Moderated Poster Session 3 Sexual Function/Dysfunction Monday, September 9 1315-1445

MODERATED POSTERS
Moderated Poster Session 3
Sexual Function/Dysfunction
Monday, September 9
1315-1445
MP-03.01
Effect of Bupropion and Tadalafil
Combination Therapy in
Female Rat Hypoactive Sexual
Desire Disorder Model
Yoon H, Chung W
Dept. of Urology, Ewha Womans
University School of Medicine, Seoul,
South Korea
Introduction and Objectives: Hypoactive sexual desire disorder (HSDD) in
female sexual dysfunction takes significant portion of female sexual dysfunction, but its treatment modalities are few.
Bupropion is known to increase sexual
desire in serotonin reuptake inhibitor
(SSRI) induced HSDD and tadalafil is a
well-known PDE5 inhibitor. In this study,
we aimed to investigate the efficacy and
safety of combination treatment of bupropion and tadalafil in female rat HSDD
model
Materials and Methods: Bilateral oophorectomized female Sprague-Dawley rats
were used as sub-primed HSDD model.
In this model, after 2 weeks of oophorectomy, estradiol (2ug) was injected
subcutaneously (SQ) before every sexual
mating. Experimental groups are VH
(Vehicle, injection of sesame oil), B (Bupropion 20mg/Kg, daily, SQ), P (tadalafil
2mg/kg, daily, PO), PB (Bupropion 20mg/
Kg SQ with tadalafil 2mg/kg PO, daily). At
baseline, 7th day, and 14th day of drug
administration, sexual behaviors were
observed in specially designed mating
cage. Sexual behaviors were analyzed as
proceptive behavior (darts and hops), receptive behavior (lordosis), paced mating
behavior (mean time of exit (sec/min).
Results: Drug administered group (B,P,
and PB) were all significantly improved
sexual behavior analysis compared with
VH group. At 14th day of drug administration, combination treatment group (PB)
showed more significant improvement in
proceptive, receptive behaviors and less
avoidance time than the other three (VH,
B, and P) groups (p<0.01 by ANOVA).
There were no drug-related deaths or
adverse reactions.
Conclusion: In female rat HSDD model,
combination treatment of bupropion and
tadalafil showed significant improvement
of sexual behavior than single-drug treatment with time-correlation. This supports
that the combination of bupropion and
S54
tadalafil may have a beneficial effect on
human HSDD.
MP-03.02
Study for the Blood Supply of Corpus
Cavernosum by ‘Virtual Cavernoscopy’
Tomida R, Kawanishi Y, Oyama T, Yamamoto H, Izumi K, Mori H, Yamanaka M,
Kanayama H
Takamatsu Red Cross Hospital,
Takamatsu, Japan; 2Tokushima
University Hospital, Tokushima, Japan
Introduction and Objectives: There are
few papers concerning the blood supply
of corpus cavernosum in erectile dysfunction (ED) patients, because until recently,
there have been no methods to visualize
the intracavernous artery without sufficient blood flow. Advancements in technology have made it possible to create
virtual cavernoscopic images to observe
the intracavernous artery in detail. We
investigated intracavernous artery type
by virtual cavernoscopy and studied the
factors which might correlate with intracavernous artery type.
Materials and Methods: The study subjects were 70 ED patients who visited our
hospital for further examination. Intracavernous artery type was investigated
by virtual cavernoscopy. Factors affecting
variation type were further examined.
Logistic regression was used. This study
was carried out with the approval and
permission of the ethics committee at our
hospital, as well as the written consent of
the patients involved.
Results: Out of the 140 corpus cavernosum, 74 had a main artery beginning
from the furcation of the crus and running toward the distal section of the
lumen (Figure 1). Other types included
blood flow that was supplied by contra
lateral cavernous arteries, the penetrating
branches of the dorsal artery or emissary
artery, and so on. According to the results
MP-03.02, Figure 1.
of the analysis, cardiovascular risk factors
and age did not link with cavernous artery type. Figure 1.
