedPE compared with those who did not (24.07 vs 23.98, ns). Mean FSFIdomain scores in women who reported ED in their male partner weresignificantly lower than those women who did not report ED, whilemean FSFI domain scores for women who reported PE in their malepartner were not statistically different from those who did not reportPE. (Table 1)Conclusion: Partner erectile dysfunction, but not premature ejacula-tion, was associated with significantly lower FSFI total and domainscores. Women presenting with sexual concerns who have a currentmale sexual partner should be asked about the presence of erectile dys-function in their partner. Clinicians need to be aware that the pres-ence of ED is likely to have a negative effect on the sexual experienceof both members of the couple.Policy of full disclosure: I am an employee of Bayer HealthCare.

PP-03-225

Prevalence of sexual disorders in women patientsconsulted urology clinicsEsen, A.1; Sicramaz, H.1; Sahin, A.2; Demir, O.1; Turan, D.2; Can, E.2

1Dokuz Eylul University, Urology, Izmir, Turkey; 2Tepecik Training Hospi-tal, Urology, Izmir, Turkey

Objective: The prevalence of female sexual disorder (FSD) is reportedbetween 25–63% in sexually active women. FSD prevalence is increas-ing with age and underlying disease such as diabetes, hypertension andcoronary arter disease. In our study, we aimed to calculate the preva-lence of FSD in married women consulted urology clinics.Methods: Between December-2005 to January-2006, 96 patients con-sulted to urology clinics of Tepecik Teaching Hospital and DokuzEylul University Medicine School with any complaints other thansexual dysfunction are included to study. Medical and sexual history ofpatients were taken and the questionnaire of Female Sexual DisordersIndex (FSFI) filled by patients. Interview with patients and filling thequestionnaire is done by a urology resident (HS) or nurse.Results: The mean age, marrital duration and first sexual intercourseage of women included study is 39.0 ± 12.1, 16.5 ± 13.8 and 21.5 ± 3.9years, respectively. The reason why the patients consulted urologyclinics described and the ratios are given in Table-1. The all subgroupsand total score of FSFI and the ratio of FSD determined patients inthis interview are shown in Table-2. According to this, FSD wasdetermined 46 (47.9%) of all patients included study, even they con-sulted with various reasons. In patients with complaints of inconti-nance FSD was determined approximately 80% of patients.Conclusion: Although patients do not declarete, female sexual disor-der is pretty often seen problem. We consider that women consultedurology clinics and who are sexually active might be questined forsexual functions with suitable approach.

PP-03-224

Sexual dysfunction in women with end stage renaldisease and the investigation of risk factorsKettas, E.1; Cayan, F.2; Akbay, E.1; Kiykim, A.3; Cayan, S.1

1University of Mersin School, Department of Urology, Turkey; 2Universityof Mersin School of, Department of Obstetrics and G, Turkey; 3University ofMersin School of, Department of Nephrology, Turkey

Objective: The aim of this study was to compare sexual dysfunctionbetween the women with end stage renal disease (ESRD) and healthywomen, and also to investigate risk factors that may cause sexual dys-function in the women with ESRD.Methods: The study included 200 women, and the women weredivided into two groups: 100 women with ESRD and 100 healthywomen as a control group. The study was approved by the ethical com-mittee. After obtaining demographic characteristics, female sexual dysfunction was evaluated with a detailed 19 item questionnaire (TheFemale Sexual Function Index, FSFI) assessing sexual desire, arousal,lubrication, orgasm, satisfaction and pain during sexual intercourse.The FSFI scores were compared between the two groups, and riskfactors that might cause sexual dysfunction were also investigated inthe women with ESRD.Results: The mean age of the women was 47.41 ± 10.28 in the ESRDgroup and 46.42 ± 10.2 in the control group, revealing no statisticallysignificance (p = 0.495). The mean FSFI total score was significantlylower in the ESRD group (13.44 ± 10.7) than in the control group(21.93 ± 7) (p = 0.001). The women with ESRD had also lower meanscore of sexual desire, arousal, lubrication, orgasm, satisfaction andpain than in the control group, revealing highly significant differencebetween the two groups (p = 0.001 for all domains). To investigate riskfactors for female sexual dysfunction in the ESRD group, there was nosignificant difference in the type of dialysis (p = 0.228), however, 4.63times higher risk in the presence of menopause (p = 0.002).Conclusion: This study shows that women with ESRD has higher riskof sexual dysfunction than healthy women. Thus, women with ESRDshould be consulted for sexual dysfunction.


J Sex Med 2007;4(suppl 2):152–202

PP-03-226

Risk factors of female sexual disordersEsen, A.1; Sahin, A.2; Sicramaz, H.1; Demir, O.1; Bal, E.2; Can, E.2

1Dokuz Eylul University, Urology, I.zmir, Turkey; 2Tepecik Training Hospi-

tal, Urology, I.zmir, Turkey

Objective: Female sexual disorder (FSD) is a versatile disease effectspatients and their partners with biologic and physicologic components.Age, education, depression, chronic diseases, menopause and generalhealth codition are effecting female sexual functions. In this study,patients who are consulted to urology polyclinics and sexually activeare included and aimed to determine the factors effecting sexual functions.Methods: Between December 2005 and January 2006, 96 patientsconsulted to urologic polyclinics of Tepecik Teaching Hospital andDokuz Eylul University Medicine School with any complaints areincluded to study. Medical and sexual history of patients assumed andthe questionnaire of Female Sexual Disorders Index (FSFI) filled bypatients. Interview with patients and filling the questionnaire is doneby a female urology resident or nurse. Age, educational status andpartners’ sexual status of patients compared with FSFI scores.Results: The mean age and marital duration of patients included thestudy 39.0 ± 12.1 and 16.5 ± 13.8 years, respectively. The mean FSFIscore of all patients is 24.5 ± 8.3. Thirteen patients (14%) had cardio-vascular disease and, 21 of all patients’ partner (22%) had sexual disorders (erectile dysfunction and/or premature ejaculation). In thecorrelation analyzes it has been found a significant relation betweenFSD and both age and partners sexual disorders (p < 0.001, r = −0.456;p = 0.016, r = −0.246, respectively), however there is no relation witheducational status.Conclusion: These results suggest that increasing age and presenceof men’s sexual disorders effects women sexual disorder. We considerthat treatment of men’s sexual disorders will improve the quality ofwomen’s sexual function.

PP-03-227

The combined use of of brachial artery flow mediateddilatation and carotid artery intima media thicknessmeasurements is an alternative method to penile colordoppler ultrasonographyUcar, G.1; Secil, M.1; Demir, O.2; Demir, T.3; Comlekci, A.3; Caliskan, S.4;Esen, A.21Dokuz Eylul University, Radiology, Izmir, Turkey; 2Dokuz Eylul Univer-sity, Urology, I

.zmir, Turkey; 3Dokuz Eylul University, Endocrinology and

Metabolism, I.zmir, Turkey; 4Dokuz Eylul University, Biochemistry, I

.zmir,

Turkey

Objective: To investigate the relationship between penile colorDoppler ultrasonography (CDU) findings and ultrasonographicendothelial parameters in patients with erectile dysfunction (ED).Methods: Fifty-six consequent ED patients with IIEF scores ≤25 wereincluded in the study. Penile (CDU) was performed to determine thevasculogenic origin of ED. Thereafter, intima-media thickness (IMT)of common carotid arteries and flow mediated vasodilatation (FMD)of brachial artery which are accepted to be morphological and physi-ological markers of endothelial dysfunction, respectively, were per-formed in all patients.Results: According to penile CDU findings, 27 patients had nonvas-culogenic and 29 patients had vasculogenic ED. Among these 29patients, 17 patients had venoocclusive insufficiency and 12 patientshad arterial or combined insufficiency. FMD of nonvasculogenic groupwas 14.50% and in vasculogenic group was 9.54%. IMT measurementsof the same groups were 0,63 mm and 0.86 mm, respectively. The dif-ferences between the groups were statistically significant for bothFMD and IMT results. IMT values of venooclusive insufficiencypatients were higher than nonvasculogenic ED patients (p < 0.05).FMD was found to be impaired significantly in patients with combinedor arterial insufficiency when compared with the venooclusive insuffi-ciency patients.

Conclusion: The combined use of brachial artery FMD and carotidarteries IMT measurements may be suggested as an alternative methodto penile CDU.

PP-03-228

Penile Doppler findings of arterial flow in relation to vascular risk factors in patients with erectile dysfunctionRokkas, K.1; Vlachopoulos, C.1; Ioakeimidis, N.1; Antoniou, G.1; Tsokanis, A.1; Bratsas, A.1; Askitis, A.1; Stefanadis, C.11Hippokration Hospital, 1st Department of Cardiology, Athens, Greece

Objective: Erectile dysfunction (ED) is associated with risk factors,including diabetes, hypertension and hypercholesterolemia. Aim of thepresent study was to investigate the effect of each individual risk factoron penile vascular hemodynamics.Methods: A total of 110 consecutive men (mean age 60 ± 11 years)with symptoms of ED were evaluated for penile vascular disease sever-ity by penile Doppler ultrasound: 41 men were treated hypertensives(HP), 24 men had hypercholesterolemia (HL) and 23 men had dia-betes (DM). We also evaluated 22 men with no risk factor (w/o RF)matched for age, body-mass index and intensity of smoking with thethree subgroups. The flow parameters of the cavernous arteries includ-ing, peak systolic velocity (PSV) and end-diastolic velocity (EDV) werecompared according to the presence of various risk factors. A meanPSV below 25 cm/s was considered to indicate arterial insufficiency.Results: The greatest decrease in PSV occurred in hypertensive men,whereas the greatest increase in EDV was observed in diabetic patients(figure). Furthermore, men with no risk factors had similar values ofEDV with those of diabetic men and higher compared to patients withhypertension and hypercholesterolemia. A multiple logistic regressionanalysis was performed with arterial insufficiency as dependent vari-able and hypertension, diabetes, hypercholesterolemia, age and anti-hypertensive agents as predictive variables. In this model, hypertension(O.R: 3.3, 95%CI: 0.9–11.5, P < 0.01), hypercholesterolemia (O.R:2.0, 95%CI: 0.5–8.9, P < 0.05) and b-antagonists (OR: 1.7, 95%CI:0.5–6.3, P < 0.05) were strong and independent markers for presenceof arterial insufficiency.Conclusion: Penile hemodynamic findings are related to vascular riskfactors. Furthermore, hypertension followed by hypercholesterolemiaand b-antagonists are strong predictors of severe arteriogenic ED.These findings provide further evidence for the close interrelationshipbetween vascular risk factors and ED.


J Sex Med 2007;4(suppl 2):152–202

PP-03-229

Aortic stiffness and carotid intima media thickness areassociated with penile Doppler findings in patientswith vasculogenic erectile dysfunctionVlachopoulos, C.1; Ioakeimidis, N.1; Tsekoura, D.1; Rokkas, K.1; Aznaouridis,K.1; Pietri, P.1; Askitis, A.1; Stefanadis, C.11Hippokration Hospital, 1st Department of Cardiology, Athens, Greece

Objective: Erectile dysfunction (ED) and atherosclerotic disease havecommon vascular pathology related to impairment of endothelium-dependent vasodilation and late structural vascular abnormalities. Vas-culogenic ED has been reported as the first sign of a generalizedvascular disease. Intima-media thickness (IMT) and aortic stiffness areuseful markers in predicting the burden of atherosclerosis. The asso-

ciation between ED and measures of IMT and aortic stiffness has notbeen investigated.Methods: A total of 108 men with ED were evaluated for penile vas-cular disease severity by penile Doppler ultrasound: 31 men (aged 61± 9 yrs) with coronary artery disease (CAD) and 69 men (aged 59 ± 11yrs) without CAD. Mean IMT of common carotid arteries was deter-mined as a marker of generalized early atherosclerosis using B-modeultrasound imaging. Carotid-femoral pulse wave velocity (PWV) wasmeasured as an index of aortic stiffness using an automated non-inva-sive device (Complior®).Results: Peak systolic velocity (PSV) was inversely correlated with age(r = −0.24, p < 0.05), pulse pressure (r = −0.25, p < 0.05), Framinghamscore (r = −0.28, p < 0.05), IMT, PWV and high sensitivity C-reactiveprotein (hsCRP) (figure). After adjusting for potential confoundingfactors such as age, mean pressure, body-mass index, total cholesterol,HDL, hsCRP and intensity of smoking, in multivariate linear regres-sion models, penile PSV was independently associated with both IMT(b = −0.35, p < 0.01) and PWV (b = −0.27, p = 0.02) (adjusted R2 ofmodels 0.27 and 0.25 respectively).Conclusion: Carotid IMT and aortic stiffness are associated withimpaired erectile function as estimated by penile PSV. This findingprovides further insights into the pathophysiology of ED and may haveimplications for the cardiovascular risk in these patients.

PP-03-230

Plasma concentration of asymmetric dimethylarginine(ADMA) in relation to vasculogenic erectiledysfunction in patients with and without coronaryartery diseaseIoakeimidis, N.1; Vlachopoulos, C.1; Vasiliadou, C.1; Rokkas, K.1; Bratsas,A.1; Siasos, G.1; Askitis, A.1; Stefanadis, C.11Hippokration Hospital, 1st Department of Cardiology, Athens, Greece

Objective: Erectile dysfunction (ED) shares common risk factors withcoronary artery disease (CAD) and endothelial dysfunction appears tobe a link between these conditions. The endogenous competitiveinhibitor of the nitric oxide synthetase, asymmetric dimethylarginine(ADMA), has been recently identified as a risk factor for future car-diovascular events. Aim of this study was to assess whether increasedlevels of ADMA are associated with ED in patients with and withoutCAD.Methods: A total of 140 men (mean age: 59 yrs) were studied: 48 menhad ED without evidence for CAD (ED w/o CAD), 35 men had EDand angiographically documented CAD (CAD plus ED), 25 men hadangiographically documented CAD and normal erectile function(CAD w/o ED) and 32 men were controls with normal erectile func-tion and no CAD. ED patients were submitted for penile color duplexDoppler ultrasonography to assess penile hemodynamic parameters.Results: In patients without CAD, subjects with ED had significantlyincreased ADMA levels compared to subjects without ED (p = 0.01,figure). In patients with CAD, subjects with ED had significantlyincreased ADMA levels compared to subjects without ED (p < 0.05).Interestingly, ADMA levels were comparable among ED w/o CADand CAD w/o ED subgroups, indicating that the unfavorable effect ofED on ADMA is similar to that of CAD. Moreover, there was a pro-gressive increase in ADMA levels from patients with cavernous venousocclusive disease [0.64 (0.46–0.84) µmol/l] to patients with mild arte-rial insufficiency [0.67 (0.47–0.91) µmol/l] and patients with severearterial insufficiency, [0.73 (0.55–0.93) µmol/l], (p < 0.05).Conclusion: Increased ADMA levels are related to the presence andseverity of ED. This finding may provide additional information to thepathophysiology of ED in men with and without CAD.


J Sex Med 2007;4(suppl 2):152–202

PP-03-231

Temporal relationship between erectile dysfunction,cardiovascular disease and quality of lifeHodges, L.1; Kirby, M.2; O’Donnell, J.3; Brodie, D.1

1Buckinghamshire Chilterns Univ, Research Centre for Health Stu, UnitedKingdom; 2University of Hertfordshire, HertNet, United Kingdom; 3FarnhamRoad Surgery, Farnham Road Surgery, Buckinghamshire, United Kingdom

Objective: Erectile dysfunction (ED) is an important health issue andmay be an independent marker for cardiovascular disease (CVD) inpreviously asymptomatic people. The objective was to assess the tem-poral relationship between erectile dysfunction and cardiovasculardisease and to examine the impact of this on quality of life.Methods: Erectile dysfunction (ED) is an important health issue andmay be an independent marker for cardiovascular disease (CVD) inpreviously asymptomatic people. The objective was to assess the tem-poral relationship between erectile dysfunction and cardiovasculardisease and to examine the impact of this on quality of life.Results: Erectile dysfunction was reported in 62% of individuals withcardiovascular disease with a mean duration of 5.2 ± 5.6 years. Thiscompared with 38% in the control group with a mean duration on 7.5± 7.0 years. Only 52% of the CVD group and 47% of the controlgroup had discussed their erectile dysfunction with a health profes-sional. Erectile function had a stepped relationship with quality of life.The international index of erectile function declined from 13.5 to 7 (p< 0.05) after the cardiovascular group had suffered an event.Conclusion: The data demonstrated that a cardiovascular event makesED worse. Approximately half of the men whose quality of life isimpaired were not consulting with a health professional. This meansthere are missed opportunities to undertake a CVD risk assessmentand provide intervention. Men with ED should be specifically targetedfor CVD preventative strategies both pharmacologically and in termsof lifestyle changes.Policy of full disclosure: We would like to acknowledge Pfizer whofunded the study through an educational grant.

PP-03-232

Arterial stiffness predicts the level of thepharmacological induced erectile response inmetabolic syndromeCoca, V.11Pfizer Romania, Bucharest, Romania

Objective: Watching the erectile capability in metabolic syndrome(MetS) after Sildenafil usage for erectile dysfunction (ED), accordingto the arterial stiffness (AS).Methods: In 216 men (44.72 ± 5.28 years old) with MetS (IDF crite-ria), pulse wave velocity (PWV) and erectile function were assessed. In97 of them (44.9%) ED was found using the IIEF-5 questionnaire

(V1). For PWV a CompliorSP ultrasound device were used also at V1.The erection degrees (penile tumefactions) were determined at V1, V2after 8 weeks of Sildenafil 50 mg, for the all participants, and at V3after 4 weeks of Sildenafil 100 mg usage, only for those who main-tained erectile levels ≤2° after V2. Results were expressed in percent-ages (%) and by calculating p value significance.Results: 1) According to PWV there were: Group A: PWV > 10 m/s,highly increase AS (34 men, 35.05%); Group B: PWV = 7–9.9 m/s,increased AS (30 persons, 30.92%); Group C: PWV < 5 m/s, non-increased AS (15 persons = 15.46%); Group D: PWV between 5.1–6.9 m/s, non-relevant (18 men, 18.57%). 2) IIEF-5 score were: V1:group A = 8.67 ± 2.4 vs. group C = 11.09 ± 1.82, (p = 0.07); V2: groupA = 14.1 ± 0.66 vs. group C = 19.67: p = 0.04. 3) Prevalence of theerections (penile tumefactions) between 3°–4° of intensity (see table).Conclusion: Arterial stiffness initially indicates a worse ED score inmetabolic syndrome persons and predicts the level of the erectileresponse to Sildenafil. High PWV could reasonable recommendsincreasing Sildenafil doses.

PP-03-233

Sexual problems in hypertensive Turkish women inTurkey and Germany: A transcultural studyDemirezen, E.1; Henke, U.2; Sanli, O.3; Kadioglu, A.3

1I.U.Florence Nightingale HYO, Public Health Nursing, Istanbul, Turkey;2Evangelische Fachhochschule RW, University of Applied Sciences, Bochum,Germany; 3Istanbul University, Istanbul, Section of Andrology, Turkey

Objective: Hypertension rate is around 56% among Turkish womenin Turkey but not well known among Turkish immigrants residing in Germany. Cardiovascular problems known to be major problem inthis largest immigrant group in Germany. The objective of this study was to evaluate sexual problems and related factors in hyperten-sive Turkish women residing in Turkey and residing in Germany asimmigrants.Methods: In this transcultural study, data were collected from 224Turkish women (109 residing in Turkey -Group 1 and 115 inGermany- Group 2) with a questionaire consisting of sociodemo-graphic data and medical history (duration of hypertension, treatmentalternatives, diabetes, obesity, smoking, hypercholesterolemia, depres-sion, menopause and past gynecological operations). Data were col-lected by one investigator (ED). Female sexual function was evaluatedwith FSFI and total score ≤26.55, and domain score ≤3 were consid-ered as abnormal.Results: Overall, mean ages of group 1 and 2 were 56.00 ± 9.20 and57.09 ± 7.82, respectively. The duration of residence in Germany was27.90 ± 7.64 years. The FSD rate was equal (82.6%) in both groups.Desire, arousal, lubrication, orgasm, satisfaction and pain problemrates were for patients residing in Turkey and Germany 79,8%, 67.9%,33.9%, 46.8%, 43.1%, 33.0 and 86.1%, 69.6%, 36.5%, 51.3%, 42.6%,28.7% respectively. There was no correlation between comorbidfactors and FSD in group 1. however, menopause and diabetes werefound to be significant in group 2.Conclusion: The present study revealed that FSFI and domain scoreswere similar among hypertensive residents in Turkey and Germany.Non comorbid factor was predictive in women residing in Turkey,meanwhile menapouse and diabetes were more common amongpatients residing in Germany.


J Sex Med 2007;4(suppl 2):152–202

PP-03-234

The evaluation of sexual function in the marriedwomen applied to the physical therapy andrehabilitation in outpatient clinicHuri, E.1; Huri, M.2; Kayihan, H.21Ankara Gölba y State Hospital, Urology, Turkey; 2Hacettepe University,Physical Therapy and Rehabilit, Ankara, Turkey

Objective: We determine sexual function status in married womenwho undergone to the physical therapy in outpatient clinic.Methods: In 40 married women, types and duration of symptoms wereevaluated. History, physical examination and laboratory tests were per-formed. 15 sessions physical therapy was planned during 3 weeks. Atthe begining of therapy and end of 15. session, Female Sexual FunctionIndex (FSFI) was filled. Sexual desire, arousal, lubrication, satisfaction,orgasm and pain were evaluated. Pearson Chi-Square Test was used.Results: Mean age was 42.2 (25–66). Physical treatment programmewas started in the patients of 26 lumbar disc hernia(LDH), 14 cervi-cal hernia, fibromyalgia. Mean duration of symptoms was 7.9 (4–23)month. In 10 (%25), menopous, 4 patients, hormone replacementtherapy (HRT) was detected. Gynecologic surgery was confirmed in6. The relation between menopous and sexual activity frequency,diminished sexual arousal, gynecologic surgery was significiant (p >0.5). The significiance between age and pain, satisfaction was detected(p > 0.5). While there was exact correlation between the patients ofLDH and fibromyalgia and the use of HRT, desire, arousal before thetherapy (p > 0.5), no correlation was detected comparing with lubri-cation, satisfaction and pain (p < 0.5). There was no difference in theevaluation of sexual function among two groups (p < 0.5). Followingthe therapy, the correlation of increased satisfaction in the sexual activ-ity with decreased physical symptoms was determined (p > 0.5).Conclusion: Sexual function in the patients of LDH and fibromyal-gia accompanied by pain can be effected, however, it can be better inwell shaped patients following the treatment.

PP-03-235

Prevalence of sexual dysfunction in women over 20years of age in IstanbulAslan, E.1; Kizilkaya Beji, N.1; Gungor, I.1; Kadioglu, A.1; Kucuk Dikencik, B.11Istanbul University, Florence Nightingale School, Turkey

Objective: This study was planned in order to determine the preva-lence and risk factors of female sexual dysfunction in women living inIstanbul, Turkey.Methods: The study was conducted in Istanbul University betweenJanuary and July 2006. Ethical approval was obtained. Total of 1264women who applied to the outpatient of the Department of InternalMedicine or their female companions were interviewed. Sexually active945 women over 20 years of age were included to the sample of thestudy. In order to constitute the stratified sample of the study, thenumbers of the women in each age group were calculated accordingto census 2000 in Istanbul. Data were obtained via face-to-face inter-views with questionnaire and Female Sexual Function Index (FSFI) toevaluate.Results: The mean age was 39.22 ± 12.38 in women. Of the womeninterviewed, 23.3% were postmenopausal. The mean FSFI score wasfound as 23.91 ± 9.64 over a maximum total score of 36. Based on totalFSFI score, 44.9% of the women had scores less then 26. The meandomain scores were found as: 3.08 ± 1.45 for desire, 3.53 ± 1.87 forarousal, 4.48 ± 2.04 for lubrication, 3.97 ± 2.00 for orgasm, 4.23 ± 1.65for satisfaction and 4.66 ± 2.00 for pain. The rate of female sexual dys-function by the age groups were 23.4% in the ages of 20–29 years,40.8% in the ages of 30–39 years, 50% in the ages of 40–49 years,71.3% in the ages of 50–59 years, 82.1% in the ages of 60–64 years, 86.5% in the ages of 65 and over.Conclusion: The prevalence of sexual dysfunction was found as sig-nificantly increasing with age. Most significantly effected domain wasfollowed by desire, arousal and orgasm in all age groups.

þ

PP-03-236

Relaxation of isolated rat vaginal strips and clitoralcorpus cavernosum by PDE-5 inhibitorsTinel, H.1; Huetter, J.1; Sandner, P.1

1Bayer Health Care, Pharmacology, Wuppertal, Germany

Objective: Disorders of genital arousal in women include not onlydiminished vaginal lubrication and decreased clitoral sensation, butalso lack of vaginal smooth muscle relaxation. The aim of the presentedstudy was to assess the potential of different PDE-5 inhibitors to mod-ulate the female sexual dysfunction.Methods: Clitoral corpus cavernosum and vaginal strips were isolatedfrom female Wistar rats and studied in the organ bath under isomet-ric tension.Results: Vardenafil at 1 and 10 µmol/l induced a relaxation of clitoralcorpus cavernosum pre-contracted with 1 µmol/l norepinephrine by54.5 ± 4.9% and 87.7 ± 6.1% respectively. The relaxation induced bysildenafil at the same concentrations was 18.5 ± 3.6% and 59.3 ± 6.0%.Tadalafil, up to 10 µmol/l, was not able to reduce the contraction ofthe rat clitoral corpus cavernosum. In experiments with vaginal strips;all three PDE-5 inhibitors induced relaxation of the tissue pre-con-tracted using 50 mmol/l KCl. Vardenafil at 0.1, 1 and 10 µmol/linduced a relaxation by 22.2 ± 3.3%, 76.8 ± 3.4%, and 98.2 ± 0.5%respectively. The relaxation induced by sildenafil at the same concen-trations amounted to 12.0 ± 2.4%, 45.2 ± 3.4% and 91.8 ± 1.6%.Tadalafil induced a significant relaxation of vaginal strips at 1 µmol/lby 19.8 ± 1.6% and at 10 µmol/l by 48.0 ± 3.1%.Conclusion: PDE-5 inhibition leads to smooth muscle relaxation inisolated rat vaginal strips and rat clitoral corpus cavernosum. Varde-nafil, sildenafil and tadalafil may be useful for treatment of femalesexual dysfunction.Policy of full disclosure: all authors are employees of Bayer HealthCare.

PP-03-237

Mild genital prolapse does not affect female sexual functionCho, H.1; Kim, J.1; Kim, J.1; Kim, M.2; Rhew, Y.3; Kwon, D.3; YoungTaek, L.2; Youn, H.4; Jung, M.1; Jun, C.1

1Catholic University, Obgyn, Seoul, Youngdungpogu, Republic of Korea;2Catholic University, Obgyn, Seoul, Seochogu, Republic of Korea; 3CatholicUniversity, Obgyn, Suwan, Republic of Korea; 4Best skilled obgyn, Obgyn,Seoul, Youngdungpogu, Republic of Korea

Objective: The aim of the present study was to evaluated the rela-tionship between the degree of prolapse of each compartment of POP-Q and sexual dysfunction.Methods: Between Nov. 2005 and Jan. 2006, women who visited hospi-tal for routine check up were asked to participate this study. Total twohundred eighty patients were enrolled this study. Women completed theFSFI questionnaires and their POP-Q were evaluated. Patients werecategorized into three groups in each measured point of POP-Q, andtheir FSFI scores were compared. The Excel was used for computerizedestimation. Score of FSFI of each group was tested with T-test, with sig-nificant values of p was under 0.05. Table 1 shows the contents of FSFIquestionnaires. Grouping of patients: Patients were grouped into threeby score of each point of POP-Q. Ninteen Scores of FSFI were analyzedand compared between groups of each point of POP-Q.Results: Aa, Ba, Ap, Bp were checked below -1 in all women. Aa (-1)had higher frequency, less difficulty and higher satisfaction in orgasmthan Aa (-2) and Aa (-3) (p < 0.05). Ba (-1) and Ba (-2) showed muchfrequent orgasm than Ba (-3). Ap (-1) had higher frequency and lessdifficulty in orgasm than Ap (-2) and Ap (-3). Bp (-1) and Bp (-2) hadhigher frequency and less difficulty in orgasm in Bp (-3). (p < 0.05).Conclusion: This study is not the conclusive one to evaluate the rela-tionship between the prolapse of pelvic floor and sexual problem.Although, we can conclude the prolapse of pelvic floor does not alwaysaffect the female sexuality, especially in minor degree. Further studiesabout the relationship between higher degree of the prolapse andsexual dysfunction should be continued.


J Sex Med 2007;4(suppl 2):152–202

PP-03-238

The Effects of vaginal birth on postpartum sexual functionYildirim, G.1; Kizilkaya Beji, N.1; Comert, N.2; Kucuk Dikencik, B.1;Tekirdag, A. I.2; Kadioglu, A.3

1Instanbul University, Florence Nightingale School of, Istanbul, Turkey;2Bakirkoy Maternity and Child H, Obstetric, Istanbul, Turkey; 3IstanbulUniversity, Urology, Turkey

Objective: This study was planned to determine the effects of perinealtrauma on postpartum sexual function.Methods: The study was conducted in 2004 in Istanbul. One hundredand sixty five women were observed during birth. The women wereinvited to the hospital for controls by phone three months after birth.Fifty five women came to the hospital for the controls. Gynaecologicexaminations were done in postpartum control. In order to evaluatethe sexual function in women a semi structured questionnaire form wasused before pregnancy and FSFI was used three months after birth inaddition to the semi structured questionnaire.Results: Forty five percent (n = 27) of women were primiparous and50,9% (n = 28) were multiparous. In the episiotomy group (n = 31),the number of women who reported lack of sexual desire was threebefore pregnancy and this was found as 14 after birth. Eleven womenreported a decrease in sexual arousal compared to pre-gestational level.Thirteen of the women reported a decrease in the frequency of orgasmafter birth. Eight of the women had dyspareunia before birth and 15had this problem after birth. In the group with episiotomy and seconddegree perineal tears (n = 15), two women reported a decrease in thesexual desire before pregnancy and 6 women reported a decrease afterbirth. Three of the women reported a decrease in sexual arousal com-pared to pre-gestational level. Seven women reported a decrease inlubrication after birth. Six of women reported a decrease in the fre-quency of orgasm after birth. Five of the women reported dissatisfac-tion in sexual life after birth while this number was only one beforepregnancy.Conclusion: Compared to women with intact perineum, a significantincrease found in desire, orgasm and pain complaints in women whohad episiotomy or episiotomy with second degree perineal tears.

PP-03-239

Evaluation of female sexual function in patientsunderwent surgery for urogenital prolapseZucchi, A.1; Costantini, E.1; Giannantoni, A.1; Fioretti, F.1; Bitelli, M.2;Mearini, L.1

1University of Perugia, Urology and Andrology Dept., Italy; 2Cassino Hos-pital, Urology, Italy

Objective: Sacropexy (SCP), with or without hysterectomy, is a validtechnique for the repair of severe urogenital prolapse. For many years,uterine prolapse has represented an indication for hysterectomy,regardless of the whether or not there is actually an uterine pathology.Nevertheless, it is essential to consider the possibility of sparing theuterus, because women today consider it increasingly important notonly to have a normal sex life but also to maintain physical and anatom-ical integrity. The aim of this study was to assess sexual function in agroup of patients who underwent SCP or hysterocolposacropexy(HSCP).Methods: 37 patients underwent surgery for urogenital prolapse (15HSCP—22 SCP). Based on sexual history, all patients were sexuallyactive before surgery. At a mean follow-up of 39 months (r. 9–132) wereassessed the patients with Female Sexual Function Index. We con-sidered sexual activity with a score of 30 good, 23 to 29 intermediate,and <23 poor.Results: In patients who underwent SCP and HSCP, respectively,sexual activity was good in 13% and 26%, intermediate in 33% and21%, and poor in 54% and 53%, also considering 5 patients (22%)and 1 patient (6%) who no longer had sexual activity postoperatively.Conclusion: In the past, no consideration has been given to theproblem of sexuality among patients who undergo pelvic surgery for

urogenital prolapse, and questionnaires assessing the sexual activity ofthese patients have been introduced in the clinical practice onlyrecently. Data from literature indicates that sexual function improvesafter surgery for urogenital prolapse and that a hysterectomy not onlyaffects the patients’ sexual activity but even improves certain aspects.Our data reveals that there are no substantial differences regardingsexual activity in patients in which the uterus has been spared or not.Furthermore surgery reduces sexual activity in 16% of pts.

PP-03-240

Sexual health of women married to men sufferingfrom the vascular form of sexual dysfunctionsGorpinchenko, I.1; Romashchenko, O.1; Melnikov, S.1; Bilogolovskaya, V.11Institute of Urology, Sexology and Andrology, Kyiv, Ukraine

Objective: Assessment of the sexual health of women whose husbandssuffer from the vascular form of sexual dysfunctions.Methods: Sexological, gynaecological and psychological checkup of32 women aged from 20 to 40 whose husbands suffer from the vascu-lar form of sexual dysfunctions was carried out. Middle age of thepatients is 29.5 years.Results: All the married couples experienced family sexual dishar-mony. 21 (65.6%) women had sexual dysfunctions: 7 (21.9%) of themexperienced reduction of libido, 4 (12.5%)—anorgasmia, 5 (15.6%)—lubrication failure, 5 (15.6%)—dyspareunia. The revealed sexual dys-functions were predetermined by the absence of harmony of the sexualrelations in marriage. In 12 (37.5%) cases such sexual dysfunctionsbecame stable after 1–2 years of joint life, and in 6 (18.7%) cases sexualdysfunctions became stronger against a background of different viola-tions of gynaecological health (after having abortions or inflammatorydiseases of the organs of small pelvis). Women with sexual dysfunc-tions didn’t find necessary to ask for specialized sexological and psy-chological help before.Conclusion: Sexual violations in women whose husbands suffer fromthe vascular form of sexual dysfunctions are observed in 65,6% ofcases. Sexual violations became stable after 1–2 years of joint life.Sexual health of the couple should be assessed in a common sense, andsexual dysfunctions in one of the partners—taking into considerationthe psychosocial and medical aspects of the sexual activity of man andwoman.

PP-03-241

Sexual dysfunction among female patients withBehcet’s diseaseKadioglu, P.1; Ozgil Yetkin, D.2; Aliustaoglu, S.3; Yalin, A. S.2; Hatemi, G.4;Oral, G.5; Kadioglu, A.6

1Cerrahpasa medical faculty, Endocrinology and diabetes, Istanbul, Turkey;2Istanbul University Cerrahpasa, Endocrinology and diabetes, Turkey; 3Cer-rahpasa medical faculty, forensic psychiatry, Istanbul, Turkey; 4Istanbul Uni-versity Cerrahpasa, Rheumatology, Turkey; 5Istanbul University Cerrahpasa,Forensic psychiatry, Turkey; 6Istanbul University, Urology, Turkey

Objective: The aim of this study was to investigate sexual dysfunctionand depression in female patients with mucocutaneous Behcet’sdisease.Methods: Twentyfive women with mucocutaneous Behcet’s disease(mean age: 24.86 ± 4.88 SD) and 16 age matched healthy control wereincluded. All subjects were evaluated with Female Sexual FunctioningIndex Questionnaire (FSFI) and Beck’s Depression Inventory (BDI).Serum levels of prolactin, dehydroepiandrosterone sulfate, free testos-terone, total testosterone, androstenedion, 17-hydroxyprogesterone,estradiol were measured.Results: The mean serum levels of hormones in Behçet’s patients werenot different from control group, except for androstenedion. Themedian serum level of androstenedion was 1.61 [IQR:1.07–2.65] inBehçet’s patients vs 2.33 [IQR:1.4–2.8] in healthy controls (p = 0.013).Sexual dysfunction was diagnosed in 15 of 25 patients (60%), and 2 ofhealthy women (12.5%) (p = 0.001). Total FSFI score was median 19.6[IQR:17.35–24.32] among the patients while, 30.65 [IQR:27.9–33.05]


J Sex Med 2007;4(suppl 2):152–202

among control group, (p < 0.001). These scores were not correlatedwith age, duration of disease and hormone levels. During the previous3 months 8 of 25 of Behçet’s patients had recurrent genital ulcers. TheFSFI score was lower in Behçet’s patients with genital ulcers, but the difference was not statistically significant (median:19.6[IQR:18.42–27.55] vs 26.15 [IQR:17.7–27.9], p = 0.65). Sexual dys-function was present in 6 of 8 patients with genital ulcers and 9 of 17patients without genital ulcers (p = 0.64).Conclusion: The prevalence of sexual dysfunction was 60% amongfemale patients with mucocutaneous Behcet’s disease, irrespective ofage, duration of disease, hormone levels, and the presence of genitalulcers. Screening and treatment of sexual dysfunction should not beignored in Behcet’s patients.

PP-03-242

The effect of pregnancy and post-partum period onfemale sexual functionGoren, M. R.1; Peskircioglu, L.1; Acar, N.1; Ozkardes, H.1

1Baskent University School of M, Department of Urology, Ankara, Turkey

Objective: To determine the factors effecting female sexuality duringpregnancy and post-partum period.Methods: One hundred volunteer women who had given a birthwithin last one year were included in the study between February 2005and April 2006. All women were asked to answer a questionnaire con-sisting of Female Sexual Function Index (FSFI) (Turkish validation byTurkish Society of Andrology) and questions directed towards women’sself comments on factors affecting their sexuality.Results: With this questionnaire parameters about arousal, lubrica-tion, orgasm, desire and pain during and after pregnancy were evalu-ated. Besides, the comments of women on factors such as timing,anxiety or religious beliefs about sexual functions during and afterpregnancy were analyzed.Conclusion: Both pregnancy and post-partum periods affect femalesexuality significantly. To determine the causes of this interactionclearly and scientific guidance of women will provide the improvementof sexual health during these periods.

PP-03-243

Is there an association between menopause, moodstatus and sexual functioning?Gyovai, G.1; Huszka, C.1; Lakatos, A.2; Racz, F.1; Nyari, T.3; Ugocsai, G.1

1Szentes Teaching Hospital, Obstetrics and Gynaecology, Hungary; 2SzentesTeaching Hospital, Urology, Hungary; 3Szeged University, Biostatistics,Hungary

Objective: The purpose of this study was to address whether (1) thereis an association between the menopause status and the various aspectsof sexual functioning, and whether (2) mood status such as depressionor dysthymia influences sexual functioning. Recent studies havedemonstrated a significant association between menopausal transitionand a higher risk of developing depression as well as a greater preva-lence of decreased libido in patients with depression compared to pre-menopausal controls.Methods: Investigations are based on 60 women from our clinic, a population-based sample of women transitioning through themenopause meeting the following criteria: the time elapsed from thelast menstruation was at least 1 year and the patient had no HormoneReplacement Therapie (HRT), no surgical menopause, and hadregular partners. The analysis made use of the following validatedquestionnaires: The changes in Sexual Functioning Questionnaire(CSFQ), a structured interview/questionnaire to measure illness andmedication-related changes in sexual functionig as well as the BeckDepression Scale (BDS) to score mood changes of the menopausaltransition. The Chi Quadrat Test was used to evaluate collected data.Results: Loss of libido was significantly correlated with depressionmeasured on the BDS. Furthermore depressed women reportedoftener being “never or rarely have an orgasm” than patients withoutdepression, however this difference was not significant.

Conclusion: Our data suggests that women in the changing yearsexperience frequent problems with sexual disfunctions (especiallylibido) that highly correlates with mood status. This might be animportant factor at evaluating such patients in order to be able to selectappropriate medication.

PP-03-244

Urinary incontinence in women: A questionnairestudy of social and sexual quality of lifeCeresoli, A.1; Colombo, F.1; Romano, A. L.1; Rivolta, L.1; Austoni, E.1

1San Giuseppe Hospital, Urology, Milan, Italy

Objective: Female urinary incontinence (UI) is a well known clinical-social condition that adversely affects social and sexual activities offemale patients. This study intended to evaluate the impact of UI onsocial and sexual quality of life and to understand the reasons under-lying the delay in recourse to medical care.Methods: From January 2002 through December 2005, we evaluated176 outpatients who had arrived at our clinics either for urinary incon-tinence-related problems (104 patients) or for surgery follow-up visits(48 patients, at least 4 years post-surgery) or for other reasons. Afteradministration of the integrated ICIQ-LF questionnaire, the UIpatients were divided into groups: stress urinary incontinence (SUI):46 patients; detrusor hyperreflexia (DH): 36 patients: Urgency/Fre-quency Syndrome (UF): 22 patients. The group of patients who hadalready undergone surgery for SUI included 48 subjects (OP), and thecontrol group included 24 health patients (CG).Results: The overall quality of life was noted to be worse in the DHand UF groups. These two groups were noted to have poorer scoresalso in the sexual life domain. 10% of SUI patients were noted to haverequested at least one specialistic visit. In 70% of cases, the loss ofurine was not considered a sufficient reason for recourse to specialis-tic treatment. 95% of women who had undergone minimally invasivesurgery reported they had completed resumed their social and sexualactivities. 90% of these patients stated they had overestimated the pos-sible negative emotional issues related to surgery.Conclusion: Urinary incontinence and voiding frequency do affectquality of life and sexuality in women. It is important to provide com-plete and detailed information with respect to therapy, pharmacolog-ical and minimally invasive surgery options in order to ensureimprovement of social and sexual quality of life.


J Sex Med 2007;4(suppl 2):152–202

PP-04 Ejaculatory Disorders

PP-04-245

Sacrolumbar intersegmental reflex circuit in menAltay, B.1; Ertekin, C.2; Bademkiran, F.2; Uysal, H.3

1Ege University School of Med., Urology, Izmir, Turkey; 2Ege UniversitySchool of Med., Neurology, Izmir, Turkey; 3Ankara Physical Therapy AndRe, Physical Therapy And Rehabilit, Turkey

Objective: To evaluate the intersegmental reflex circuit from sacral tolumbar dermatom, which plays a role in ejaculation physiology withneurophysiological methods in patients with premature ejaculation(PE), with spinal cord injury (SCI) and men with normal erectile function.Methods: Cremaster and bulbocavernous muscle activities were exam-ined with needle electrodes in 33 healthy men, 16 patients with SCI(C4-T8) and 26 patients with PE by the help of the stimulations atinner thigh for upper lumbar and on dorsal shaft of the penis for lowersacral dermatomas.Results: Although only cremateric reflex responses were found withlumbar dermatomal stimulation, both cremasteric and bulbocavernousmuscle findings were recorded with lower sacral stimulation. Meanlatency time for Cremaster reflex was 52.8 ms, for bulbocavernousreflex it was 35.4 ms and with lower sacral stimulation it was 65.3 msin the control group. The basic electrophysiologic pattern was not dif-ferent in patients with SCI. Different than the control group, bulbo-cavernous reflex was determined in all the patients,but cremaster reflexcould not be recorded in 39% of patients with PE.Conclusion: The neuorophysiological pattern in reflex responses ofcremaster and bulbocavernous muscle during sacral or lumbar der-matomal stimulation gives a reasonable clue to the role of interseg-mental reflex route in ejaculatory physiology.