Conclusion: It was revealed that, the
intracavernous arterial supply depends
on various types of arteries. As age and
cardiovascular risk factors did not link
with the intracavernous artery type, it is
suggested that variation is not collateral
circulation developed as an acquired
response but is inherent. When we
make plans for revascularization, the
intracavernous artery type of each individual patient must be studied by virtual
cavernoscopy.
MP-03.03
Has OAB Impact on Male
Sexual Health?
Drasa K1, Dredha H2, Rusi R3
1
Central Polyclinic, Tirana, Albania;
2
QSUT, Tirana, Albania; 3Privat Clinic,
Tirana, Albania
Introduction and Objectives: The
impact of overactive bladder (OAB) on
overall male sexual health (MSH) is little
known. For this reason we evaluated the
impact of OAB on MSH, within an epidemiological study of men over 40 years
of age.
Materials and Methods: Patients (pts)
were asked to rate how often they experienced urinary symptoms during the
past 4 weeks on a 5-point Likert skale.
They were permitted to opt out from the
sexual health survey which contained the
IIEF for erectile dysfunction (ED) and
question about ejaculation dysfunction
(EjD) and premature ejaculation (PE).
Those with OAB and/or lower urinary
tract symptoms (LUTS) were asked questions about urinary symptoms impact on
sexual health. Descriptive statistic and
logistic regressions were used to assess
the impact of OAB on sexual health.
Results: The average of our 97 pts was
55.5 years. Using the ≥ “sometimes”
definition ,49% of men had No/minimal
symptoms (NMS), 24% had continent
OAB (C-OAB) and OAB (I-OAB); 87% of
pts with NMS reported that they were
sexual 25% incontinent active, compared
to 63% with C-OAB and 51% I-OAB. Men
with OAB were > three times more likely
to report their own health reasons prevented them from being sexually active
as compared to NMS men (C-OAB, 29%;
I-OAB, 32%; NMS, 8%). In addition, 21%
with C-OAB and 31% with I-OAB reported
that they had decreased or stopped sexual activity due to their urinary symptoms
compared to 3% with NMS. Also, 22%
with C-OAB and 32% with I-OAB reported
UROLOGY 82 (3 Supplement 1), September 2013
MODERATED POSTERS
that their urinary symptoms decreased
their enjoyment of sexual activity compared to 3% NMS. Of the NMS patients,
16% reported mild or greater ED (≤ 21
IIEF) as compared to 32% and 38% of
men with C-OAB and I-OAB, respectively.
Finally, 18% of NMS experienced PE half
the time or greater, as compared to 27%
and 33% with C-OAB and I-OAB.
Conclusion: OAB is significantly associated with diminished sexual health and ED
and PE. Sexual health should be assessed
in men presenting with OAB.
MP-03.04
Hyperuricemia: A Possible
Cause of Hemospermia
Kurkar A, Elderwy A, Abulsorour S,
Awad S
Assiut University Hospital, Assiut, Egypt
Introduction and Objectives: Hemospermia is often considered idiopathic.
We report our experience with hemospermia and a long-term follow-up.
Materials and Methods: Between July
2005 to July 2012, 143 patients with hemospermia presented to outpatient clinic
in our hospital. History, examination,
work-up, treatment, outcomes and long
term follow-up were reported in a prospective database. Patients were followed
at monthly intervals by semen analysis
till disappearance of hemospermia then
every 3 months for one year.
Results: The commonest 5 findings identified as a possible cause of hemospermia
were: bilharziasis 21.6%, hyperuricemia
15.4%, idiopathic 14.7%, tuberculosis
8.4% and chronic prostatitis 8.4%. Of hemospermia patients; 22 had hyperuricemia with mean serum uric acid level was
9.2 mg/dL (range 7.6-11.4). The mean age
at presentation was 32 years (range 2048). Those patients had 5-12 hemospermia attacks for 2-8 months before presentation. Associated findings were: LUTS
in 14 patients, painful ejaculation in 15,
arthralgia in 12, positive urine for urate
crystals in 10, positive semen for urate
crystals in 7, dotted prostate calcifications
in TRUS in 5. All cases were treated with
allopurinol 300 mg tablets twice daily for
8 weeks and maintenance dose of 300 mg
daily. Hemospermia disappeared within
a mean of 2 months (range 1-4) for all
patients.
Conclusion: Hyperuricemia is a new
probable cause of hemospermia. Further
randomized studies are mandatory for
establishment of such postulation.
MP-03.05
Impact of Abdominal Obesity
on Testosterone Levels and
Erectile Dysfunction
Fillo J1, Breza J1, Levcikova M2, Luha J2
1
Urology Department, Comenius
University, Faculty Hospital, Bratislava,
Slovakia; 2Internal Medicine, Comenius
University, Faculty Hospital, Bratislava,
Slovakia
Introduction and Objectives: Male sex
hormones play an important role in ED
and variety of testosterone deficiency
symptoms. The number of men with
abdominal obesity (AO) is continuously
growing. Testosterone deficiency syndrome (TDS) significantly decrease quality of life and his occurrence is 38,7% of
men over 45 yr. Obesity appears to be a
driving factor since adipose cells secrete
leptin, which results in a decrease in
testosterone level.
Materials and Methods: We examined
from 2/2006 up to now 206 men from 42
years to 78 years. AO (waist circumference over 94cm) has 192 men and 14
men as control group without AO. Every
patient had complete urological examination with hormonal evaluation. To assess
subjective symptoms related TDS were
utilized the Aging Males Symptoms Scale,
to evaluate ED we used Sexual Health
Questionnaire IIEF 5.
Results: From our group 206 patients
we found some degree of ED in 73.3%
(151/206) pts. TST levels below 14 nmol/l
had 134/206 pts (65.0%) and below 9
nmol/l 62/206 pts (30.0%). We found
association with AO and TST levels (Table
1). Number of patients with low TST
levels increases with increasing waist
circumference. Low levels of TST were
found in all age groups.
Conclusion: Patients over 40 years of age
with AO and ED should also be examined
for TDS and metabolic syndrome. In this
group of patients we found TST levels
below 14 nmol/l in 134/206 pts (65.0%)
and below 9 nmol/l 62/206 pts (30.0%). It
is important not treat only ED; with appropriate treatment we can improve the
quality of life of the affected men.
MP-03.06
Effects of Tadalafil Treatment
on Erectile Function Recovery
Post Bilateral Nerve-Sparing
Radical Prostatectomy
Brock G1, Montorsi F2, Stolzenburg J3,
Mulhall J4, Moncada I5, Patel H6, Chevallier D7, Krajka K8, Dickson R9, Henneges
C10, Büttner H10
1
University of Western Ontario, London,
Ontario, Canada; 2Instituto Scientifico
Universitario San Raffaele, Milan,
Italy; 3Universitätsklinikum Leipzig,
Leipzig, Germany; 4Memorial SloanKettering Cancer Center, New York, USA;
5
Hospital La Zarzuela, Madrid, Spain;
6
University Hospital North Norway,
Tromso, Norway; 7Hôpital Universitaire
Archet 2, Nice, France; 8Uniwersyteckie
Centrum Kliniczne, Gdansk, Poland;
9
Lilly Canada Inc, Toronto, Ontario,
Canada; 10Lilly Deutschland GmbH, Bad
Homburg, Germany
Introduction and Objectives: The rehabilitative impact of Tadalafil (TAD) following nerve-sparing prostatectomy (nsRP)
on penile function remains unclear. This
multicenter, randomized, double-blind,
double-dummy, placebo (PLC)-controlled
trial (NCT01026818) primarily assessed
the proportion of patients (pts) achieving
an International Index of Erectile Function Domain score (IIEF-EF)≥22 after
6wk washout. Secondary measures included IIEF-EF, Sexual Encounter Profile
question 3 (SEP3) and penile length (PL).