PP-04-246

Experience with evaluation of premature ejaculation (PE)Fekete, F.1; Rusz, A.2; Romics, I.2

1Private Urological Practice, Budapest, Hungary; 2Semmelweis University,Urology, Budapest, Hungary

Objective: Prematue ejaculation/PE/ is an important sexual problem.Methods: 09.2005–08.2006 85 man with PE evaluated by a question-naire.Results: Ejaculation before insertion reported in 11/13%/, within 1minute in 39/47%/, 1–3 minutes in 32/39%/. Frequency of inter-courses was <1/week 10/12%/, 1/week 25/30%/, 1–2/week 21/25%/,>2/week 27/33%/. Problems with erection reported: rare 11/13%/,frequent 3/4%/, always peresenting 1/1%/. 68/82%/ had no erectionproblems. Sexual self-esteem was not affected by PE 7/8%/, slightlyaffected 7/8%/, moderatelly affected 31/37%/, seriously affected38/46%/. Satisfaction with sexual life: satisfacted 8/10%/, medium sat-isfacted 22/26%/, little satisfacted 24/29%/, dissatisfacted 29/35%/.Duration: 65 patient /78%/ had PE as a “life-long” problem, 18/22%/reported that PE developed last few years. From 18 with “developedPE” chronic urogenital inflammation detected in 3/17%/. LUTS com-plained in 5/6%/ of 83 patients, in 3 of them a chronic genital inflam-mation was detected. The actual partners attitude to the PE waspositive-supporting in 61/73%/, neutral in 17/20%/ and critical in5/6%/. 65/78%/ patients tried to use condoms but its helped to delatethe ejaculation only in 22/34%/, not helped in 43/66%/. 14/17%/patients tried previously local anesthetic cream or spray and it was suc-cessful in 5/36%/ of them. Repeated intercourse was tried by 58/70%/patients and was successful in 71% of them.Conclusion: Questionnaire was a practical tool to evaluate the PE andits influence to self-esteem and sexual life. Patients with “developed”PE and/or LUTS shuld be investigated to detect chronic inflamma-tion. Condoms and local anesthtetics reported by our patients less suc-cessful, than repeated intercourses.

PP-04-247

Ejaculation latency times and their relationship withpenile sensitivity in men with normal sexual functionVanden Broucke, H.1; Everaert, K.2; Peersman, W.3; Claes, H.4; Vanderschueren, D.5; van Kampen, M.1

1University of Leuven, Department of Physiotherapy, Belgium; 2Universityof Thent, Department of Urology, Gent, Belgium; 3Arteveldehogeschool,Department of Physiotherapy, Gent, Belgium; 4University of Leuven,Department of Urology, Belgium; 5University of Leuven, Department ofEndocrinology, Belgium

Objective: There is a need for objective and validated measurementsof ejaculation latency times (ELT) and penile sensitivity in men withnormal sexual function. The aim of this investigation was to determinea) the normal range and repeatability of ELT in a laboratory versus athome masturbation and intercourse in normal men; b) the thresholdand repeatability of penile sensitivity on six penile surface areas meas-ured by two different vibrometers; c) if penile sensitivity correlateswith ELT.Methods: Fifty-eight healthy volunteers (age between 20 and 40 years)provided ELT during three different procedures and were evaluatedwith the biothesiometer and SMV-5 vibrometer on six different penilesurface areas.Results: ELT is highest during intercourse (median: 8.25 minutes;range 1.32–18.31), lower in the laboratory (median: 7.22 minutes;range 1.37–18.79) and lowest during masturbation (median: 4.89minutes; range 1.08–14.19). The three ELT scores were highly repro-ducible (ICC: 0.88–0.93) within subjects. There is high variabilitybetween subjects. Vibrotactile thresholds on six penile surface areasalso were similar and highly repeatable for both vibrometers (ICC:0.81–0.96). There is however no correlation between penile sensitiv-ity and ELT (R2 below 8%).Conclusion: ELT in the laboratory are respectively lower than during intercourse and higher than during masturbation. Vibrometersproduce reliable and repeatable penile vibrotactile threshold results.Penile sensitivity measurements however do not correlate with ELTin men with normal sexual function.

PP-04-248

Relaxory neurotransmitter modulating thecontractility of smooth muscle from seminalvesicleWang, W.1; Wu, C.2; Fry, C.2; Minhas, S.3; Ralph, D.3

1Urology, Haikou, People’s Republic of China; 2Urology, Physiology, London,United Kingdom; 3Urology, London, United Kingdom

Objective: As the most common male sexual disorder, premature ejac-ulation (PE) can impact on a man’s life in many aspects. Unfortunately,the mechanism of PE, to date, has not been elucidated clearly. Abnor-mal neurotransmission to smooth muscle from seminal vesicles (SV)may underlie PE. Our previous study has identified contractile neuro-transmitters, but the relaxatory neurotransmitters are poorly under-stood and need to be further investigated. The objectives of this studyis to testify if nitric oxide (NO) may serve as a relaxatory neurotrans-mitter and provide a physiological basis to the causes of PE.Methods: Muscle strips were prepared from guinea-pig SV and nerve-mediated contractions were elicited by 3 s trains of electrical fieldstimuli (0.1 ms, 10–100 Hz). L-NAME, D-NAME, L-arginine, S-nitroso-glutathione (GSNO), and the combination of L-NAME andL-arginine or GSNO were used to identify and characterize NO.Results: L-NAME enhanced, but L-arginine inhibited the contrac-tion of smooth muscle from SV at all stimulation frequencies (p <0.001), and the relative enhancement of L-NAME and inhibition ofL-arginine at 40 Hz were 64.4 ± 48.0% and 30.0 ± 11.8% respectively.When combined with L-arginine, the enhanced effect of L-NAMEwas attenuated (p < 0.05), and decreased to 19.3 ± 19.2% at 40 Hz.GSNO had no effect on the contraction. When combined with L-NAME, GSNO could decrease the enhanced effect of L-NAME atmost of the stimulation frequencies (30–100 Hz) (p < 0.01), with thedecreased rate of 9.0 ± 1.8% at 40 Hz.


J Sex Med 2007;4(suppl 2):152–202

Conclusion: Abundant nitric oxide synthase (NOS) is present and NOserves as a relaxatory neurotransmitter to modulate the contractility ofsmooth muscle from SV. Abnormality in NOS and NO may lead todysfunction of SV and hence contribute to the mechanisms of PE.

PP-04-249

Relaxory neurotransmitter modulating thecontractility of smooth muscle from vas deferensWang, W.1; Fry, C.2; Wu, C.2; Minhas, S.3; Ralph, D.3

1Urology, Haikou, People’s Republic of China; 2Urology, Physiology, London,United Kingdom; 3Urology, London, United Kingdom

Objective: Male causes for infertility with 25% prevalence are foundin 50% of these infertile couples. However, we can not find the etiol-ogy in 40–60% of cases by routine physical examinations and labora-tory tests. Abnormal neurotransmission to smooth muscle from vasdeferens (VD) may underlie unidentified male infertility. Our previousstudy has identified contractile neurotransmitters. However, the relax-atory neurotransmitters are poorly understood and need to be furtherinvestigated. The objectives of this study is to testify if nitric oxide(NO) may serve as a relaxatory neurotransmitter, and provide a phys-iological basis to the causes of male infertility.Methods: Muscle segments were prepared from guinea-pig VD andnerve-mediated contractions were elicited by 3 s trains of electricalfield stimuli (0.1 ms, 10–100 Hz). L-NAME, L-arginine, S-nitroso-glutathione (GSNO) were used to identify and characterize NO.Results: Unlike seminal vesicle, all the L-NAME, L-arginine andGSNO, have no effects on the contraction of smooth muscle from VD(p > 0.05).Conclusion: No or very sparse NOS exists and NO does not partic-ipate in regulating the tone of smooth muscle from VD. These fea-tures of VD coincide with and contribute to their physiological roles,ensuring mature sperms to be transported from the epididymis toseminal vesicles and stored as many as possible in them continuously.Abnormality in NOS and NO may lead to dysfunction of VD andhence contribute to the mechanisms of male infertility.

PP-04-250

Premature ejaculation and heroin use: Is there a link?La Pera, G.1; Peris, F.1; Carderi, A.1; Marianantoni, Z.1; Fattori, M. S.2;Taggi, F.31San Camillo-Forlanini Hospital, Urology, Roma, Italy; 2San Camillo-Forlanini Hospital, Pharmacy, Roma, Italy; 3Italian Health Institute, Environment and Prevention, Roma, Italy

Objective: Aim of this study is to measure the prevalence of prema-ture ejaculation (PE) in a population of ex drug addicts and to evalu-ate whether or not the subjects sought and used heroin aiming toimprove their sexual drive.Methods: 86 male patients aged between 18 and 35 years (mean age30.24), recruited from 5 drug abuse rehabilitation centers, were inves-tigated. They were given a questionnaire analyzing retrospectivelyfamily background, first sexual experiences and the role of sexual dys-functions in inducing the use of drugs. The patients were almost allpoly drug users The drug predominantly used was heroin (54.6%), fol-lowed by cocaine (40.7%).Results: 46 subjects (53.4%) presented premature ejaculation accord-ing to the definition of H.S. Kaplan. Of these, 12 (26%) declared thatthe ejaculation occurred within 15 seconds or 15 strokes of penetra-tion and 34 (74%) within a few minutes. Of these 46 subjects with PE,19 (41.3%) explicitly declared that PE had been the cause leading tothe onset of drug use. The drug predominantly used in whole groupwith PE was heroin in 66% while in the subgroup with ejaculationwithin 15 sec. heroin was the drug predominantly used in 91% of sub-jects.Conclusion: 1.PE is particularly frequent in drug abusers; 2.PE couldrepresent a risk factor in inducing to substance abuse; 3.Heroin delaysejaculation and improves the control of the ejaculatory reflex; 4.Heroinis used to enhance sexual performances and to improve PE; 5.It is

urgent to clarify whether early treatment of sexual dysfunction can bean easy and effective tool for the primary prevention of substance abuseand addiction in young males and in the prevention of relapse duringopioid detoxification programs.

PP-04-251

Why combination treatment for premature ejaculation?Perelman, M. A.11Weill Medical College Cornell, Human Sexuality Program, New York, NY,USA

Objective: Premature ejaculation (PE) involves psychosocial andphysiologic factors that must be considered in its diagnosis and treat-ment. I propose that combination therapy (CT), integrating sextherapy and pharmaceuticals, is frequently the best approach for PE.Methods: Literature review of the etiology, physiology, and treatmentof PE.Results: PE is characterized by concerns regarding ejaculatory latency,control over ejaculation, and distress. While the pathophysiology isnot fully understood, ejaculatory latency probably distributes along acurve similar to numerous other human characteristics. Men with PElack the ability to identify their premonitory sensations (PS) and/oradequately manage their response to PS and escalating levels of sexualarousal, regardless of other predisposing factors. To control their ejac-ulatory process, they must learn to “dial down” their mental and/orphysical arousal below their threshold for emission. Pharmacologicapproaches include topical anesthetics and off-label use of SSRI anti-depressants and phosphodiesterase-5 inhibitors; patients frequentlyrelapse after discontinuation. Sex therapists appreciate the multidi-mensional nature of PE for the patient and partner, but few patientsseek this approach, which is labor-intensive and sometimes lacks long-term follow-up success. New agents designed specifically for PE mayprovide an improved pharmacotherapeutic response, but similar toantidepressants, will typically impart a modest (albeit meaningful)improvement in latency. However, pharmaceuticals may allow men torecognize PS more readily, facilitating a “choice point,” which is keyto behavioral change and learning. Creating choice based on intentrequires knowledge of the ejaculatory process. Physicians using phar-macotherapy should also teach patients behavioral techniques, helpingaffected men to understand and differentiate PS, emission, and ejec-tion stages of the ejaculatory response.Conclusion: This CT approach will prolong ejaculatory latency,increase confidence, increase control, and improve sexual satisfactionfor men and their partners. CT should become the new “gold stan-dard” for treating PE.Policy of full disclosure: Dr. Perelman is consultant/advisor forJohnson & Johnson and an investigator/consultant/advisor, Pfizer.

PP-04-252

Premature Ejaculation: Psycho-social background ofpatients and treatment preferencesHattat, H.1; Hattat, I.2; Akkus, E.3; Alici, B.3; Özkara, H.31Hattat Hospital, Uro-Andrology, Istanbul, Turkey; 2European Sexual Dys-function, Turkey Office, Istanbul, Turkey; 3Cerrahpasa Medical School, Uro-Andrology, Istanbul, Turkey

Objective: Premature Ejaculation is one of the most common malesexual dysfunction topics. This study aims to show the relationbetween the psycho-social backgrounds of the patients as well as thepreferences of different treatment options.Methods: A comprehensive, Internet-based survey was conductedamong ESDA Turkey’s male online consultation patients for prema-ture ejaculation. From 2300 forms sent, a total of 1136 forms were sentback from a group of male patients aging between 18–65 during 3years. The self-administrated online form was consisted of 5 questionsabout premature ejaculation and sexual satisfaction, 2 questions abouttreatment preference and also Zung Self-rating Depression Scale wassent as a part of the form.


J Sex Med 2007;4(suppl 2):152–202

Results: Among 1136 men, %19 were younger than 30 years where% 55 were aged between 30–50 and %26 were older than 50. %32 ofthe patients had sexual intercourse less than 3 times a month where%51 had sex 3–5 times a month and %17 had more than 5 times amonth. %77 of all men experienced PE in most of their sexual inter-course where %18 answered sometimes and %5 answered a few times.%86 found their sexual intercourse dissatisfying where %12 found itmoderately satisfying and %2 found it satisfying. %53 of the patientspreferred the oral therapy where %39 preferred the local anesthetisesand %8 preferred the behavioural therapy. The higher levels of depres-sion are observed with the increasing percentages of PE and with thedecreasing percentages of satisfaction.Conclusion: One of the most important underlying factors of PE isdepression. The majority of the patients prefer oral and local agentsinstead of the behavioural therapy although behavioural therapy seemsto be an important method in terms of treating the underlying psy-chological factors.

PP-05 Surgery, Priapism, and Peyronie’s Disease

PP-05-253

Our experience with Methylene Blue (methylthioninechloride MB) in the treating of priapismPassavanti, G.1; Pizzuti, V.1; Spinosa, E.1; Aloisi, A. M.2; Carlucci, M.2;Paolini, R.1; Bragaglia, A.1

1Misericordia Hospital, Urology, Grosseto, Italy; 2University of Siena, Phys-iology, Italy

Objective: The knowledge acquired in the 1980’s about the physiol-ogy of erection has allowed us to change considerably the phys-iopathologic and therapeutic scheme of priapism and also to check theusefulness of MB in the treating of this syndrome.Methods: 7patients aged between 27and71(av.36), were treated forpriapism. Pathogenesis was idiopathic in 4cases, by PGE1 in 2 andleukaemia in 1. Cavernous blood had PO2 between 44 and 53 mmHg(av.49), pCO2 48 and 59 mmHg (av.52), and ph 6.6 and 7.3 (av.6.81).Therapy was started from a minimum of 7 to a maximum of 36 hoursfrom the beginning of erection.Results: 4cases were treated with aspiration of 100 cc of blood, ICin-jections with NaHCO3 and ICinjections of MB (10 mg every 5minutesfor 10times). Such procedure was performed twice. 2patients, besidesthis procedure, required an ICi every 5 minutes, of 20 mcg of adren-aline. In 1case we had to perform also a elGhorab shunt. In all cases,during the treatment, and within the following 6–8hours, we admin-istered 200 mg of MBIV. Priapism lasted from 10to96 hours and it wasover, in 5 cases, in 10–18 hours, while in 2 cases (idiopathic and byleukaemia) it lasted 48 and 96 hours with a serious residual fibrosis.Conclusion: The introduction of oral drugs has changed the epi-demiology of priapism. A better knowledge of the molecular mecha-nisms that govern the cavernous myorelaxation has allowed us to usenot only adrenaline but also MB(ICandIV) which inhibits the guany-late cyclase and which has no side effects. In our experience, actingpromptly and the use of MB have given us the opportunity to resolvepriapism in 5cases (71.4%). Therefore, we think that MB represents asuccessful therapy and that the protocol used in such cases may be agood method to plan the treating of low-flow priapism.

PP-05-254

Male-to-female sex reassignment surgery (SRS):Comparison of two techniquesVerze, P.1; Imbimbo, C.1; Palmieri, A.1; Longo, N.1; Barba, C.2; Arcaniolo, D.2; Mirone, V.21University “Federico II”, Urology, Naples, Italy; 2University, Urology,Naples, Italy

Objective: Follow-up studies of 36 Male to Female transsexuals afterSex Reassignment surgery using the Simple Penile Skin Inversion andthe Invagination of a peno-scrotal.Methods: Questionnaires were given to 36 Male to Female transsex-uals who had been operated at our clinic, between January 2003 andDecember 2004. The surgical techniques used were The Simple PenileSkin Inversion, performed on 20 patients (group 1) and the Invagina-tion of a peno-scrotal, performed on 16 patients. The questionnairewas devised to investigate the following areas: pre-surgery life his-tory, post-surgery life history, sexual habits and behaviour, overall satisfaction.Results: The average age of the patient was 28 years old, varyingbetween 21 years and 43 years. None of the interviewed patients hadfelt hesitant before surgery and all had completed satisfactory psycho-logical counselling. Out of all the interviewed patients, 94% hadresumed sexual activity with the adoption of alternate methods. Ingroup 1, 78% were satisfied with the cosmetics of their genitalia, com-pared to 59% in group 2, only 40% in group 1 were satisfied with thesize of the neovagina, compared to 62% in group 2. All patients agreedthat they would recommend the operation to others.Conclusion: A significant number of patients were satisfied with thechosen surgery and felt comfortable with their new post-operative


J Sex Med 2007;4(suppl 2):152–202

gender. Those who had undergone the Simple Penile Skin Inversiontechnique were found to be satisfied with the appearance of their gen-italia but not as satisfied with the depth, compared to those who hadundergone Invagination of a peno-scrotal.

PP-05-255

Augmentation phalloplasty: Apical and pericavernousalpenile implantSalhi, J.1; del Prete, M.2

1Androclinic, Roma, Italy; 2San Giacomo Hospital, Surgery, Roma, Italy

Objective: The augmentation surgery of the penis has not yet solvedthe problem of the type of material to be used for the increase of thepenile circumference, besides the persistence of perplexity and distrusttoward this type of surgery burdened by complications and failures.Methods: The implant is comprised of three parts: the first “bean-shaped” is inserted at the tip of the cavernous bodies under the glansand for this is called “apical”, the other two are speculars lateral parts,called “pericavernouse”. Each is constituted of a hemicilinder crescentsection with flattened distal extremity. The structure is composed froman external wrap (multi-layer) in biocompatible material filled byhighly cohesive silicon gel. The surgery is performed in day-hospital,with two small transversal incisions at the base of the glans, bilaterally.A pocket of subglandular lodging is prepared proceeding from thesides so as not to injure the dorsal neurovascular bundle and theurethra. After the insertion of the implant the glans is sutured to thecorpora. For the pericavernous implant, a subfascial tunnel is preparedbilaterally for the whole length of the penis. The pericavernous pros-thesis 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.Infection occurred in tow patients and was treated by explanation-reimplantation.Conclusion: This pericavernoso implant responds to a demand for asimple and rapid procedure that can provide good and lasting aesthet-ical results without jeopardizing penile function.

PP-05-256

Permanent penile lengthening byintracavernousinjection of n-butyl-2-cyanoacrylate in dogsMoossa, F.1; Farag, K.2

1Helwan, Egypt; 2Faculty of Veterinary Medicine, Surgery, Cairo, Egypt

Objective: N-butyl-2-cyanoacrylate (NBCA) is a watery tissue adhe-sive which hardens within 20 s in moist conditions, particularly inblood. The purpose of this study was to evaluate the feasibility andreliability of using intracavernous injection with NBCA to increasepermanently the length of the penis in dogs.Methods: The experimental study was conducted on six adult malemongrel dogs. Under general anesthesia the prepuce of the penis wasretracted and 10 mg of papaverine was injected in the glans to inducean erection. Two animals were left as controls while in the remainingfour a mixture of 0.5 ml NBCA and 0.75 ml lipidol was injected intothe erect penis.A Plain X-ray was taken of all injected penises. All dogswere clinically monitored for 3 months and then killed for the histo-logical assessment.Results: There was no significant morbidity after injection in any dog,in the controls the erection subsided after 48 h, with resultant fibrosisof the glans. The plain X-ray showed the radio-opacity of the injectedmaterial within the soft tissue shadow of the lengthened penis. In onedog there was ulceration of the squamous epithelium of the glans, withextrusion of the solidified material, having been injected superficially.Histologically, NBCA induced a minimal inflammatory reactionaround it.