Materials and Methods: Pts≤68yrs with
adenocarcinoma of the prostate (Gleason≤7) and normal preoperative EF were
randomized 1:1:1 to either 9-month
treatment of TAD 5mg once a day (OaD),
TAD 20mg on demand (pro re nata, PRN)
or PLC post nsRP, followed by a 6 wks
washout phase and a 3 month open-label
phase on TAD OaD (all pts). Logistic
MP-03.05, Table 1. Influence of AO on TST Levels.
Waist
circumference
below 94cm
Grade I.
94-101cm
Grade II.
102-109cm
Grade III.
110-119cm
Grade IV.
120cm+
Total
TST level
0-9nmol/l
1pts
8.3%
11
23.4%
14
22.6%
20
34.4%
16
57.1%
62 pts
(100%)
9-14
3
25.0%
18
38.3%
26
41.9%
19
34.5%
8
28.6%
74
14+
8
66.7%
18
38.3%
22
35.5%
16
29.1%
4
14.3%
68
Total
14 pts
47
62
55
28
206 pts
UROLOGY 82 (3 Supplement 1), September 2013
S55
MODERATED POSTERS
regression and ANCOVA adjusting for
treatment, age and country were applied
to IIEF-EF≥22, SEP3 and PL.
Results: A total of 423 pts were randomized to TAD OaD (N=139), TAD PRN
(N=143) and PLC (N=141). Mean (SD)
age was 57.9 (5.58) yrs. 20.9% in the
TAD OaD, 16.9% in the TAD PRN and
19.1% in the PLC arm reached an IIEFEF≥22; odds ratios (95%CI) for TAD OaD
and TAD PRN vs PLC were 1.14 (0.63,
2.06; p=0.675) and 0.89 (0.48, 1.65;
p=0.704). SEP3 (Figure 1.) improved
more during the double-blind phase
in pts actively treated, where only TAD
OaD vs PLC was significant, decreased
during washout, but further improved
during open-label treatment (numerically
best for pts randomized to TAD OaD).
IIEF-EF showed consistent results. PL
reduction after the double-blind phase
was significantly lower vs PLC in the TAD
OaD arm only (LSmean; 95%CI: 4.20;
0.47, 7.93; p=0.028). Treatments were
well-tolerated.
Conclusion: EF improvements gained
during 9-month active TAD treatment
were not maintained after a 6wk washout. However, TAD OaD given early after
nsRP suggests advantages versus delayed
treatment in responsiveness to treatment
and in protecting from structural penile
impairment post nsRP. Figure 1.
MP-03.07
A Randomized, Double-Blind,
Placebo-Controlled, Crossover Trial
of “On–Demand” Tramadol for
Treatment of Premature Ejaculation
Kurkar A, Elderwy A, Abulsorour S,
Awad S
Assiut University Hospital, Assiut, Egypt
Introduction and Objectives: To assess
the dose-related effects of tramadol on a
group of patients with premature ejaculation (PE).
Materials and Methods: Between June
2010 and July 2012, 180 PE patients presented to outpatient clinic of our hospital. Patients were randomized in a 1:1:1
fashion to receive different sequences
of the 3 medications: placebo, 50 mg of
tramadol and 100 mg of tramadol. Every
patient received 10 doses of each medication for 2 months. Intravaginal ejaculatory latency time (IELT) was recorded in
seconds initially and for each arm. Successful treatment of PE is defined if IELT
exceeded 120 seconds. Side effects with
medications were reported.
Results: Of patients enrolled, 125
(69.4%) continued the study. Patients’ age
range was 20-55 years with PE complaint
S56
MP-03.06, Figure 1.
of one to ten year duration. Mean IELT
was 72 at presentation, 82 for placebo,
150 for tramadol 50 mg and 272 for tramadol 100 mg (p<0.001 for all comparisons). PE was successfully treated in only
2.4% of patients with placebo, in contrast
to 53.6% and 85.6% with 50 and 100 mg
tramadol respectively (p<0.001 for all
comparisons). Post-micturition dribble
annoyed 12.8% of those who received
50 mg tramadol and 33.6% of those who
received 100 mg tramadol (p<0.001).