Conclusion: N-butyl-2-cyanoacrylate is safe and inexpensiveinjectable bulk- enhancing agent which can be injected intracav-ernouslly to produce a simple permanent lengthening of the penis forselected medical problems.

PP-05-257

Treatment of penile cripple after operations for hypospadiasPerdzynski, W.1; Adamek, M.1

1Damian’s Hospital, Reconstr. Surgery of Male G-U, Warsaw, Poland

Objective: Unsuccessful treatment of severe hypospadias may lead topenile cripple. Goal of paper is presentation of treatment results.Methods: From 2003 to 2005 authors treated 12 patients operatedmany times in other departments. Criterion for inclusion were pres-entation of at least three complications: stenosis of urethra(in 7patients), curvature of penis/glans(in 9), extensive scarring(in 8),urethro-cutaneous fistulas[ucf] (in 7), position of urethral meatus onpenile body/scrotum(in 9), underdevelopment of penis(in 3), iatro-genic covered penis(in 1). In urethral stenosis Snodgrass operation(in4), dorsal “onlay” flap on mesentery(in 2), releasing urethra from scarswith formation of urethrostomies joining meatuses by buccal mucosalgraft(in 2) were done. In abdominal curvatures Nesbit operation(in 6)or Yachia operation(in 1) were done. In one patient with curvature andpenile underdevelopment 2 grafts were used. In one patient 5 fistulaswere joined together cutting skin bridges between them and recon-struction of urethra was done.Results: In all patients with urethral stenosis good urine outflow wasdetected. In all patients with penile curvature straightening wasachieved. In 6 patients ucf were sutured with good results, in onepatient fistula recurred. In 6 patients urethral meatus was positionedon the top of glans. One patient is after Ist stage and another one isafter IInd stage of reconstruction of urethra (from scrotum to theglans) but in the latter ucf formed.Conclusion: 1. One-stage treatment should be preferable in cases ofpenile cripple caused by scarring, penile curvature, in patients withposition of meatus in distal or central part of penile body and withurethro-cutaneous fistulas. 2. The most challenging to treat is post-operative stenosis and shortening of urethra associated with big scar-ring and penile curvature. Such patients often need two-stagetreatment.Policy of full disclosure: No financial interest.

PP-05-258

An audit of the presentation and management ofischaemic priapismAdeniyi, A.1; Anderson, P.2; Kumar, P.1; Christopher, N.1; Ralph, D.1;Minhas, S.1


Objective: Priapism is a urological emergency. Prompt surgical inter-vention will determine successful outcome. The aim of this study wasto review the management of priapism at a tertiary referral centre.Methods: A case-note review of patients was carried out, recordingparameters including aetiological factors, duration prior to presenta-tion, origin of referrals, nature of intervention and outcomes.Results: Sixty-two patients with a mean age of 40 yrs (median 41 yrs,range 7–75) with the mean duration at initial presentation of 86 hrs(median 36 hrs, range 6–1002). 50% of patients presented after36hours. Aetiologies were; idiopathic (35.5%), haemoglobinopathy(16.1%), iatrogenic (12.9%), self-inflicted (e.g. recreational Viagra)(14.5%), post-traumatic (8.1%) and others (12.9%). Forty-seven(90%) received corporal aspiration with intra-corporal injection of analpha-adrenergic agent in 29 (56%). Twelve (19%) received between1 & 4 shunt procedures prior to referral. Twenty-seven (44%) hadacute placement of a penile prosthesis. The risk of operative interven-tion/ penile prosthesis insertion presenting 20 hr or more were 65%and 52.5% (20% and 1.3% if < 20hours) respectively.


J Sex Med 2007;4(suppl 2):152–202

Conclusion: There is an unacceptable delay between the presentationof priapism and treatment, whilst interventions are not standardised.Appropriate guidelines, protocols and health education need to bedeveloped to improve patient outcome.Policy of full disclosure: My post as Senior fellow at the institute ofurology is funded by American medical systems.

PP-05-259

Outcome from advanced penile cancer—A UK seriesKayes, O.1; Anderson, P.2; Hegarty, P.1; Ralph, D.1; Minhas, S.1


Objective: Early intervention for penile cancer will improve survival.However, 30% of patients are diagnosed with advanced disease. Theaim of this study is to evaluate the early outcome data for patients withadvanced disease who were treated using EAU guidelines (2002).Methods: Patients diagnosed with penile cancer at a single institutionsince 2002 were included. Patient data was prospectively recorded onan electronic database and all were staged and treated according toEAU guidelines. Advanced disease was defined as N2, N3 and/or M1with reference to UICC TMN staging system.Results: 104 patients with penile cancer were included, with mean ageof 68 years and median follow up of 17 months (range 0–42 months).Following inguinal lymphadenectomy, 27 patients were node-negativeand 24 node-positive. 21(20%) patients were classified as ‘advanceddisease’. Only 2/17 (12%) of pelvic lymphadencetomies performedwere positive. 3 year survival data was 100% for node negative patientsbut only 40% for advanced disease. 2 patients underwent extensivereconstructive surgery after developing metastatic abdominal walldeposits.Conclusion: These results demonstrate that advanced penile cancerconfers a significant survival disadvantage. The role of neoadjuvant andadjuvant chemo-radiation therapy must be assessed in these patientsin multi-centre trials.Policy of full disclosure: My post at the Institute of Urology is fundedby American Medical Systems.

PP-05-260

Webbed and buried penis—Surgical approachGekas, A.1; Kartsaklis, P.1; Palaiodimos, I.1; Andreadakis, S.1; Konstantinidis, C.2; Stamopoulos, P.1; Baltogiannis, D.3; Sofikitis, N.3

1General Hospital of Patras, Urology Department, Greece; 2National Insti-tution of Rehabi., Urology Department, Athens, Greece; 3University Hospi-tal of Ioannina, Urology Department, Ioannina, Greece

Objective: Buried and webbed penis are some of the penile skin anom-alies. Our aim is to expose our experience on surgical reconstructionof these anomalies, in adult patients, whose congenital anomaly wasnot improved during puberty.Methods: In 2005, four young men proceeded in our department, suf-fered from penile skin anomalies. Two patients had buried penis andtwo of them suffered from webbed penis. In cases of buried penis, thenormal penis was hidden under pubic skin. It was exposed and the fore-skin was used to cover the whole penis. Removal of the surroundingfat tissue was helpful. Webbed penis is an anomaly where the ventralpenile skin is deficient and the scrotal skin extends as a sagittal fold onthe ventrum of the penis. We proceeded with scrotal and penile plasty.Our patients were circumcised very carefully and thoroughly in orderto avoid any bad cosmetic result.Results: All of our patients have been pleased with the cosmetic result.No skin necrosis or infection was observed.Conclusion: Webbed and buried penis is only a cosmetic problem inchildhood but in adults may provoke difficulties during sexual inter-course and/or may have psychological effects causing patient’s embar-rassment. There is a tendency to spontaneous improvement with age.The surgical approach is an effective treatment in patients with per-sisting dysmorphia.

PP-05-261

A case of penile fracture with complete urethraldisruption during sexual intercourseJagoldie, K.1; Erklavec, M.1; Bizjak, I.1;Poteko, S.1; Korosec Jagodic, H.21SB CELJE, Dept. of Urology, Slovenia; 2SB CELJE, Anesthesiology, Slovenia

Objective: Penile fracture is a rare condition. Primary it is a ruptureof corpus cavernosum that occurs when the penis is erect. The rupturecan affect also the corpus spongiosum and the urethra.Methods: We report a case of 37 years old man who presented withacute penile pain, penile swelling and inability to pass the urine aftera blunt trauma during sexual intercourse. In emergency surgery wefound bilateral partial rupture of the corpus cavernosum with completeurethral and corpus spongiosum disruption (figure 1). Interruptedsutures were used to repair rupture of both corpus cavernosus. Theurethra was anastomosed in one layer, tension free with interruptedsutures.Results: In one year follow up the patient presented with normalvoiding and sexual function.Conclusion: Emergency surgical repair in penile fracture can preserveerectile and voiding function.Policy of full disclosure: we have no diclousure statement.

PP-05-262

Induratio penis plastica: Corporoplastic with smallgauge malleable semirigid penile implant and graft ofsaphenous veinSilvani, M.1; Quaranta, S.2; Concone, D.3; Minocci, D.2

1ASL 12, Biella, Italy; 2ASL 12, S.C. Urologia, Biella, Italy; 3Universitàdegli Studi del Pie, Scuola di Specializzazione, Novara, Italy

Objective: A case of Peyronie’s disease in a 63 years old patient hasbeen described.Methods: His history includes hyperglycaemia, chronic HCV-relatedhepatopathy. Seven years ago has been diagnosed Peyronie’s disease.The physical and pharmacologic therapy didn’t have satisfactoryeffects. During the last 15 month he noticed penile shortening,medium and distal third of the scapus penis stenosis, erectile dysfunc-tion. After a classical degloving a mini-invasive corporotomy it hasbeen performed. Particular attention was reserved to the safety of theerectile tissue below. Afterwards a 10 mm dilatation and calibration ofthe right cavernosum it has been performed with Metzenbaum scis-sors and dilatators. It has been implanted a 7 mm semi-rigid prosthe-sis, 2 cm longer than the cavernosum, to permit a cavernosumrelaxation after the incision of the sclerotic plate. After suturing theright cavernosum, the same procedure was repeated on the contralat-eral cavernosum. The operation went on with the incision of the Buck’s


J Sex Med 2007;4(suppl 2):152–202

Fascia, binding the perforating arteries in order to maintain thehaemostasis. The neurovascular bundle has been isolated and the cavernosum albuginea has been incised in correspondence of themaximum grade of recurvatuum, from a urethral margin to the other,saving the endothelial tissue. A graft of saphenous vein has beenretrieved, devalvulated, prepared for implant on the albuginea’s breakAfter a Buck’s fascia reconstruction, with haemostatic purpose, theintervention came to an end placing a tubular drain and executing aposthetomy.Results: After the intervention the penile’s length has been restored;this result will be maintained by the semi-rigid implant, that per-mit the graft to attach on an extended penis, avoiding the tissues’retraction.Conclusion: For patients with Peyronie’s disease and residual erectionwe recommend corporoplastic with malleable prosthesis and graftingof saphenous vein.

PP-05-263

Extracorporeal shock wave therapy improves sexualperformance and satisfaction in patients withPeyronie’s diseaseAlkhayal, S.1; John, G.1; Fletcher, M.1; Lehmann, V.11Royal Sussex County Hospital, Urology, Brighton, United Kingdom

Objective: Peyronie’s disease may cause significant sexual dysfunctionaffecting the quality of life of both the patient and his partner.Although Extracorporeal Shock Wave Therapy (ESWT) is debated in the treatment of the disease, it’s effect on sexual function was evaluated.Methods: 52 patients with PD were sent a questionnaire to evaluatetheir Sexual function before and after treatment with ESWT. Pain onerection, erectile function and the ability to achieve sexual intercourse,as well as overall sexual satisfaction were assessed. Patients who werefully satisfied with their sexual function before treatment wereexcluded from the analysis.Results: 41 patients responded to the questionnaire, 5 were satisfiedwith their sexual function before and after treatment and thereforewere excluded from the analysis. 36 patients had some degree of sexualdysfunction, mean (range) age 58 (33–78) years and disease durationof 23.5 (12–60) months. The mean number of sessions received was 4(3–6) and follow-up of 9 (1–24) months. Nonparametric statistical testswere used to analyse the data before and after treatment. 14 out of 23patients (61%) with pain on erection before treatment reported sig-nificant improvement or relief of pain, P = 0.001. The ability to achievesexual intercourse improved in 46% of the patients, while the IIEF-5score increased in 21 (61%) patients with a mean improvement of 3.3,P < 0.001. Overall sexual satisfaction score improved in 47% of thepatients, p < 0.001. Improvement in penile pain correlated significantlywith the ability to achieve intercourse but did not correlate well withoverall sexual satisfaction improvement.Conclusion: Although ESWT is debated for the correction of peniledeformity in Peyronie’s disease, it can result in significant improve-ment in the patient’s ability to achieve satisfactory intercourse andoverall sexual satisfaction.

PP-05-264

Paradoxical arterial priapism: Post-traumaticmonolateral low penile perfusion and curvatureassociated to contro-lateral arterious-cavernouslaceration and fistulizationGattuccio, I.1; Italiano, E.1; Zangara, F.1; Montalto, F.1; Savoca, G.1; LoGiudice, S.1; Parrinello, M.1; Gagliardo, C.1; Gattuccio, F.1

1University of Palermo, D.M.I., Italy

Objective: CLINICAL CASE G.A., 26 years old, came to our obser-vation for progressive erectile disfunction after a blunt perinal-scrotaltrauma due to a motorbike incident in october’04.

Methods: The patient has been submitted to a penile basal color-Doppler ultrasound (CDU) testifing on the presence of a large andhyperemic pseudo-aneurismatic lacuna in the right corpus caver-nosum, associated to the presence of a nodule of cicatricial fibrosis inthe controlateral corpus, involving the main left cavernous artery. Inconsideration of the particular post-traumatic hemodynamic conditionwe have postponed the dinamyc evaluation and prescribed a Vardenafiltreatment. After two months, in view of the good clinical responseabout ED and absence of episodes of prolonged or involuntary erec-tions we have performed a second evaluation through a dynamic CDU(Pge1 10 mcg); the dynamic test confirmed the serious deficiency ofthe arterial perfusion of the left corpus cavernosum, due to cicatricialfibrosis while demonstrated a sufficient compensatory vascularization,characterized by normal erectile response and optimal perfusionindexes of the surviving cavernous artery, even if paradoxically andextensively interested by the aforesaid post-traumatic fistula.Results: Now the patient suffers from slight penile lateral curvatureand often assumes Tadalafil, due to own exigence of long bio-avail-ability, related to his sexual behaviour; however he reports episodes ofsufficient erection even without drug, in accord of the dynamic CDUevaluation. The patient is informed about possible short-term futurepenile deformation of the left corpus cavernosum and fibrosis at longterm due to the traumatic hipervascolarizzation of the right one,attually paradoxically vicarious and consequently not suitable fortreatments of embolizzation or local devascularizzation.Conclusion: We highligth the exigence of a CDU ultrasound, in everycase of genital trauma to be able to evaluate, define and eventually treateven less known pathological elements as the cavernous vascularlesions.

PP-05-265

Sex reassignment surgery for male-to-femaletranssexuals: Initial experienceBarbosa, R.1; Tomada, N.2; Vendeira, P.3; Cardoso, A.1; Reis, J.1; Amarante, J.1

1Hospital S. João, Plastic Surgery, Oporto, Portugal; 2Hospital S. Joao,Urology, Oporto, Portugal; 3Faculty of Medicine of Porto, Lab. MolecularCell Biology, Portugal

Objective: Sex reassignment surgery for male to female transsexualsis a new field in Portugal, requiring Plastic surgery and Urology inter-play. We describe our initial experience illustrating some technicalpoints and final results.Methods: We performed four cases between June-2004 and June-2006. The first patient was a Klinefelter and the others had a normalkaryotype with the diagnosis of gender identity disorder. We used avaginoplasty by inversion of penile and scrotal skin flaps, and pedicledsensate neoclitoroplasty in one case.


J Sex Med 2007;4(suppl 2):152–202

Results: The operative technique followed the sequence of bilateralorchidectomy, penectomy and plasty of vagina, clitoris (one case), labiaminora and majora. After degloving the penis, bilateral orchidectomyis performed by dissecting the spermatic cord at the external inguinalring. Urethra and glans penis with the intact neurovascular bundle arethen freed from the corpus cavernosum, which is resected at the baseof the penis. Dissection is done toward the rectum with special care toavoid rectal injury, and behind the prostate, the seminal vesicles andthe bladder. Suture of penile and scrotal flaps follows, creating a tubethat is inserted in the dissected peritoneal cavity, creating the neo-vagina. Openings are made in the inverted penile skin to form the newurethral meatus and clitoris. Labia minora and majora are formed bythe scrotal flap. A mould is inserted in the neo-vagina and tied-over tomaintain the flaps in place. We did not experience any case of partialnecrosis of the flaps or wound dehiscence. Retraction of the neo-vaginawas not significative, maintaining depth and width adequate for sexualintercourse.Conclusion: We present only an initial experience, but we find thatthe use of penile and scrotal flaps is safe and permits good aestheticresults, and particularly satisfying function with pedicled sensate neo-clitoroplasty.

PP-05-266

Development of approaches to estimate the implantedthree-dimensional polymeric materials for tissueengineering in genital surgeryScheplev, P.1; Garin, N.1; Gvasaliya, B.1; Gusev, S.1; Borisenko, G.1

1RMAPE, Urology, Moscow, Russia

Objective: Development of materials for tissue engineering is amodern problem which decision opens new prospects to restore thelost tissues and organs for transplantations. One of the problems inthis site is to study new biocompatible polymers, especially their inter-action with human cells during formation of engineered tissue.Methods: To estimate the cells growth, morphology and a functionalparameters of cells during cultivating on the three-dimensional scaf-fold (Innopol D) some approaches were developed in this work. It wasquantitatively shown, that cells of HeLa line are actively proliferatingon the polylactoglicolic acid scaffold.Results: According to data of scanning electronic microscopy andoptical microscopy, cells in regular intervals fill the scaffolds, and poly-lactoglicolic acid does not cause any changes in morphology of cells.The content of endocellular glutation during cultivating does notchange. Application of an antioxidant (N-acetylcystein) does not influ-ence the cell growth and glutation balance, that demonstrates a normalfunctional condition of cells and absence of polymer toxic action.Conclusion: Thus, morphological and biochemical parametersconfirm an opportunity of use the tree-dimensional polymer—poly-lactoglicoplic acid scaffolds in tissue engineering purposes.Policy of full disclosure: Scaffolds Innopol D were given to our lab-oratory free of charge by the company Innotech med. Seoul, S. Korea.

PP-05-267

Risk factors in development of recurrent urethralstrictures after urethroplastyScheplev, P.1; Gvasaliya, B.1; Garin, N.11RMAPE, Urology, Moscow, Russia

Objective: Recurrent urethral strictures is a serious problem in genitalsurgery. There is no ideal method that will be free of recurrence of thedisease.Methods: 85 patients underwent urethroplasty with a mean follow-upof 24 months ± 16. The indications were severe urethral strictures.The length of stricture was 2–18 cm. The ethiology was pelvic andperineal trauma (37), iatrogenic (urethral instrumentation) (31), bac-terial urethritis (10) and unknown (7). Eleven patients (13%) haddeveloped stricture recurrence. To evaluate significant factors in devel-opment stricture recurrence we used artificial neural networks (ANN).A database of all patient records (more than 45 parameters) was used

to train and validate the ANN. Initial the database, in which the infor-mation on each patient as a vector described in 38 parameters ((anam-nesis, clinical and laboratoral datas, type of operation (one stage or twostage, primary anostomosis or using skin graft or buccal mucosa),accompanying pathology)) was submitted. The task of a neuralnetwork consists in recognition and classification of entrance imagesby comparison with the standards stored in associative memory. ANNscan accommodate large numbers of prognostic variables and cananalyze their varying degrees of impact on the outcome, which is notpossible using conventional statistical techniques.Results: The neural network was received, in which to each enteredprognostic parameter there corresponded a degree of its importancein a postoperative complications rate. The most significant factors indevelopment stricture recurrence were: failed previous urethroplasty,fistula, type of operation (two stage urethroplasty was followed bylower recurrence rate than one stage procedure). There was no corre-lation between the length of stricture, age of the patient and the riskfor recurrence.Conclusion: Using of neural network can be useful in evaluating theprognosis in similar patients.

PP-05-268

Peyronie’s disease, total penile skin necrosis andreconstruction with scrotal flap in two steps: Case reportLa Pera, G.1; Peris, F.1; Anceschi, U.1; Maggiulli, G.2; Felici, A.2; Lentini, M.1

1San Camillo-Forlanini Hospital, Urology, Roma, Italy; 2San Camillo-Forlanini Hospital, Plastic Surgery, Roma, Italy

Objective: The Authors described the case of a 53 years old man withPeyronie’s disease.Methods: Two years before, the patient had undergone to Nesbit pro-cedure with poor results. In our Institution the patient underwent anew operation with sub-coronal incision and degloving, isolation ofthe neuro-vascolar bundle, implant of Soubrini soft prosthesis andplaque incision with Pelvicoll patch. In spite of a good lengthening andcorrection of the penile curvature, in the post op the patient developedan important skin necrosis of the whole shaft from the penis basis tothe tip under the glands.Results: We therefore, performed a surgical debridement to removethe necrotic skin leaving the corpora cavernosa exposed. In order tomanage such case we face two difficult problems. Firstly, remove ornot the implant and the Pelvicoll patch due to the infection and necro-sis, and secondly how to cover the exposed corpora cavernosa. Theprosthesis removing, would very likely have made impossible a newimplant at later date due to severe fibrosis and severe shortening of thepenis. Having observed during the operation that corporotomies wereintact we made the decision to not remove the prosthesis and makeseveral cultural samples with copious wound irrigation with saline,peroxide and povidone-iodine solution. We then rolled up the corporacavernosa with Gentafish, a sponge of gentamycin at a concentrationof 500 times the MIC. As far as concerns the problem of the denudedpenis, we buried the penis shaft in subcutaneous scrotum tunnelbetween the dartos and the skin living the glands out of the scrotum.After 4 months we performed the second step of the surgical treatmentmobilizing the penis shaft with a scrotal full thickness skin flap.Conclusion: After 6 months the patient had good cosmetic and func-tional results.

PP-05-269

The treatment and outcomes in urethral squamouscell carcinomaSoden, F.1; Kayes, O.1; Freeman, A.1; Ralph, D.1; Minhas, S.1

1Univerity College Hospital, Institute of Urology, London, United Kingdom

Objective: Urethral squamous cell carcinomas (SCC) tend to be of ahigher stage and/or grade at diagnosis than other penile carcinomas.


J Sex Med 2007;4(suppl 2):152–202

We look at our experience of urethral SCC patients, outcomes fol-lowing surgery and their options for reconstruction.Methods: Patients with urethral SCC where identified from a penilecancer database and pathology records. Reports and slides werereviewed to eliminate errors that may appear in large databases and toconfirm only SCC arising from the urethra, excluding those of mixedor uncertain origin. Information regarding treatment and outcomeswas obtained from the medical notes and the database.Results: 8 patients were identified that had undergone surgery for ure-thral SCC. All except 1 patient had a radical urethrectomy or penec-tomy with one having a partial penectomy, two patients had positivelimits. All except two patients, with grade 2 SCC, had a lym-phadenectomy of which 2 had positive nodes. 4 patients had penileconservation or reconstruction and 3 patients had a mitroffanoff. 3patients developed metastatic disease within 3 years and 2 local recur-rence, all of which had either G3 or pT4 disease. 4 patients receivedadjuvant radio/chemotherapy at some stage during their treatment.Conclusion: The prognosis for those with this rare tumour is poordespite surgical intervention. Contrary to previous reports radicalsurgery is the best treatment option in these patients, although recon-struction can be attempted to maintain erectile function.

PP-05-270

Fibroepithelial polyp of glans penis: A case reportSanseverino, R.1; Baio, A.1; Intilla, O.1; Di Mauro, U.1; Realfonso, T.1;Napodano, G.1

1Umberto I’ Hospital, Urology, Nocera Inferiore, Italy

Objective: Fibroepithelial polyps are benign mesodermic tumors thatcan be observed in renal pelvis, ureter, bladder, urethra and penis;regardless of site they are histologically similar. Fibroepithelial polypsof penis are a very rare occurrence and they has been previouslyreported as complication of phimosis or long term condom catheteruse. We report a case of fibroepithelial polyp of glans penis associatedneither phimosis nor long term use condom catheter use.Methods: A 35 year old man presented at our institution for a penilelesion that was appeared fifteen months before. Patient had never useda condom catheter; his past medical history didn’t reveal any relevantpathology; no specific symptoms were recorded. A cauliflower likelesion was observed at the ventral side of the glans penis, near the ure-thral meatus on physical examination. The lesion measured 7 × 5 × 2cm. After placement of the urethral catheter, a wide local excision ofmass was performed under locoregional anaesthesia. The glans skinwas repair with 4/0 absorbable suture.Results: No postoperative complications were registered. The lesionhad a polypoid macroscopic appearance, tough elastic consistency andwhite colour. Microscopic examination revealed a fibroepithelialpolyp. The follow up visits at 3, 6, 12, 24 and 36 months postopera-tively showed no recurrence.Conclusion: Fibroepithelial polyps of glans penis are rare benignmesodermic tumors. In contrast with literature reported, in our caseit isn’t associated with long term condom catheter use or phimosis.

PP-05-271

Clinical characterestics of patients with Peyronie’sdisease in a sexual problems andrology outpatient clinicKathirvel, N.1; Wylie, K.2

1Beverley, United Kingdom; 2Royal Hallamshire Hospital, Department ofUrology, Androlog, Sheffield, United Kingdom

Objective: The aim of the study was to analyse the clinical charac-teristics of patients with Peyronie’s disease (PD) referred to the medicalreview clinic of the andrology service.Methods: Patients referred to the male sexual dysfunction clinicbetween December 2004 and August 2006 were assessed by nurse spe-cialists and referred to physicians as physical examination was deemednecessary. PD was confirmed by the physicians and then patients were

requested to complete a questionnaire covering various aspects of thedisease. The data was analysed using SPSS statistical software.Results: 95 patients were recruited. The data was analysed for 94patients (one refused to participate). The mean age was 56 years (range17–83) Penile curvature was the most common presenting symptom(71%), followed by erectile dysfunction-ED (32%), pain (16%) andlump (14%). 31% had combination of symptoms, the commonestbeing penile curvature and ED. 51% had symptoms for over 18months. 57% of patients reported worsening of penile curvature. Themean degree of penile curvature was 44 (range 5–90). Other peniledeformities include loss of penile length (53%), narrowing of shaft(33%) and softening of penis beyond lump or scar (28%). We lookedat the presence of other factors that may have clinical associations withthe condition. There were 19% current and 54% past smokers.17%had diabetes, 38% hypertension, 27% hypercholesterolemia and 10%coronary heart disease.Conclusion: Although penile curvature was the most common pre-senting symptom, a significant proportion of patients (32%) presentwith ED. This should be borne in mind while evaluating patients withED. Vascular risk factors were present in significant proportion ofpatients and the contribution of these to the pathogenesis of the con-dition and potential influence on treatment options needs furtherinvestigation.

PP-05-272

Shock-wave therapy for Peyronie’s disease: High-energy shock waves do not restore mechanism ofcorporal venous occlusionGorpynchenko, I.11Institute of Urology, Sexology / Andrology, Kiev, Ukraine

Objective: To test the hypothesis that changing of plaque elasticitycaused by high-energy shock waves (HESW) may be associated withrestoring of mechanism of corporal venous occlusion (MCVO).Methods: 30 patients with Peyronie’s disease (PD) and corporalvenoocclusive dysfunction (CVOD) (end diastolic velocity (EDV) >5 cm/sec) with normal arterial supply (peak systolic velocity > 35 cm/sec)were involved. Diagnosis: penile photography with goniometry, penileultrasonography (B and duplex regimes). Therapeutic regime: 10 sessions of shock-wave therapy (SWT) (energy level—5–6; 800impulses/mm2 of plaque) (1 session per weak). The device Compact(Dornier) was used. Statistical analysis: Mean ± standard deviation andmedian (Me) with quartiles were used to describe data distribution. AWilcoxon paired test was applied. Significance level—0,05.Results: Mean age of the patients was 47 ± 6 years. Mean disease dura-tion was 14 ± 5 months. Influence of SWT on data distribution pre-sented in table. Before SWT After SWT Me (quartiles) Me (quartiles)Penile deviation (°) 40 (35; 50) 25 (20; 35) Plaque length (cm) 2,5 (2;3) 2.5 (2; 3) EDV (cm/c) 9 (8; 12) 8 (7; 10) After the treatment adecreasing of penile deviation was detected in all patients and was sta-tistically significant (P < 0.0001). SWT dose not cause statistically sig-nificant changes of plaque size (P = 0.65) and EDV (P = 0.2).Conclusion: Correction of penile deviation after high-energy SWTis rather caused by increasing of the elasticity of the plaque thendecreasing of its size. Rising of the plaque elasticity after SWT dosenot result in restoration of MCVO. It was concluded that along withdecreasing of elasticity of tunica albuginea other factors such as struc-tural changes in subtunical veins may play role in pathogenesis ofCVOD caused by PD.

PP-05-273

Concomitant placement of male sling with inflatablepenile prosthesis by unique penoscrotal incisionRolle, L.1; Morra, I.2; Ceruti, C.1; Ragni, F.2; Tamagnone, A.1; Timpano, M.1; Negro, C.1; Fontana, D.1

1Ospedale Molinette, S.C.D.U. Urologia 2, Torino, Italy; 2Ospedale SanLuigi Gonzaga, S.C.D.U. Urologia, Orbassano (TO), Italy


J Sex Med 2007;4(suppl 2):152–202

Objective: Erectile dysfunction and urinary incontinence are the twomost frequent complications after radical prostatectomy. We describethe technique for the concomitant implantation of inflatable penileprosthesis with the synthetic male sling by a unique peno-scrotal incision.Methods: A 62 year-old patient underwent retropubic radical prosta-tectomy for organ-confined prostate cancer in January 2005. One yearlater, he complained a complete erectile dysfunction and a persistentmild stress urinary incontinence. The patient underwent treatmentwith placement of a synthetic bulbo-urethral sling (InvanceTM fromAmerican Medical Systems) with concomitant implantation of a inflat-able penile prosthesis. a unique inverted V-shaped peno-scrotal inci-sion was performed; it was firstly started the male sling placementusing 6 bone screws drilled into the descending pelvic rami bilaterally.Then, the implantation of the penile prosthesis was completed. Finally,the 4 × 7 silicone coated polymer mesh was stretched over the bulbo-spongiosus muscle. A sovrapubic drainage was positioned and removed24 hour later.Results: No perioperative complication occurred. The patient wasdischarged within 48 hours. Antibiothic prophylaxis and pain-killerswere administered. Six months after the procedure the patientreported a complete urinary continence (no use of pads) and is able toachieve a complete sexual intercourse.Conclusion: Our initial experience shows that the concomitant place-ment of the male sling with the inflatable penile prosthesis is a feasi-ble and easy technique.

PP-05-274

Penis (glans) carcinoma: Disassembly, glandsectomyand urethro-glansplasticSedigh, O.1; Paradiso, M.1; Varvello, F.1; Liberale, F.1; Graziano, M. E.1;Ferrando, U.1


Objective: In low grade penis carcinoma in young and motivatedpatients, we avoid deforming surgery such as amputation to offer areconstructive (remodelling) of the glands, with aesthetic and func-tional results. We present the case of a 62 years old patient, HIV-pos-itive, with a ulcerated glands cancer, negative lymph nodes evaluatedwith total body scan, who has been treated with reconstructive technique.Methods: Surgical steps:—subcoronaly incision and dartos fascia iso-lation—isolation and camping of neurovascular bundle—separation ofcorpora spongiosa from urethra and isolation of corpora cavernosaapexes—section and tying of neurovascular bundle—isolation of distalurethra for 4–5 cm and its section from 1 cm to the gland insertion.Distal fragment of penis sent to intraoperatory histological examina-tions—glandsectomy—reconstruction of neo-gland using urethral iso-lated tract and its mucosa attached to corpora cavernosa apexes withVicryl 4-0, (tension free)—tying of urethra and ventral surface ofcorpora cavernosa—reconstruction of neurovascular bundle—urethralmucosa and penis skin in slightly hypospadic position—application ofa dynamic catheter 16 Ch in order to defend urethra—medication withFitostimoline on urethral mucosa and semi-compressiveConclusion: Histological examination: negative margins, squamouskeratinized gland cancer moderately differentiated pT2 G2 pNx.After-surgery course was regular, after 10 day urethral mucosa istrophic and rose. Aesthetic result is good after 4 months. We can saythat this technique is proposable to youung patients with localiseddisease, who need an efficacies oncological control of the disease anda good aesthetic result.

PP-05-275

Frenular Grafting—an alternative to circumcisionSpillings, A.1; Kayes, O.1; Chi-Yi, L.1; Nim, C.1; Minhas, S.1; Ralph, D.1

1University College Hospital, Andrology, London, United Kingdom

Objective: We describe a refined alternative technique involving the incision of scarred frenular tissue and the insertion of an interpo-

sition skin graft in patients with tight frenulum and associated phimosis.Methods: Six men diagnosed with a combination of tight frenulumand a degree of phimosis, were selected for a frenular grafting proce-dure. All patients expressed a strong desire to avoid circumcision.Results: The donor site used for the graft, was initially split-thicknessskin from the inner thigh (n = 2) and latterly a horizontal ellipse offull-thickness dorsal, inner preputial skin (n = 4). All patients had viablegrafts at follow up with no evidence of partial necrosis. The functionaland cosmetic outcomes appeared excellent.Conclusion: Frenular grafting offers a novel solution in patients withtight frenulum and concomitant phimosis who wish to retain theirforeskin.

PP-05-276

The comparison of symptoms according to the phaseof Peyronie’s diseaseAkman, T.1; Oktar, T.1; Sanli, O.1; Guven, S.1; Akbulut, M.F.1; Kadioglu, A.2

1Medical Faculty of Istanbul, Department of Urology, Turkey; 2Istanbul Uni-versitesi, Dept. of Urology, Capa, Istanbul, Turkey

Objective: Two discernible phases were noted during the progressionof the Peyronie’s disease. The aim of our study is to compare the symp-toms in acute and chronic phases of Peyronie s disease.Methods: The data of 856 patients with Peyronie s disease were ana-lyzed retrospectively. Patients were categorized into 2 groups as acuteand chronic phase of the disease. Both groups were compared withregard to symptoms such as pain, deformity and erectile status. Theerectile status was assessed by a self-developed questionnaire and com-bined injection and stimulation (C.I.S) test.Results: Of 856 Peyronie’s patients, 59.3% (n: 508) were in acutephase and 40.6% (n: 348) were in chronic phase of the disease. The comparison of the 2 groups of patients were summarized in table-1. The mean age of the patients in acute phase was 51.9 ± 10.3years, which was significantly lower than the patients in chronic phase (54.8 ± 10.9 yrs)(p = 0.0001). The mean age, rate of ED andnegative response to CIS test were significantly higher in patients presenting in chronic phase of the disease (Table-1). No statisticallysignificant difference was detected between two groups in terms ofdegree of penile curvature. Among patients with duration of diseaseless than 6 months, pain was significantly higher than other Peyronie’spatients, being most common during the first 3 months of the disease(Table-2).Policy of full disclosure: Peyronie’s disease is most commonly seenin men in their fifties and more than half of them present in the acutephase of the disease. Patients in acute phase are younger and rate ofED is lower than in chronic phase of the disease. Pain on erection wasfrequently observed within the first six months of disease, which wasmore pronounced during the first 3 months.


J Sex Med 2007;4(suppl 2):152–202

PP-05-277

Classification of disease of PeyronieGurzhenko, Y.11Institute of Urology of AIS of, Dept. of Sexology—Andrology, Kiev, Ukraine

Objective: The clinical classification of disease is offer on the basis ofmonitoring 1487 patients with Peyronie’s disease (PD).Methods: On the stages. Subclinical (pain syndrome 1–2 degreewithout a compression and curvature). 1 stage (pain syndrome 1–2degree, hardening of 0–1 degree and curvature 0–2 degree). 2 the stage(pain syndrome 1–3 degree or without it, a compression 1–3 degreewithout violation of erectil function or limitations of sexual life (SL).3 the stage (absence of pain syndrome, compression 2–3 degree, cur-vature 2–3 degree with impossibility of SL because of curvature. Onflowing: 1. Slowly progressive form; 2. Quickly progressive form. Onclinical displays: 1. Pain—0—absence; 1—pain during erection; 2—considerable pain, difficulty in SL; 3—pain without erection 2.Curvature—0 absence; 1- to 30°; 2- to 60°; 3- >60°. 3. Compression—0—absence; 1- 1 cm in a diameter; 2- 1–3 cm; 3- >3 cm On localiza-tion of name-plate: 1. At a root; 2. In area of trunc; 3. At a head Ondirection of curvature: 1. Dorsal; 2. Lateral (right, left); 3. Dorsolat-eral left; 3. Dorsolateral right On the presence of complications. Onthe presence of concomitant diseases.Conclusion: Exemplary diagnosis: Peyronie’s disease (PD). 2 stage.Slowly progressive form. A pain syndrome of 2 degree, Curvature ofdorsolateral left of 2 degree, Compression with localization at the rootof penis of 2 degree with violation of erectil function. Dupuytren’s contracture.

PP-05-278

Experience of surgical treatment of patients withdisease of PeyronieGorpinchenko, I.1; Stahovskiy, E.1; Gurzhenko, Y.1; Kornienko, A.1

1Institute of Urology of AIS of, Dept. of Sexology—Andrology, Kiev, Ukraine

Objective: 28 patients with Peyronie’s disease (PD) were operated bythe method of delete of name-plate and plication of albumen shell bythe shred of hypodermic vein of thigh.Methods: Researches of the state of sexual function, curvature, circu-lation of blood of penis, laboratory indexes were executed before anoperation. The pictures of penis in the state of erection were done ina dynamics for visualization of results of treatment. Were also madeDoppler ultrasonography, cavernosography, axillary tomography ofpenis. Deontological conversation about possible results and compli-cations of operation was conducted with patients. A postoperative esti-mation was made in 2 months, 6 months and in a year after anoperation.Results: 24 (85.7%) from 28 patients were attained direct erectionsafter an operation. 4 (14.3%) patients had curvature of penis duringerection, which enabled to carry out coitus (corner of curvature inlimits to 30°). Shortening of penis on 0.5–1.5 cm was observed in 6(21.4%) cases. Diminishing of sensitiveness of head of penis wasmarked by 4 (14.3%) patients. 25 (89.3%) patients did not mark thechanges of quality of erections after treatment in comparison to pre-surgical period.Conclusion: surgical treatment of PD by the method of delete ofname-plate and plication of albumen shell the shred of hypodermicvein of thigh is effective enough and it can be recommended in practice.

PP-05-279

Stage of morphological evolution of albumen shell ofpenis of patients with disease PeyronieGurzhenko, Y.11Institute of Urology of AIS of, Dept. of Sexology—Andrology, Kiev, Ukraine

Methods: The checkup and treatment 888 patients by Peyronie’sdisease (PD) at age from 18 to 86 years with duration of disease from

1 month to 12 years are in basis of our work, and also 55 laboratoryanimals which the model of PD was created by.Results: 1 stage. The starting mechanism of PD is a trauma of penis.2 stage. Insignificant break of albumen shell or increase of permeabil-ity of vessels during intensive sexual coitus. 3 stage. A hemorrhage isstasis of uniform elements of blood, violations of reological propertiesof blood, pressure on the walls of endothelium, discompensation ofendothelium cellules, output of plasma albumens. 4 stage. Activatingof cellular reactions: Activating of labrocyte reaction: their amount inconjunctive tissue round vessels is multiplied. Activating of plasmocytereaction—there is degranulation with the spike of ribonucleoprotein,which are plastic material for formation of albuminous faction of col-lagen fibres. Activating of lymphoid elements—from vessels lympho-cyte go out and form perivascular infiltration, there is degrarulationwith the spike of lymphoquin, which activate fibroblasts. Activating offibroblastic reaction. Symbiosis of fibroblasts and lymphocyte is instru-mental in strengthening of formation of collagen fibres and surplusgrowth of conjunctive tissue. 5 stage. Stage of hyalinosis of vessels. Theamount of fibroblasts which assimilate the albumens of blood and formcollagen fibres is multiplied. As a result of dystrophy of tissue as a resultelastiod degenerations change tinctorial properties of tissue and itacquires ability to accumulate the ions of calcium. 6 stage. Stage of cal-cinosis. On the basis of these information MORPHOLOGICALCLASSIFICATION is developed: 1. Stage of sharp inflammatoryreaction 2. Stage of subsharp inflammatory reaction. 3. Stage ofchronic inflammation. 4. Stage of calcification.

PP-05-280

State of hypophysial gonadal system of patients withdisease of PeyronieGurzhenko, Y.1; Imshinetskaya, L.11Institute of Urology of AIS of, Dept. of Sexology—Andrology, Kiev, Ukraine

Objective: Research of the functional state of the HypophysialGonadal SYSTEM (HG) is conducted at 378 patients with the differ-ent stages of disease of Peyronie (DP) at age from 17 to 69 yearswithout concomitant andrological pathology.Methods: Taking into account clinical displays and age maintenancein plasma of blood of testosterone (T), lutropine (LT), follitropine(FT) were studied by radio chemical methods.Results: The level of T in the group of patients made 19.19 + 0.59nmole/l (norm—25.96 + 1.3 nmole/l), thus at 81.5% this index is morelow (16.50 + 0.46 nmole/l; p < 0.05). Table of contents of J-lT in plasmaof blood on the average a few higher than norm (5.27 + 0.45 mE/l)and made 6.64 + 0.39 mE/l, here at 53.6% inspected patients level ofplasma LT in 1.8 times higher than middle age norm and made 9.6 +0.5 mE/l; p < 0.01). Level of FT in 3.9 times exceeds an age norm (1.59+ 0.30 mE/l) and makes on the average 6.18 + 0.25 mE/l, thus at 97%inspected FT was even a few higher (6.34 + 0.25 mE/l; p < 0,001).Conclusion: The reliable decline of level of T is established with thesimultaneous increase of gonadotropic hormones. Conformity to thelaw of changes of hormonal background is exposed depending on ageand stage of process, that confirms the role of hormonal disfunctionin genesis of DP. Thus, a change of the function of the HG-system atDP at the men of mature age flows on the type of involution andro-genic insufficiency.