MP-03.08, Table 1. Comparison between Pre- and Post-Treatment of Desmopressin.
pre
post
p-value
IPSS score
17.7 ± 7.3
13.9 ± 6.7
<0.001*
IPSS – QOL
3.8 ± 1.3
3.2 ± 1.0
0.002*
AMS score
33.7 ± 9.6
31.1 ± 7.9
0.054
IIEF score
33.4 ± 18.8
29.3 ± 21.2
0.136
Total volume
1702.8 ± 509.3
1704.5 ± 560.3
0.987
NUV
789.3 ± 356.3
475.1 ± 156.3
<0.001*
NPi
46.6 ± 14.4
30.1 ± 13.1
<0.001*
ANV
3.6 ± 1.5
2.5 ± 0.7
<0.001*
Ni
2.5 ± 0.9
1.7 ± 0.7
<0.001*
NBCi
2.0 ± 0.7
1.7 ± 0.5
0.018*
Testosterone
5.28 ± 2.4
4.71 ± 1.9
0.094
Free testosterone
5.43 ± 2.9
5.16 ± 2.0
0.454
Na+
139.4 ± 2.8
139.3 ± 3.2
0.803
Questionnaire
Frequency Volume Chart
Lab
IPSS = international prostate symptom score, AMS = aging male’s symptom
IIEF = international index of erectile function
NUV = nocturnal urine volume, NPi = nocturnal polyuria index = NUV / total volume
ANV = actual number of nightly voids, Ni = nocturia index = NUV / maximum voided volume
NBCi = nocturnal bladder capacity index = ANV - Ni +1
UROLOGY 82 (3 Supplement 1), September 2013
MODERATED POSTERS
Weak scanty ejaculation was the main
complaint in 7.2% vs. 21.6% of those using 50 and 100 mg tramadol respectively
(p=0.002).
Conclusion: Tramadol hydrochloride
exhibits a significant dose-related efficacy
and side effects over placebo for treatment of PE.
MP-03.08
Is Nocturia Related to LOH (Late
Onset Hypogonadism)? Relationship
of Nocturia with Serum Testosterone
Level, IIEF (International Index
of Erectile Function) and AMS
(Aging Male’s Symptom) Scale
Kim J1, Chae J1, Kim J1, Oh M1, Yoon C1,
Park H1, Kim J1, Lee S2, Moon D1
1
Department of Urology, Korea
University Medical Center, Seoul,
South Korea; 2Department of Urology,
Sungkyunkwan University School of
Medicine, Seoul, South Korea
Introduction and Objectives: To assess the effect of nocturia on serum testosterone level in association with IIEF
and AMS scales and to assess the effect
of desmopressin in improvement of not
only nocturia but also serum testosterone
level, IIEF, AMS scale.
Materials and Methods: The study was
an open-label, non-placebo controlled,
observational trial. We prospectively
enrolled men with nocturia and symptoms of late onset hypogonadism. The
patients were given desmopressin for 3
months then we compared testosterone
level, indices of frequency volume chart
(FVC), change of IIEF, IPSS (International
Prostate Symptom Score), AMS scale
before and after treatment. Patients with
history of cardiovascular disease, or hyponatremia, using hypnotics, with primary
hypogonadism or hypogonadotrophic
hypogonadism were excluded.
Results: Sixty-two men (mean age 66.9
years) had complete pre-and post treatment questionnaires and laboratory
test. By the end of study, mean scores
decreased from 17.7 to 13.9 (IPSS), 3.8 to
3.2 (IPSS-QOL score), 33.7 to 31.1 (AMS),
33.4 to 29.3 (IIEF). In FVC, nocturnal
urine volume, nocturnal polyuria index,
actual number of nocturia, nocturia index, nocturnal bladder capacity index
were significantly decreased (Table 1).