PP-05-281

Ultrastructural characteristic of cellular elements ofalbumen shell of penis at disease of PeyronieGurzhenko, Y.11Institute of Urology of AIS of, Dept. of Sexology—Andrology, Kiev, Ukraine

Objective: We conducted the electron microscopy study of basic com-ponents of albumen shell at patients on the different stages of Peyronie’s disease (PD).Methods: For an electronic microscopy used preparations of albumenshell, got at 7 patients during an operation on occasion of PD. Objectsfixed in 2% glutaraldegidis with next fixation by 1% solution of


J Sex Med 2007;4(suppl 2):152–202

tetraoxid of osmium by Millonig. After dehydratation in alcohols andin oxide sawed through objects were concluded in apon-eraldit. Thedouble contrasting of preparations was made by the method ofReynolds and studied on the emission microscope.Results: The got results allowed to set that the initial links of PD arerelated to violations in the system of microcirculation with the increaseof permeability of shallow vessels of blood, that over is brought totransfusion of plasma factions, including glucoseaminoglycane, glyco-proteids and other complexes which as dispersion electron compactmaterial was determined near-by capillaries. In pericapillar areas bigquantity of transsudation of blood and bioactive substances werefound. It stimulated proliferation and activating of fibroblasts. In per-icapillar areas there were groups of fibroblasts, containing the microfi-bres of procollagen in a cytoplasm, and also the fibrillar bunches ofcollagen, located in an intercellular substance, were exposed. Thedynamic prolonging of this process resulted in surplus formation ofcollagen fibres near-by the shallow vessels of blood, that caused scle-rosis and local desolation of capillary system. Such hearth violation ofprocesses of trophic caused metabolic and dystrophic changes in col-lagen structures and polymerization of complexes of collagen from glu-coseaminoglycane of transsudation and by formation of non structedhyalinized material which is a matrix for extracellular calcification andlocal forming of dense calcificated name-plates of albumen shell at PD.

PP-05-282

The corporoplasty with simultaneous penile prosthesisimplantation in Peyronie diseaseSokolschik, M.1; Petrovich, R.1; Gagarina, S.1; Vasiev, Y.1; Sadakova, I.11NMSC, Andrology, Moscow, Russia

Objective: Due to modern theory of Peyronie disease pathogenesisplastic induration appear after microtrauma of tunica albuginea. Everycorporoplasty with dissection of plaque has traumatic character andcan lead to recurrence. Also fibrotic processes may partly damage cav-ernous tissue, so Peyronie disease is often accompanied by erectile dys-function. Corporoplasty in patients with erectile dysfunction neverimproves erection and it can lead to erectile dysfunction in patientswith normal erection.Methods: In our clinical practice we use the method of corporoplastywith simultaneously prosthesis implantation in patients with Peyronie’sdisease and erectile dysfunction.Results: During the operation the plaque is dissected. After that penileprosthesis implantation is performed via defect in tunica albuginea.Then this defect is covered with a Gore-Tex or venous patch. In ourclinic 78 patients were undergone this surgery. In every case there wasa good esthetic and functional result. In 2 cases there was prostheticinfection.Conclusion: This method allows solve the problem of erectile dys-function in case of combination with Peyronie’s disease. The recur-rence of disease is impossible because of axial protection ofphalloprosthesis. Moreover we can speak about the return to initialsize of penis in case of it’s shortening for the corporoplasty leads topenis lengthening with the help of prosthesis.

PP-05-283

Determination of Turkish patient satisfaction afterpenile prosthesis surgeryGoren, M. R.1; Çakar, B.2; Peskircioglu, L.2; Ozkardes, H.2

1Baskent University School of M, Urology, Ankara, Turkey; 2Baskent Uni-versity School of M, Department of Urology, Ankara, Turkey

Objective: Penile prosthesis implantation has over 90 % satisfactionrate for the general penile implant population. The objective of thisstudy was determining the satisfaction rates of Turkish penile implantpopulation, and the requirement of additional medications followingthe surgery.Methods: Between 1995 and 2006, 46 patients with a mean age of56.9 years (range; 28–80 years) included to study. Penile prosthesis

surgery performed in 35 patients with arterial insufficiency, 6 patientswith Peyronie’s Disease, 3 patients with cavernosal fibrosis and 2patients after radical prostatectomy. Mean follow-up time was 51months (range; 10–111 months). Eleven malleable, 9 two-piece inflat-able and 26 three-piece inflatable prostheses were used. In 5 cases themalleable prostheses were replaced with three-piece prostheses onpatient’s demand. Questions of 7, 8, 13 and 14 of the validated Turkishversion of International Index of Erectile Function were used to deter-mine satisfaction.Results: Five of 46 patients’ prostheses were removed because of theprostheses’ infection. One prosthesis was replaced because of the pumpfailure. None of the patients were unsatisfied with penile prosthesis.Conclusion: Our data suggest that penile prosthesis implantation pro-vides a satisfactory sexual life in all patients without the requirementof additional approaches such as oral medications.

PP-05-284

Idiopathic Priapism in patient with Cerebellar Ataxiaand left colon neoplasm: A case reportPolito, M.1; Giannubilo, W.1; Leone, M.1; d’Anzeo, G.1; Dellabella, M.2;Muzzonigro, G.21OO.RR. Ancona, Urology, Italy; 2A.O. OO.RR., Urology, Ancona, Italy

Objective: to report the clinical case of priapism in patient with Cere-bellar Ataxia and AdenoCarcinoma of the left Colon.Methods: Patient 59 years old, with priapism from 3 days, affected byCerebellar Ataxia diagnosed 10 years before, in therapy with neu-roleptic medication (no Clorpromazina). At the physical examination:erection, no other pathological findings, normal laboratory tests,normal micturition, neglected aspect, bradipsychism, bradilalia. Theinterview with the partner revealed an unbridled sexual activity andmasturabation in the last 6 months. No use of pro-erectile medica-tions, no history of genital trauma, no hematologic disorders.Results: we performed a haemogas-analysis which revealed a PCO2> 60 mmHg, and subsequently trans-cavernous drainage and trans-glandular bilateral shunt. After this operation, the PCO2 was <35mmHg and we obtain the resolution of the priapism, with no post-operatory complications until the discharge. After 5 days, the patientreturned to our Clinic with the same clinical picture (he referred sexual activity). So we performed selective angiography for InternalPudendal Artery which showed no pathological findings. The tumoralmarkers CA-19-9, Ca 125, CEA resulted elevated; after a gastroscopy,the colonscopy revealed a mass in the left colon. Considered the irre-versibility of andrological condition, the patient was operated oflaparoscopic resection of left colon, with pathological diagnosis oftubular-villous adenoma with high grade displasia.Conclusion: our clinical case was related with a neoplastic pathology;priapism resistant to standard treatment for this condition, should beinvestigated for secondary etiology.

PP-05-285

Our experience of the evolution of priapismBondil, P.1; Bouraoui, K.1; Ozone, F.1; Demey, A.1; Adawi, F.11General Hopsital, Dept. of Urology-Andrology, Chambery, France

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. Our objective was to assess the reality of the reductionof iatrogenic post-ICI priapism.Methods: to analyze the evolution of priapisms observed in our hos-pital by comparing their frequency, mechanism, aetiology and treat-ment between two periods: 1985–1996 and 1997–2006.Results: 1) 1985–1996: 46 cases (mean age: 39) all from venous originincluding 35 iatrogenic (29 post-ICI), 5 haematological and 6 idio-pathic. 10 cases (mean age: 40.5) from various aetiology (including 2post-ICI) have been operated on after failure of medical treatment


J Sex Med 2007;4(suppl 2):152–202

after a mean delay of 43 hours. 2) 1997–2006: 28 cases (mean age: 53)of various mechanism: a) 15 venous (6 iatrogenic including 2 post-ICI,1 haematological, 8 idiopathic). 6 cases (mean age: 55) have been oper-ated on after failure of medical treatment after a mean delay of 42hours, b) 3 post-traumatic arterial medically treated, c) 10 intermittentnocturnal of undetermined aetiology all medically treated.Conclusion: Our comparative analysis shows: a) 3 expected facts: aclear decrease of post-ICI priapism, the priapism remains a rare con-dition and the venous priapism, an emergency, b) one unexpected fact:a clear change of physiopathological mechanism with 46% of novenous origin. Theses changes reflect certainly a better prevention ofpost-ICI priapism and likely, a better understanding of no venous priapisms.

PP-05-286

Painful La Peyronie disease: Are really inefficient theintracavernous injections of corticoids?Bondil, P.1; Demey, A.2; Ozone, F.3; Knouzy, B.2

1General Hopsital, Dept. of Urology-Andrology, Chambery, France; 2generalhospital, urology-andrology, chambery, France; 3general hopsital, urology-andrology, chambery, France

Objective: The international guidelines counteract the use of intra-cavernous injections of corticoids (ICIC) for La Peyronie disease (LP).In a previous study (1) about 45 cases of LP in acute phase, we haveshown their rapid and clear efficacy on pain. Our objective was toconfirm this beneficial effect on pain by using a more objective meas-urement than the simple physician interrogation.Methods: a) sample: 24 men (mean age: 53.5) 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 if improvement).Results: The 62% decrease of mAVS (mean AVS) initial 4.2 vs. 1.6final shows the efficacy of ICIC with similar results: a) 13 recoveries(54.2%): 3.45 mAVS initial vs. O.1 final; b) 4 clear (50% AVS decrease)improvements (16.6%): 6.75 mAVS initial vs. 3.4 final; c) 7 poor orabsent efficacies (29.2%): 4 mAVS initial vs. 3.5 final. The mean ICICnumber was 4.5 (3–7) showing the rapid efficacy. None impairmenthave been noted. For the most severe cases (10 initial AVS > or = 5),the efficacy is present (55.2% improvement) but lower (6.7 mAVSinitial vs. 3 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 with immediate beneficialeffect (rapid and clear decrease of pain in 70%) and likely secondary(decrease of sequels by reducing the inflammatory phase). 1) ProgUrol. 2006, 16: 52–7.

PP-05-287

Rehabilitation after plastic penile surgeryLauer, W.1; Perkowski, D.2; Markuszewski, M.2; Krajka, K.21Medical University, Urology, Gdansk, Poland; 2medical university, urology,gdañsk, Poland

Objective: Recently there is growing interest in surgical treatment ofpenile disorders. It is visible between patients and urologists. The mostfrequent disorders are inhibited or acquired penile deviations. Thelater are often encountered in men over 40 and its treatment requiresusing post-operative rehabilitation in order to restore ability toperform sexual intercourses. We present our own method of rehabili-tation.Methods: Rehabilitation programme is implemented in all patientsafter operations of penile deviations caused by Peyronie disease orpost-traumatic lesions. The programme includes: 1. Cialis 10 mg 3×week, 2. Intracorporeal injection of papaverine 40 mg 3× week, 3.

Pulling device Andro-Penis, 4. Vacuum device. Two first items arestarted in second week post-operative and two later are initiated in athird week. Patients are taught in the hospital in order to be able topractice independently at home. Teaching includes instructive filmsand performing exercises under supervision of the staff.Results: Multifactor programme combining education and practice isextremely warmly welcomed by patients. The final long-term result ofthe operation relies on persistent fulfilling of the programme for 2–3months after the procedure as well as on the kind of surgery and pre-operative sexual shape.Conclusion: Complex postoperative rehabilitation should be integralpart of surgical treatment of penile deviation.

PP-05-288

Surgical treatment of Peyronie’s diseaseKrajka, K.1; Matuszewski, M.1; Moszczynski, W.11Medical University, Urology, Gdansk, Poland

Objective: Surgical treatment of Peyronie disease not always bringsoptimal results especially if it causes shortening of a penis. That is whynew techniques are still being developed in order to correct the peniledeviation without harming sexual function. The film presents surgicalmethod without excision of the plaque.Methods: A 64 years old patient was referred to the department ofurology, because of penile deviation and pain during sexual inter-course. He was qualified to surgical treatment. The procedure startedwith penile denudation. Then the tunica albuginea was reachedthrough Buck’s fascia. Next the incision was made along the edges ofthe plaque and it’s fibrous tissue was delicately freed from normaltunica. Finally layers were closed with intermittent sutures.Results: Post-operative period was uneventful. Patients was able torestart sexual activity after 4 weeks.Conclusion: The method seems worth considering when qualifyingmen with Peyronie disease to surgery, although it requires precisionand delicate preparing.

PP-05-289

Systemic vascular abnormalities in Peyronie’s diseaseAgrawal, V.1; Minhas, S.1; Ellins, E.2; Donald, A.1; Halcox, J.1; Ralph, D.1

1Institute of Urology, Andrology, London, United Kingdom; 2Institute ofUrology, Urology, London, United Kingdom

Objective: Patients with Peyronie’s Disease (PD) commonly have oneor more risk factors for endothelial dysfunction and atherosclerosis(RFs). We hypothesise that PD is associated with systemic vascularchanges even in the absence of RFs.Methods: Vascular function was assessed using high resolution ultra-sound in 21 PD patients (aged 30–65 years) without RFs and 21 age-matched healthy controls. Endothelium nitric oxide release-dependent, flow-mediated brachial artery vasodilatation (FMD) wasmeasured in response to increased shear stress (reactive hyperaemiainduced by forearm-cuff inflation and then deflation). This responsewas contrasted with that to 400 lg sublingual glyceryl trinitrate(GTN), (endothelium-independent vasodilator). Anthropometriccharacteristics, blood pressure, fasting lipids and glucose were measured.Results: Baseline forearm bloodflow and flow response to ischaemiawas greater in PD patients. Despite this, endothelium-dependentvasodilatation (FMD) was impaired in PD patients compared to con-trols (5.68 ± 2.92 vs. 7.4071 ± 2.66%, P < 0.05). Blood pressure, lipids,glucose arterial distensibility, and responses to GTN were similar inPD patients and controls.Conclusion: Patients with PD have evidence of systemic conduitartery endothelial impairment as well as altered resistance vessel function even in the absence of RFs. These wider vascular abnormal-ities in PD are likely to be of clinical relevance and require furtherstudy.


J Sex Med 2007;4(suppl 2):152–202

PP-06 General Issues in Sexual Medicine

PP-06-290

The real-life safety and efficacy of vardenafil: An international post-marketing surveillance study—results from 5373 Polish patientsTrypens, P.1; Depko, A.2; Dadej, R.3; Landen, H.4

1Przychodnia Urologiczna UroVes, Przychodnia Urologiczna UroVes,Warsaw, Poland; 2Spec. Przych. Lekarska dla Pra, Poradnia Seksuologiczna,Warsaw, Poland; 3I Katedra i Klin. Urol. i Onko, AM im. K.Marcinkowskiego w Poz, Poznan, Poland; 4Bayer HealthCare Pharma,Department of Post-Marketing S, Leverkusen, Germany

Objective: Erectile dysfunction (ED) is a serious problem for patientand it can markedly impair his quality of life. The management of EDhas dramatically changed since the introduction of orally administeredphosphodiesterase 5 (PDE 5) inhibitors. The aim of this study was toevaluate the efficacy, tolerability and patient acceptability of vardenafilunder day-to-day clinical practice conditions.Methods: In this non-controlled, non-interventional post-marketingsurveillance study, 5373 patients attended to initiating and at least onecontrol physician visits over approximately two months. Informationon treatment success, successful penetration (SEP-2), maintenance oferection (SEP-3), and satisfaction with erection was obtained via physi-cian interview and a voluntarily completed patient questionnaire.Results: The large majority of patients reported an overall improve-ment in ED (97.9%), with similar improvements rates for the 10 mg(97.9%) and 20 mg (97.8%) doses. Most patients achieved treatmentsuccess after the first (78.7%) or second tablet (93% cumulative).Sexual attempts were successful with respect to partner penetration in96.8% of patients and with respect to maintenance of erection duringintercourse in 88,3% of patients. Vardenafil was generally well toler-ated. Adverse events were very rare (0.7%), predominantly headache,flushing and flue syndrome were reported.Conclusion: Under “real life” conditions encountered in clinical prac-tice, vardenafil was an effective, reliable and well-tolerated treatmentfor patients with ED.Policy of full disclosure: The Study was conduced in cooperationwith Bayer Poland. Dr Harald Landen is an employee of Bayer Health-Care AG.

PP-06-291

Evaluation of a Sexual Assessment Monitor (SAM); adiagnostic device for premature ejaculationDinsmore, W.1; Ralph, D.2; Kell, P.2; Wylie, K.3; Dean, J.4; Novak, C.5;Wyllie, J.5; Wyllie, M.6

1Royal Victoria Hospital, Genito-Urinary Medicine Depart, Belfast, Ireland;2Hospital of St Johns and St El, Urinary Medicine Department, London,United Kingdom; 3Porterbrook Clinic, Urinary Medicine Department,Sheffield, United Kingdom; 4The Salisbury Clinic, Urinary MedicineDepartment, Plymouth, United Kingdom; 5Plethora Solutions, Clinicaldevelopment, London, United Kingdom; 6Plethora Solutions, London, UnitedKingdom

Objective: To validate the Sexual Assessment Monitor (SAM); a devicedesigned to collect electronic data on ejaculatory latency time (ELT).Methods: Men with PE and healthy subjects, aged 18–75 years wereenrolled in studies across the UK to evaluate SAM. SAM consists of acontrol box attached to a laptop computer, and two front attachments,a vibrator and sensor. The vibrator consists of an encapsulated lowpowered electric motor, which can provide a constant or variable fre-quency of vibration and is positioned at the frenulum using a cuff. Thesensor is an indium / gallium loop, which is positioned at the base ofthe penis to detect ejaculatory pulses as they travel through the penis.The pulses are transmitted to a data recorder and automatically clas-sified by a computer-generated algorithm to identify the times to erec-tion and ejaculation, and hence ELT.Results: SAM was validated using 58 patients with PE (36 using DSM-IV criteria and 22 with self-reported PE) and 53 healthy volunteers in

a clinical setting. Overall, 98.6% of SAM traces from healthy volun-teers and 99% of traces obtained from patients with PE were evalu-able, and the majority of these were complete traces, having botherection and ejaculation profiles present. The pooled data show thatELT was much higher for healthy volunteers than PE patients (geo-metric means: 11 : 27 vs 2 : 49 minutes respectively), with a healthyvolunteer to PE patient ratio of 2 : 87 minutes (p < 0.0001).Conclusion: SAM gives consistent and reproducible results of ELTfor both healthy volunteers and patients with PE. SAM may providean invaluable tool for the diagnosis of PE and could also be utilised inclinical trials assessing treatments, and in epidemiology studies.

PP-06-292

Half of those reporting a sexual problem are satisfied with their sexual function: Results from the hoppes studyKirana, P.-S.1; Fridakis, M.1; Nakopoulou, E.2; Rosen, R.3; McKinlay, J.3;Hatzichristou, D.11Aristotle University Of Thessaloniki, Research Center for Health Pro.,Thessaloniki, Greece; 2Aristotle University Of Thessa, Center for Sexual andReproduction, Thessaloniki, Greece; 3New England Research Institute, Deptof Health, Watertown, Ma, USA

Objective: To identify factors associated to satisfaction from sexualfunctioning among hospitalized patients that report a sexual dysfunc-tion (SD).Methods: HOPPES is a hospital-based survey investigating the rela-tionship between psychosocial profile, patient-centerness, symptoms’self-perception and health status in a random sample of patients admit-ted to a general hospital. The research design included a representativecross section of each clinic, and equal numbers of subjects in each of 6design cells, defined by age (18–40, 41–60, 61–80 years) and gender.Subjective perception of sexual functioning was measured by the SCSFand satisfaction by sexual functioning was measured by a single item ofthe SCSF. Satisfaction with partner relationship was measured by DAS-7, subjective perception of health by the first item of the SF-12 andtreatment seeking by a single question. Analysis included descriptivestatistics and significance tests (independent samples t-test, ANOVA,correlation coefficients) and interval estimates.Results: The sample (N = 454) consisted of 51.1% women and 48.9%men (mean age 50+16.5). Forty eight per cent (N = 219) of the samplereported at least one sexual dysfunction. Of them, 50.2% (N = 110)reported being satisfied from their sexual function and the rest 49.8%(N = 109) not satisfied. The types of dysfunction that were mostly asso-ciated to men’s satisfaction were ED and curved penis, while forwomen difficulty reaching orgasm and reduced sexual desire. Satisfac-tion was not associated to gender, age, marital status, educational leveland income, satisfaction from partner relationship, perceived healthand subjective well-being.Conclusion: The presence of a sexual dysfunction doesn’t necessarilymean that people are dissatisfied by their sexual functioning. In addi-tion, satisfaction from sexual functioning seems to be separate fromperceived health, satisfaction from partner relationship and subjectivewell-being. Such data have important implications for health policyand clinical practice.

PP-06-293

Patients’ self-perception of sexual function: Resultsfrom the HOPPES studyKirana, P.-S.1; Fridakis, M.1; Salpiggidis, G.2; Rosen, R.3; McKinlay, J.3;Hatzichristou, D.21Aristotle University Of Thessaloniki, Research Center for Health Pro, Thes-saloniki, Greece; 2Aristotle University Of Thessa, Center For Sexual AndReproduction, Thessaloniki, Greece; 3New England Research Institute, Deptof Health, Watertown, Ma, USA

Objective: To report hospitalized patients’ perception of sexual func-tion and factors related to it in a random sample of patients admittedto a general hospital.

PP-06-295

Presence of sexual problems may not indicatedissatisfaction from sexual life: Results from theHOPPES studyKirana, P.-S.1; Fridakis, M.1; Papacharitou, S.2; Rosen, R.3; Mckinlay, J.3;Hatzichristou, D.41Aristotle University Of Thessaloniki, Research Center for Health Pro, Thes-saloniki, Greece; 2Aristotle University of Thessaloniki, Greece; 3New EnglandResearch Institute, Dept of Health, Watertown, Ma, USA; 4Aristotle Uni-versity of Thessaloniki, Center For Sexual And Reproduction, Thessaloniki,Greece

Objective: To identify factors associated to satisfaction from sexual life(SL) among hospitalized patients that report a sexual dysfunction (SD).Methods: HOPPES is a hospital-based survey investigating the rela-tionship between psychosocial profile, patient-centerness, symptoms’self-perception and health status in a random sample of patients admit-ted to a general hospital. The design included a representative crosssection of each clinic, and equal numbers of subjects in each of 6 designcells, defined by age (18–40, 41–60, 61–80 years) and gender. Subjec-tive evaluation of sexual functioning was measured by SCSF and sat-isfaction from SL was measured by one item of the Life SatisfactionIndex. Satisfaction with relationship was measured by DAS-7 and per-ceived health by one item of SF-12. Analysis included descriptive sta-tistics, significance tests (independent samples t-test, ANOVA,correlation coefficients) and interval estimates.Results: The sample (N = 454) consisted of 51.1% women and 48.9%men, with a mean age 50 (std = 16.5). Forty seven per cent (N = 214)of the total sample reported at least one SD. Of them, 16.8% (N = 36)reported low level of satisfaction, 44.9% (N = 96) medium and only38.3% (N = 82) high satisfaction from their SL. The types of SD asso-ciated to men’s satisfaction were lack of sexual desire (p = 0.03) andED (p = 0.003), while for women reduced lubrication (p = 0.026) Satisfaction was not associated to gender, age, marital status, educa-tional level, income and perceived health, but was associated to satis-faction from relationship and subjective well-being.Conclusion: The presence of SD doesn’t necessarily lead to dissatis-faction from SL. Dissatisfaction from SL is associated to satisfactionwith relationship, and subjective well-being, but not to demographiccharacteristics. Interestingly, the only SD that affect satisfaction fromSL are lack of sexual desire and ED in men, and reduced lubricationin women.

PP-06-296

Treatment seeking behavior for sexual problems:Results from the HOPPES studyKirana, P.-S.1; Fridakis, M.1; Hatzimouratidis, K.2; Rosen, R.3; Mckinlay,J.3; Hatzichristou, D.21Aristotle University Of Thessa, Research Center for Health Pro, Thessa-loniki, Greece; 2Aristotle University Of Thessa, Center For Sexual AndReproduc, Thessaloniki, Greece; 3New England Research Institute, Dept ofHealth, Watertown, Ma, USA

Objective: To identify factors associated to treatment seeking behav-ior for sexual problems, in a random sample of patients attending ageneral hospital.Methods: HOPPES is a hospital-based survey investigating the rela-tionship between psychosocial profile, patient-centeredness, symp-toms’ self-perception and health status in a random sample of patientsadmitted to a general hospital. The research design included a repre-sentative cross section of each clinic, and equal numbers of subjects ineach of 6 design cells, defined by age (18–40/41–60/61–80 years) andgender. Subjective evaluation of sexual functioning was included usingthe SCSF, treatment seeking by a single question, satisfaction withpartner relationship by DAS-7 and perceived health by one item ofSF-12. Analysis included central tendency, dispersion and crosstabula-tions, as well as significance tests (independent samples t-test,ANOVA, correlation coefficients) and interval estimates.


J Sex Med 2007;4(suppl 2):152–202

Methods: HOPPES is a hospital-based survey investigating the rela-tionship between psychosocial profile, patient-centerness, symptoms’self-perception and health status in a random sample of patients admit-ted to a general hospital. The research design had as its goal to recruita representative cross section of each clinic (20 clinics), and equalnumbers of subjects in each of 6 design cells, defined by age (18–40,41–60, 61–80 years) and gender. Subjective perception of sexual func-tioning was measured by the SCSF (4- items). Satisfaction with partnerrelationship was measured by DAS-7 and perceived health by one itemof the SF-12. Analysis included descriptive analysis and significancetests (independent samples t-test, ANOVA, correlation coefficients)and interval estimates.Results: The sample (N = 454) consisted of 51.1% women and 48.9%men (mean age 50 + 16.5). Forty nine per cent (N = 221) of the totalsample reported at least one sexual dysfunction (SD). Sexual dysfunc-tions were significantly more frequent in females (r = 0.271, p = 0.006)and more frequent as age increased (r = 0.468, p = 0). The most fre-quently reported dysfunctions by men were: erection problem (24.8%)and lack of sexual desire (24.3%), while by women were lack of sexualdesire (42.7%), reduced vaginal lubrication (23.7%), difficulty reach-ing orgasm (21.6%). Those with SD had lower levels of subjectivewell-being, perception of poorer health and less satisfaction from theirpartner, compared to those without.Conclusion: Half of the hospitalized patients report at least one SD,which are significantly more frequent in females and aged patients.Such patients present a psychosocial profile that indicates few copingresources, indicating the need for further research on the issue.

PP-06-294

Perceptions about sexual health issues in nursingNakopoulou, E.1; Papaharitou, S.1; Moraitou, M.1; Ferenidou, F.1;Athanasiadis, L.11Aristotle University of Thessaloniki, Center For Sexual And Reproduction,Thessaloniki, Greece

Objective: To explore perceptions regarding patients’ sexual concerns,as reported by practicing nurses.Methods: The study recruited a convenience sample of staff nurses(SN) attending a 1-year course which is a prerequisite for their pro-fessional upgrading. Four focus groups, each consisting of 10–12members, were conducted and co-ordinated by two moderators. Ses-sions lasted approximately 60 min and were tape-recorded with par-ticipants’ permission. Discussion started with SN’s perceived definitionof sexual health, followed by open-ended questions. Transcripts wereprocessed with content analysis.Results: A total of 44 SN (42 females and 2 males, aged 27–45 yrs)participated in the study with a median of 15 years of professionalexperience. The themes identified were discussing patients’ sexualproblems and a need for training. Although SN believed sexual healthto be an important part of general health, they do not routinely assesspatients’ sexual concerns. They attributed their reluctance to a varietyof reasons: lack of time and privacy, heavy workload, patients’ genderand age. Few SN noted that ‘. . . talking about sexual health issues, isbeyond my duties . . .’. They further mentioned socio-cultural factorsand familial upbringing referring to the fact that it is a taboo issue.Precedence of physical problems and considering sexual health as lowpriority, limit also opportunities for discussion. Finally, a need forfurther training was evident either in the form of undergraduatecourses or continuous education seminars as participants suggested.Conclusion: The study revealed that SN find it difficult to addresspatients’ sexual concerns for a variety of personal and contextualreasons. Our findings suggest that, it is important to incorporate innursing curricula and continuous education programmes, both sexual-ity issues and training on communication skills. Thus nurses will beencouraged to examine their attitudes in order to contribute to theimplementation of sexual medicine.


J Sex Med 2007;4(suppl 2):152–202

Results: The sample (N = 454) consisted of 51.1% women and 48.9%men (mean age 50 + 16.5). 49% (N = 221) of them reported at leastone sexual dysfunction (SD); regarding treatment seeking for their SD,23.3% (N = 106) wouldn’t like to discuss with a doctor, 13.2% (N =60) would like to discuss, while 12.1% (N = 55) had already consulteda doctor. Treatment seeking was not associated to any demographicparameter, but educational level (r = 0.291, p = 0); It was also associ-ated to the following SD: pain (r = 0.667, p = 0.001) and ED (r = 0.626,p = 0) for men, and pain (r = 0.579, p = 0) and lack of sexual desire (r= 0.466, p = 0.015) for women. Interestingly, treatment seeking wasnot associated to satisfaction with partner and perceived health, butonly to the impact of subjective well-being (p = 0.006).Conclusion: Demographic characteristics play minor role in treat-ment seeking for sexual problems; the type of SD and patients’ sub-jective well being seems to be the main determinants.

PP-06-297

Prevalence and diversity of sexual disorders amongmale and female patients referred to family healthcareclinic, Tehran, IranGhavam, M.1

1Urmia Medical University, Psychiatry, Iran

Objective: Sexual malfunctions of individuals may also be originatedfrom physical or mental sources. Several variables control the sexualresponses and affect the health of sexual behavior. Sexual disorders alsoaffect marriage and are considered the source of tension. The presenttrial aims to study the diversity of sexual response disorders amongmarried men and women and to identify the effective variables such asage, sex, persistence of sexual problems, physical illnesses, mild mentaldisorders, marital relation tensions, tendency to treatment and the typeof treatment.Methods: We applied a descriptive method in this research and col-lected data from available samples (32 female and 61 male marriedpatients) referred to Family Healthcare Clinic. The average age ofsamples was 36.4 (S = 9.5). Interviews, clinical examinations and followups are applied to all of the test subjects.Results: Results indicated that erectile disorders among male (49.1%)and anorgasmia or orgasmic disorders among female (38.7%) were themost frequent problems of patients. Premature ejaculation amongmale and vaginismus among female patients were the second majorgroup of problems. Duration of sexual problems was less than 12months among one-third of the samples. However, 22.2 percent ofthem were involved with sexual difficulties for more than 5 years. Onthe other hand, 30.2% of them were also involved with different mildmental or some kind of physical problem. Almost 47.7% of patientsreported tension in their marital relation, where in 9 cases these ten-sions led to divorcement request from judicial authorities.Conclusion: The present study revealed the diversity of sexualresponse disorders and their predictive variables among marriedcouples. We discussed the result compliance of the present studies withfindings of other studies overseas. The finding-application analysis isalso presented to have a better understanding of the variables.

PP-06-298

Is there a significance of histamine in the control ofpenile erection?Becker, A. J.1; Ückert, S.2; Schröder, M.2; Scheller, F.3; Jonas, U.2; Stief, C.G.11Ludwig-Maximilians-University, Dept. of Urology, Munich, Germany;2Hannover Medical School, Dept. of Urology, Germany; 3Hannover MedicalSchool, Dept. Nuclear Medicine, Germany

Objective: Histamine 4-(2′-aminoethyl)-imidazol is a bioactive amineclosely related to the control of vascular tissue and the nitric oxide(NO) and cyclic GMP—mediated vasorelaxation. Although it has beensuggested that histamine might be involved in the induction and main-tenance of penile erection, its role and function in the human corpuscavernosum penis is only poorly understood. The aim of our study was

to evaluate the course of histamine plasma levels through differentstages of sexual arousal in the systemic and cavernous blood of healthymale subjects.Methods: 34 healthy adult male subjects aged 19 to 44 years (meanage 26 y) were exposed to erotic stimuli in order to elicit penile tumes-cence and rigidity. Whole blood was simultaneously aspirated from thecorpus cavernosum (CC) and a cubital vein (CV) during the differentpenile conditions flaccidity (n = 17/34), tumescence (n = 33/33), rigid-ity (n = 32/34), and detumescence (n = 21/34). Blood was also collectedin the postejaculatory period (PEP) (n = 10/15). Plasma levels of his-tamine (ng/mL) were determined by means of a radioimmunoassay(RIA).Results: Histamine slightly decreased in the cavernous blood with thebeginning of sexual arousal, when the flaccid penis became tumescent(0.95 0.5 to 0.87 0.36). During rigidity, mean histamine level decreasedfurther (0.81 0.3) but remained unaltered in the phase of detumescenceand after ejaculation. In the systemic circulation, no alterations inplasma histamine were observed with the initiation or termination ofpenile erection, whereas a significant drop was registered in the PEP(detumescence: 0.77 0.34, PEP: 0.64 0.24).Conclusion: Our results are not in favor of the hypothesis of an exci-tatory role of histamine in the control of penile erection.

PP-06-299

Erectile Dysfunction—Resourcing the couple: A therapeutic model enabling physicians to supportthe erectile dysfunction patient and partnerQuilliam, S.1

1Cambridge, United Kingdom

Objective: Erectile dysfunction affects not only the patients but theirpartners; the condition has an impact both emotionally and on rela-tionship stability. Hence physicians may need to offer not only medicalintervention but also emotional resources.Methods: The author’s extensive experience as an advice columnisthas led her to develop a model enabling physicians to identify andaddress emotional/ partnership problems in the ED situation.—Aseries of questions addressed to the patient (and, where relevant,partner) and a diagnostic guide to possible answers enables thephyscian to pinpoint in which of five key areas the couples lackresources to deal with erectile dysfunction.—A list of interventionsguides the physician to provide on-the-spot interventions and actionsuggestions in whichever of the given key areas the patient is mostderesourced.—Where on-the-spot intervention is not appropriate,guidelines allow the physician to make referral relevant to the five keyareas. Cruicially the model is useable even in a brief consultation timeand by physicians untrained in sex therapy. Although based on apsycho-social rather than a medical approach, this model is of greatrelevance to physicians and to this Congress, beacause it provides asimple and straightforward way to enhance medical consultation byproviding emotional support.Results: The presentation will outline the model and present case his-tories; participants will then be encouraged to learn the model by dis-cussing its use in their practice.Conclusion: Owing to the interactive nature of the work, this topicwould be suitable only for a face-to-face symposium, not a poster pres-entation.Policy of full disclosure: The author is on the Women’s Erectile Dys-function Advisory Board for Levitra, supported by Bayer Healthcare.

PP-06-300

A history of sexual abuse: How reliable is a self-administered questionnaire compared to anadministered questionnaire?Elzevier, H. W.1; Voorham- van der Zalm, P. J.1; Pelger, R. C. M.1

1Leiden University Med Center, Urology, Netherlands

Objective: Sexual abuse is common, but probably like Female SexualDysfunctions (FSDs) under-recognized, in patients with pelvic floor

PP-06-302

“san-sex.ro”—esda Romanian connectionCalomfirescu, N.1; Liiceanu, A.1; Belinski, C.1; Gaita, D.2; Fiica, S.1; Calom-firescu, C.1; Arama, V.1; Manu, A.3; Voinescu, V.4; Orsavski, V.5; San-SexExpert Group1Central Emergency Military, Hospital—Urology, Bucharest, Romania;2Central Emergency Military, Hospital—Urology, Timisoara, Romania; 3Sp. Prof. Dr. Dimitrie Gerota, Bucharest, Romania; 4Spital “Prof. Dr. T.Burghele”, Bucharest, Romania; 5Bucharest, Romania

Objective: www.san-sex.ro is the first educational project in the fieldof sexual medicine in Romania and was initiated by the RomanianAssociation for Sexual Medicine (AMSR) and we analyzed the first 6month of activity.Methods: Starting with January ’06 we created the site www.san-sex.ro, the Romanian connection of ESDA. With a friendly interface,accessing the site, you can find the address of a doctor specialized insexual medicine, access an encyclopedia, different articles about sexualmedicine or ask an expert in this field by e-mail.Results: Analyzing the results, we have to reveal first some data aboutthe accessibility of internet in Romania. In all the studies about 30%from the sample do not have access to internet. For youth people(15–25), 44% from men and 29% for women do navigate on internetdaily. Also, 6% from men and 18% from women don’t ever navigate.For the adult people (26–45): 28% from men and 16% from womendo navigate on internet daily. 30% from men and 35% from womennever navigate. For older people (46–55): just 3% from men and 8%from women navigate daily and 60% from men and 75% from womennever. For medium and superior level of the income and education82% are using internet and 30% accessed the site on sexual theme inthe last month. The number of visitors of our site started in Januaryfrom 381 was 1902 in August. The most interesting subjects for thevisitors were STI, E.D., premature ejaculation and feminine sexualdysfunction.Conclusion: A percentage of 12.5% from the visitors add to“favorites” our site. For us, it means a good start and a strong desireto continue and develop the education modalities.

PP-06-303

Sexual information level in active women populationin RomaniaCalomfirescu, N.1; Fiica, S.1; Belinski, C.1; Gaita, D.2; Bucuras, D. L.3;Cambosie, A.4; Mota, M.5; Bulai, A.1; AMSR Study Group1Central Emergency Military, Hospital—Urology, Bucharest, Romania;2Central Emergency Military, Hospital—Urology, Timisoara, Romania; 3Sp. Clinic Jud., Timisoara, Romania; 4Centrul Nat. de Acupunctura, siHomopatie, Bucharest, Romania; 5Univ. de Medicina si, Farmacie Craiova,Romania

Objective: “The sexuality of Romanian active population” is thelargest study accomplished in Romania in this field and was initiatedby the Romanian Association for Sexual Medicine (AMSR). Theresearch objectives: 1. Informing and communication 2. The sexual lifeof the active people 3. The erectile dysfunction and treatment 4.Social- demographical profiles.Methods: • The research has been accomplished on a sample of 1240people with an age between 15 and 55 years old • The research is basedon a quantitative methodology, statistically significant • Three groups:youth women (15–25), young (26–45), adult (46–55).Results: General information and sexual topics: • The women arelooking for useful information and entertainment • The main com-munication partners in sexual topics are the partner and the friends • The most known sexual affections are AIDS and syphilis • The pillsand the condoms are the most used contraception methods Regardingthe sexual life: • Sexual life begin is 16 years for the urban people and17 years for rural people • The most important sexual life character-istics are having orgasm and romantic mood • The number of sexualacts are 10–11 per month • Two thirds of the women have had a singlestable sexual partner • The women consider that the main problems


J Sex Med 2007;4(suppl 2):152–202

complaints. Healthcare professionals find it difficult to discuss sexualissues with patients . Questionnaires can be helpful improving recog-nition and management of sexual abused patients. The aim of the studywas to compare detection of sexual abuse in a self-administered ques-tionnaire vs. a administered questionnaire.Methods: We evaluated 20 sexual abused patients visiting our depart-ment of urology for pelvic floor complaints and who were treated bya pelvic floor clinician. Patients completed a self-administered pelvicfloor questionnaire before visiting our outpatient pelvic floor depart-ment. Some of the patients were treated by a pelvic floor clinician whoadministered the Pelvic Floor Leiden Inventories (PelFIs), a new con-dition-specific pelvic floor assessment questionnaire, including generalhealth urological, gynaecological, surgical, sexuological questionsduring the first visit. In both questionnaires a history of sexual abusemay be reported. We compared the reliability of both questionnairesin detecting sexual abuse.Results: From June 2005 to August 2006, 20 patients with pelvic floordysfunction reported sexual abuse during administration of the PelFIs.The mean age, at first consultation, was 44,5 year (range 19–68 years).All patients had completed a self-administered questionnaire sent bymail before visiting our outpatient pelvic floor department. Only 6 ofthem (30%) with a mean age of 50,2 year (range 38–68 years) notedin the self-administered questionnaire they had no history of sexualabuse but during administration of the PelFIs later on admitted sexualabuse.Conclusion: A administered pelvic floor questionnaire is more appro-priate for detecting sexual abuse than a self-administered question-naire. However in daily practice a self-administered questionnaire canbe helpful and a means for detecting sexual abuse by healthcare pro-fessionals having problems addressing sexual issues.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.

PP-06-301

The use of sexual symbolism and metaphor in thepsychosexual treatment of male anorgasmia—a case reportPacey, S.11Camden Primary Care Trust, 4 Bentinck Mansions, London, UnitedKingdom

Objective: The treatment goal for this 35-year-old man and hispartner was for him to ejaculate and orgasm in her vagina. There is atpresent no proven pharmacotherapy for male anorgasmia and in psy-chosexual therapy, strategies to treat this dysfunction have progressedlittle since Kaplan. Clinical experience is that clients presenting withthis problem, particularly if they have learned to ejaculate and orgasmin masturbation, are baffled by this problem. Moreover, it is hardsometimes for them to see the progress they make in therapy, as theyperceive ejaculation and orgasm as one event, not the outcome of aprocess.Methods: Alongside established sex therapy ‘tools’ and cognitive-behavioural tasks, techniques which seemed to contribute significantlyto the successful outcome of this case included the use of powerfulmetaphor and sexual symbolism. Of particular importance was the factthat the imagery was drawn from the man’s description of a childhoodincident involving his parents’ horses. He believed that this incidentwas at the root of his shyness and lack of confidence. Intermittently inthe therapy, the therapist used the equestrian imagery to discuss theman’s sexual self-image and to develop his story, as if watching a film,illustrating the progress the partners were making. Two additionalfactors helped: the relationship was both new (one year) and loving.Results: The couple’s intimacy grew remarkably: the man became anassertive lover, able to ejaculate when he wanted. The partners pro-gressed from infrequent dating to co-habiting, engagement, marriageand first pregnancy.Conclusion: It may help to broaden current psychosexual treatmentswhen treating psychogenic male anejaculation/anorgasmia.


J Sex Med 2007;4(suppl 2):152–202

that affect men’s sexual life are the erection problems Pathology andtreatment: • The mainsexual problems are the pain before menstrua-tion 20% and the impossibility to have orgasm 14% • 25% declaretheir partners have had erection problems • 33% declare that theirpartner have problems with the ejaculation • 20% take into accountthe possibility that the partners will appeal to a treatment for erectiledysfunction.Conclusion: This study gives us data about the level of sexual infor-mation in active women population in Romania.

PP-06-304

Remembered international index of erectile functiondomain scores are not accurate in assessingpreoperative sexual function (SF) in candidates tobilateral nerve sparing radical prostatectomy (BNSRP)Salonia, A.1; Gallina, A.1; Zanni, G.1; Briganti, A. B.1; Sacca, A.1; Doha, F.1; Capitanio, U.1; Pellucchi, F.1; Sozzi, F.1; Rigatti, P.1; Montorsi, F.11IRCCS San Raffaele, Urologia, Milan, Italy

Objective: To test the agreement between a remembered IIEF, whichtargeted SF regarding 6 months prior to the surgery, and a real-timeIIEF, which targeted the preceding 4 weeks, in candidates for aBNSRRP.Methods: From May 2005 to May 2006, 333 consecutive patientswere candidates to BNSRRP. On admission the day prior to surgeryeach patient was asked to fill in a set of validated questionnaires includ-ing both a real-time IIEF and a remembered IIEF. The 2-tailedStudent’s t test, the Chi-squared (χ2) test, the Pearson correlation coef-ficient, and inter-rater agreement (Kappa) tested the agreementbetween the two assessments.Results: All exclusions resulted in a convenience sample of 103(30.9%) evaluable patients. Remembered IIEF showed a greater preva-lence of patients with normal erectile function (EF) and a loweramount of preoperative ED than the real-time data. Correlation analy-ses demonstrated a significant positive correlation between remem-bered and real-time IIEF domain scores. In contrast, the Kappastatistic suggested that there was no agreement better than chancebetween remembered and real time IIEF values.Conclusion: The use of remembered IIEF domains scores does notprovide neither a perfect nor a good agreement with a real-time assess-ment, being therefore scientifically not adequate and useful to objec-tify the preoperative actual situation in candidates to BNSRRP.

PP-06-305

Potential impact of the educational level impact onthe rate of treatment adherence in patients witherectile dysfunction (ed). Results of a single majortertiary acadamic centreSalonia, A.1; Firaz, A.1; Pellucchi, F.1; Molina, R.1; Briganti, A.1; Zanni, G.1; Doah, F.1; Petralia, G.1; Barbieri, L.1; Rigatti, P.1; Montorsi, F.11IRCCS San Raffaele, Urologia, Milan, Italy

Objective: To retrospectively assess whether the educational level mayhave a significant impact 1) in shortening the delay before seeking firstmedical help after ED onset, and 2) on the rate of treatment adher-ence in ED patients visited in a single outpatient academic centre.Methods: Retrospective data from a convenience sample of 302 EDpatients were comprehensively analysed. Patients were segregatedaccording to their level of education. Duration of ED before attend-ing first medical help was available for 231 patients. Patients compli-ance have been studied in 82 patients for whom suggested therapy andfollowup data were available. Data are presented as mean +/− standarddeviation of the mean (SD), and median. Statistical analysis: Chi-squared test for the comparison of proportions; multivariate regres-sion analysis.Results: Patients with an elementary/primary school educational levelsought first medical help within a period equal or lower than 2 yearssince ED onset in a greater proportion than after a time frame of more

than 2 years (71.8 vs 28.2%; P < 0.001). This was not true for patientswho attended either secondary school (P = 0.88) or university (P =0.43). In contrast, a higher percent of treatment adherence wasdetected in patients with a greater educational level (namely, P = 0.097,P = 0.006, and P = 0.020, respectively for ED patients who had an ele-mentary/primary school degree, a secondary school degree and an uni-versity degree).Conclusion: These data seem to suggest that education level slightlyimpacts on the delay for seeking first medical help in newly onset EDpatients. Moreover, they seem to suggest that greater educational levelmight significantly impact the rate of adherence to the treatment inthis cohort of ED patients referring to a single major tertiary academiccentre.

PP-06-306

Unsuccessful investigation of preoperative couple’sand sexual relationship issues in candidates to radical prostatectomySalonia, A.1; Zanni, G.1; Capitanio, U.1; Gallina, A.1; Briganti, A.1; Dehò,F.1; Strada, E.1; Suardi, N.1; Rigatti, P.1; Montorsi, F.1

1IRCCS San Raffaele, Urologia, Milan, Italy

Objective: To assess the preoperative psychometric parameters con-cerning couple’s and sexual relationship issues in candidates to radicalprostatectomy (RP).Methods: From November 2002 to April 2005 (Period 1), on admis-sion the day prior to surgery 719 consecutive patients with a stable het-erosexual relationship and candidates to RP were comprehensivelyevaluated with a semi-structured interview and a set of indexes aimedat assessing couple’s and sexual relationship issues. From May 2005 toJuly 2006 (Period 2), both candidates to RP and patients’ partners wererequested to complete similar validated instruments.Results: After having started to request patients’ partners to fill thequestionnaires in we observed a significant decrease of the patientsadherence to the protocol aimed at assessing preoperative psychome-tric issues; indeed, a direct comparison showed a complete data col-lection in Period 1 vs Period 2 of 546/719 (75.9%) vs 79/320 (24.7%)(Chi-square: 240.01; P < 0.0001). Moreover, 82/320 (25.6%) partnersaccepted to receive the set of psychometric questionnaires, but only6/82 (7.3%) of those completed them. During Period 2 patientsrefused to complete the questionnaires mostly because they did notwant an assessment of their own sexual health issues contemporary tothat of their partners, although the partners had had a significant influ-ence in the decision-making on patient preference for the treatmentof the prostate cancer. We found a woman’s own refusal to receive thequestionnaires in 157/238 (66%) and the patient’s “prohibition” in theremnants (81/238; 34%) (Chi-square: 47.47; P < 0.0001).Conclusion: Assessment of sexual function profile prior to RP is com-pulsory to prospectively define the functional outcome of surgery;however, these results demonstrate that investigating contemporarycouple’s relationship issues before RP is mostly unsuccessful and sig-nificantly reduce the prevalence of complete data collection.

PP-06-307

Teaching program for physicians in medical sexologyBitzer, J.11University Hospitals, Dep. Obstet Gynecol, Basel, Switzerland

Objective: Bridge the gap between physicians in various medical spe-cialities and sexologists. Help physicians to address and provide basicsexual counselling for their patients in need Help physicians to referto sexologists.Methods: Review of the litterature regarding prevalence of sexual dysfunction in patients with cardiovascular, neurological, metabolic,malignant and psychiatric diseases. Analysis of liason work of the divi-sion of sexual medicine at the university hospital of Basel with referredpatients with group discussions among physicians and sexologistsDevelopment of training program in basic communication, assesse-ment and sexual counselling.

70% of them were caucasians, 20% negroes; 8% gypsy and 2% of asianraces.Results: We found out that 43 of the 50 adolescents had “AdolescentsConsultations” before their pregnancies. Their scholarity was low. Sixof them had not finished primary school, thirty eight had school totheir fifth to nineth grade and only six reached high school. We foundout that 20% were addicts and 92% had multiple sexual partners.Conclusion: We concluded that the adolescents who got pregnant haddysfunctional family background, with a low level of communicationbetween them. The majority remained with their families after child-birth. Even though the majority attended the “Adolescents Consulta-tion” this fact did not prevent a non planned or desired pregnancy.The answer to the question remains: Does multiple sexual partnersmake up for other addict behaviors?

PP-06-310

Autoerotic accidents in legal medicine—a retrospective study of 17 casesAlbrecht, K.1; Mansouri, F.2; Schultheiss, D.3; Ueckert, S.1; Jonas, U.1; Breitmeier, D.2

1Hannover Medical School, Urology, Germany; 2Hannover Medical School,Institute of Legal Medicine, Germany; 3Protestant Hospital Gie<b>en,Department of Urology, Germany

Objective: An autoerotic accident occurs during individual, usuallysolitary sexual activity in which a device or resources used to enhancestimulation in some way resulted in the victim’s death. The literatureof Legal Medicine described fatal autoerotic accidents, mostly as casereports, involving the use of wide variety of objects presenting bizarresituations. However, despite the frequent descriptions of theses acci-dents, only a little is known about there incidence. The aim of this ret-rospective study was to gather epidemiologic data and to describe somecharacteristics of the individual circumstances in which the body wasfound as well as autopsy results.Methods: All cases of the legally-mediated investigations of cadaversin the Institute of Legal Medicine (Hannover Medical School) wereevaluated. This study considers all fatalities occuring during autoeroticactivities as accidental autoerotic deaths.Results: In a time period of 19 years, the Institute of Legal Medicineperformed 15.687 forensic examinations. The analysis revealed 17 fatalautoerotic cases (0,1%). All victims were males (age: 16–76 y). Onemen was widdowed, three were married and thirteen were single.Twelve men died in their own or parents apartments. Ten of the menwere found by friends or family. Four men were wearing women´sclothes. Traces of sperma was detected on the body or clothes of nine.Nearly all cases demonstrated unusual circumstances found upon thediscovery of the men like urinary catheters or toxicologic substances.Causes of death included central paralysis (11), subarachnoid hemor-rhage (2), intoxication (1), hypothermia,(1), left heart failure (1) anddrowning (1).Conclusion: Accidental autoerotic deaths, concerning only male indi-viduals, are rare in the daily work of forensic examiners. The history,findings at scene and autopsy and the knowledge of other cases are ofutmost importance to accurately reconstruct an individual case of afatal autoerotic accident.

PP-06-311

Our experience of male dyspareuniaBondil, P.1; Ozone, F.1; Bouraoui, K.1; Demey, A.1; Adawi, F.11General Hopsital, Dept. of Urology-Andrology, 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.Methods: Method: The clinical features (age, aetiology and treat-ment) of men consulting only for this reason (painful ejaculationsexcluded) have been noted since November 2004 to August 2006.


J Sex Med 2007;4(suppl 2):152–202

Results: The teaching program contains the following elements:Techniques to overcome barriers to talk about sexual issues in patientsand physicians Pathway to descriptive diagnosis of the sexual problemClinical pathway to obtain a comprehensive etiopatholgical under-standing of the sexual problem: Preexisting personal factors, Diseasespecific factors (7 Ds), Reaction of the patient and the couple to thedisease Pathway for basic counselling and referral.Conclusion: The program presents a teaching tool including com-municative skills for physicians to address sexual problems and the syn-thesis of sexological workup with the diagnostic and therapeuticprocess in the various medical specialities. It offers an easy to learnalgorythm and thus facilitates the communication between medicalspecialist and professional trained in sexual medicine.

PP-06-308

A new model for a supraregional penile cancer serviceutilising an urgent fax response system and regularteleconferenced multidisciplinary (MDT) meetingsSummerton, D.1; Mayer, N.1; Bamford, M.1; Rajesh, A.1; Mulcahy, K.1;Terry, T.11Leicester General Hospital, Urology, United Kingdom

Objective: It is recommended that penile cancer (PC) is treated innetworks where the population exceeds 4 million. Previously, this raredisease was treated in small numbers in multiple centres. A newregional service, with a catchment population of 6.5 million, was intro-duced in 2005. Activity before and after the first year of this centralisedservice is presented and compared.Methods: Every new or existing PC case needing definitve treatmentor a management plan is faxed or e-mailed on a standard proformafrom all the regional units to the co-ordinating hospital. A recom-mended treatment plan, based on the EAU guidelines, is then returnedwithin 48 hrs and performed locally or referred to the central unit. Alllcases are then discussed at the monthly MDT meeting via a Tandberg2500 multi-site teleconferencing system. Histology is reviewed and anMRI penis and pelvis with intracavernosal alprostadil performed priorto (usually conservative) surgery with the use of intraoperative frozensections.Results: Before 2005, in the index hospital (population 1 million), 5new PC cases were operated upon per year (mainly biopsies, circum-cision, partial and total penectomy). In the first 12 months of thesupraregional service, 53 new cases have been discussed. Two surgeonsat this lead site have performed 17 biopsies, 14 glansectomies, 10partial and 6 total penectomies, and 16 inguinal and 1 pelvic lym-phadenectomies in one year. Central histological review of 15 casesfrom the network has resulted in 5 upgraded cancers.Conclusion: The introduction of a supraregional PCMDT has greatlyfacilitated the rational treatment of this rare but important disease and sugical experience has been significantly concentrated in a high-throughput unit. Teleconferencing is a convenient, more time-efficientand effective method of communication. The implications , advantagesand potential problems of this approach are discussed.

PP-06-309

Pregnancy in adolescenceGuimaraes, I.1; Almeida, I.11Clinica Infante Santo, Lisboa, Portugal

Objective: The impact of a pregnancy in adolescence reflects not onlycultural and social aspects but also individual ones. The effective com-munication between parents and children about sexual matters canchange the way the adolescents live their sexual lives. OBJECTIVES—We tried to find a connection between frequency of “Adolescents Con-sultations” and pregnancy; between addict behaviour and pregnancyand their scholarity. As a specific objective, relate their scholarity withtheir first pregnancy.Methods: Our study picked up 50 adolescents in the “Pregnancy Con-sultation” of Maternidade Alfredo da Costa, Lisbon, Portugal, whoused this consultation during 2005, theirs ages rounding 13 to 17 years;


J Sex Med 2007;4(suppl 2):152–202

Results: Results: 85 cases of a mean age 47 (19–76) of various aetiol-ogy: a) 32 La Peyronie diseases treated by intracavernous corticother-apy; b) 21 post-traumatic: 15 partial ruptures of fraenulum (surgicaltreatment), 3 partial cavernous ruptures and 3 superficial cutaneousscratches (medical treatment); c) 13 dermatological: 8 scleroatrophiclichens, 4 chronic balanitis,1 dorsal penile lymphangitis (medical orsurgical treatment); d) 7 post-surgical iatrogenic: 1 distal pain afterinflatable prosthesis implantation (removed), 3 after conservativesurgery for La Peyronie disease (2 ablations of no resorbable ligatures,1 posthectomy), 2 painful fraenulum scars (Z plasty) and 1 painful post-posthectomy scar (Z plasty); e) 6 mechanical: 3 primary phimosis inyoung men, 2 penile ventral curvatures (1 congenital, 1 La Peyroniedisease) and 1 chronic paraphimosis (surgical treatment); f) 6 idopathicbut with a particular context of both hyper sensitivity of glans andprimary sexual difficulties in 3 young men (sexological approach and anaesthetic cream), diabetic neuropathy (1), chronic priapism (1)and 1 without any anomalies (oral or local analgesic before sexualintercourses).Conclusion: Conclusions: male dyspareunia is likely underestimatedbecause it not a rare condition for consulting (4 by month in our expe-rience). It is often the revealing symptom of La Peyronie disease orforeskin pathology. According to its severity, it may impair the sexuallife with often a psychological suffering. The clinical analysis showswithout difficulties its medical or surgical management with goodresults.

PP-06-312

Analysis of data related to the Siena’s experienceduring the Prevention Week in Andrology, 2006Ponchietti, R.1; Tallis, V.1; Trovarelli, S.1; Paliouri, E.1; Trovarelli, F.2

1Università di Siena, Pediatria e Ostetricia, Italy; 2Clinica Rugani, Urolo-gia, Siena, Italy

Objective: Our aim is to present the results of the Andrological Pre-vention Week 2006 carried out by the U.O.C. of Andrology and MaleGenital Apparatus Surgery—Azienda Ospedaliera UniversitariaSenese, from 5/06/2006 to 10/06/2006.Methods: 98 men submitted to this initiation. Each of them had tocompile an anonimus questionnaire, formulated by the Italian Societyof Andrology, in order to collect their case history and other epi-demiologic data. Another questionnaire (St. Louis Questionnaire) wasadministered to patients over 40 years old, to evaluate the effects ofageing on the quality of life (QoL). The clinical research included thecollection of a careful medical history and a general and aimed clini-cal examination (external genitalia and prostate).Results: The patients age was included between 16 and 69 years old(average age 44, median 42). Patients presented to our institution withthe following requests: prevention control while being totally in health(50), erectile dysfunction (28), testicular disease (10), infertility (5),prostatic disease (4), penile disease (4), orgasm dysfunction (3), othercauses (8). Among the 50 patients evaluated for prevention, 16 resultednegative at clinical examination, 17 with varicocele, 5 with cystis of theepididimus, 7 with BPH, 4 with testicular hypotrophy, 2 with bal-anopreputial hypospadia and 4 with short frenula.Conclusion: The aim of our work is to confirm the utility of this ini-tiative promoted by the Ministery of Health and the Italian Society ofAndrology. For many patients this visit has been the first occasion fora specialistic evaluation of genital apparatus, since only 19 of them hadhad a previous andrologic clinical examination.

PP-06-313

Characterization of the BDSM community inPortugal: An internet based studyPascoal, P.1; Rui Henriques, R.2; Monteiro Pereira, N.2

1Hospital Julio de Matos, Servico de P C, Lisboa, Portugal; 2UniversidadeLusofona, Lisboa, Portugal

Objective: Our objective was to describe the profile of the BDSMInternet based community in Portugal.Methods: The study is transversal, observational and exploratory. Theauthors visited different BDSM parties and events and contacted theorganization of these parties, of different newsgroups, of discussionforums, of Internet journals and magazines in order to present theirgeneral objective and make a connection with the community. Thequery was set up in a website especially devoted to the study of humansexuality through on-line data collection. The General Questionnaireincluded questions on sex, gender, education, marital status, residence,cohabitation, sexual orientation, and perception of sexual dysfunction.The news groups and forum moderators previously contacted sent thelink and a presentation letter to the users by e-mail. The study was on-line for 1 month.Results: There was a total of 68 respondents, average age 33 years,67% were men and 33% were female; 81% were college studentsor/had college education; 47% were married and 42% had no on-going relationship; 65% lived in the capital city of Lisbon; 70% wereheterosexual; 20% lived alone; and circa 75% had no perception ofsexual dysfunction. Arousal difficulties were the most common sexualproblem presented (25%). Only 5% described themselves as “exclu-sively BDSM”. Their BDSM related fantasies started at 22 yearsaverage, but their started their BDSM practices at 29 years average.Each BDSM session lasts around 1 1/2 hour and is practiced once perweek in average.Conclusion: Internet based data collection proved to be a usefulmethodology for the study of erotic minorities. The socio-demographical data is similar to most results using face-to-facemethodology. The BDSM community in Portugal has recently organ-ized itself in the Internet and seems to be constituted by urban highlyeducated people who experience BDSM as a complement to theirsexual live.

PP-06-314

Body image and sexuality: Comparative studyBeato, A. F.1; Pascoal, P.2; Narciso Davide, I.3; Monteiro Pereira, N.4

1Hospital Julio de Matos, Lisboa, Portugal; 2Hospital Julio de Matos, Servicode P C, Lisboa, Portugal; 3Faculdade de Psicologia da, Universidade deLisboa, Portugal; 4Universidade Lusofona, Lisboa, Portugal

Objective: Our objective was to describe and to understand if there are differences between male and female in terms of body image and sexuality. These are the first results of an on-going study.Methods: The study is transversal, observational and comparative. Wecompared 28 men with 30 women from a convenience sample of thegeneral population. The study has been developed using a GeneralAssessment Questionnaire which gathered socio-demographical andsexual related information, the PIC (Perception of Body Image) devel-oped by the authors, The Rosenberg Self Esteem Scale (1965), theGlobal Measure of Body Satisfaction the Sub-Scale of Body Satisfac-tion of (Probst, Vandereycken, Van Coppenolle & Vanderlinden, 1995)and the Cognitive Distraction Scale- Sub-Scale of Bodily Appearance(Dove & Wiederman, 2000). The data were submitted quantitativeanalysis.Results: There were few significant differences between the twogroups (p > 0.005). Women desire a slimmer figure but do not seemmore unsatisfied than men with their bodies. Women use sheets moreoften to cover their bodies and prevent their partners from observingtheir nudity.Conclusion: The current study shows differences between men andwomen concerning body image ideals but not body satisfaction.However it seems that women have developed compensating strate-gies to deal with their concerns about nudity and body image duringsexual encounters. These strategies need to be further and extensivelyevaluated as well as their impact on the partners and on the wholequality of sexual interaction.


J Sex Med 2007;4(suppl 2):152–202

PP-06-315

Desire to improve sexual experiences and willingnessto seek treatment for erectile dysfunction: Results ofthe Global Better Sex SurveyKirby, M.1; Glina, S.2; Vardi, Y.3; Hvidsten, K.4

1HertNet, The Nevells Road Surgery, Letchworth Garden City, UnitedKingdom; 2Instituto H. Ellis, São Paulo, SP, Brazil; 3Rambam MedicalCenter, Neurology Unit, Haifa, Israel; 4Pfizer, Inc, World Wide OutcomesResearch, New York, USA

Objective: To better understand the impact of erectile dysfunction(ED) and the attitudes toward seeking treatment for ED among menand women worldwide.Methods: Men and women were recruited by phone, door to door, andstreet intercept for the Global Better Sex Survey in 2005. To qualify,men must have had sexual intercourse at least once in the past 12months; women must have had heterosexual sex in the past 12 months.Results: A total of 6291 men and 6272 women responded to thesurvey; 17% of women and 30% of men indicated being highly or veryhighly interested in improving their sexual experience. Approximately

half of men surveyed had ED. However, only 7% of men reportedusing a prescription medication for ED in the previous 4 weeks; only4% of women reported that their male partners used an ED medica-tion. When ED medication was used, the majority of men and womenreported that ED medication had improved the hardness of erections,reliability in achieving erections, duration of erections, and pleasurefrom sexual activity; 87% of men and 79% of women reported thatED treatment has allowed them to have better sex. Among men whohad not taken a prescription medication for ED, 74% said they wouldbe willing to do so to improve their erections if they thought they hadED, and 64% of women would support that decision.Conclusion: Although ED affects more than half of men worldwide,few men have sought treatment for their condition. Medication for EDcan improve sex for the majority of men and their female partners. Mostmen would take a prescription medication for ED to improve their erec-tions, and their female partners would support such a decision.Policy of full disclosure: Research grants and honoraria for advice andconference attending from GSK, MSD, Pfizer, Takeda and Astellas.

In abstracts where Policy of Full Disclosure is missing, authorshave not submitted this information.

p-04 pharmacology

Documents