Testosterone in men with low testosterone level (<3.5 ng/ml) was improved
after 3-month desmopressin treatment
(2.85 to 3.71, p=0.044).
Conclusion: Desmopressin improved
indices of FVC, lower urinary symptoms (IPSS), symptoms of late onset
hypogonadism (AMS, IIEF). In addition,
testosterone level increased in men with
low testosterone level after 3-month
desmopressin treatment.
MP-03.09
The Reason of Withdrawal from
Intracavernosal Injection Treatment
in Patients with Erectile Dysfunction
Lee S1, Choo S1, Sung H1, Moon D2
1
Sungkyunkwan University School of
Medicine, Samsung Medical Center,
Seoul, South Korea; 2Korea University
Hospital, Seoul, South Korea
Introduction and Objectives: Intracavernosal injection (ICI) treatment for
erectile dysfunction (ED) was introduced
earlier than phosphodiesterase 5 inhibitors (PDE5Is). ICI treatment still has been
advocated as second line therapy for ED
in many treatment algorithms since the
introduction of PDE5Is. Despite high response rate of ICI treatment, withdrawal
rate has been reported up to 80%. About
ICI treatment, there have been few data
available in the era of PDE5Is. The aim of
this study was to investigate withdrawal
rate and its reason from ICI treatment in
patients with ED.
Materials and Methods: From the introduction of sildenafil in Korea, Oct
1999 to Dec 2011, all medical record of
patients who have been prescribed with
ICI treatment was reviewed. Medical
record review and telephone survey on
all patients were performed to investigate
intercourse, withdrawal rate and its reason, adverse events, and satisfaction on
sex life after ICI treatments. Satisfaction
domain of the international index of erectile function questionnaire was used to
ask satisfaction about overall sex life.
Results: During the period, 845 patients
were prescribed with ICI treatments. Of
these, we were able to contact with 384
patients. Mean age was 59.3±8.9 years
with follow-up duration of 34.6±47.2
months. After ICI treatments, 65.7% were
able to intercourse, and withdrawal rate
was 81.2%. The reason of withdrawal
from ICI treatments were poor response
(37.6%), inconvenience for use (18.2%),
switch to other treatments (14.1%), adverse events (5.7%), high maintenance
(5.7%), decreased libido (4.8%), and
return of spontaneous erection (2.5%).
Sixty-two patients switching treatments
selected PDE5Is (60.7%) and insertion
of penile prosthesis (21.3%). Adverse
events occurred in the 25.5%, and which
included pain (38.2%), priapism (28.4%),
curvature (16.3%), plaque (11.4%), and
subcutaneous hematoma (5.7%). In terms
UROLOGY 82 (3 Supplement 1), September 2013
of adverse events, there was no difference
between withdrawal (23.5%) and nonwithdrawal group (34.8%, p>0.05). Satisfaction rate was higher in the treatmentcontinuing group than non-continuing
group (satisfied plus moderately satisfied,
78.3 vs. 37.3%, p<0.001).
Conclusion: Withdrawal rate from ICI
treatments was as high as 81.2%. The
most common reason of withdrawal
was poor response and inconvenience
for use. However, treatment-continuing
group was more satisfied with ICI treatment than non-continuing group. Sufficient counseling is needed before ICI
treatments.
MP-03.10
Effect of Body Weight Reduction
on Serum Total Testosterone:
Comparative Study of
Metabolic Syndrome and
Non–Metabolic Syndrome
You D, Song G, Han K, Ahn T
Dept. of Urology, University of Ulsan
College of Medicine, Asan Medical
Center, Seoul, South Korea
Introduction and Objectives: Several
studies have confirmed the significant
inverse correlation between testosterone
and obesity and testosterone lowering
is associated with important clinical disorders such as metabolic syndrome. The
purpose of the present study is to compare the effects of body weight reduction on serum testosterone in metabolic
syndrome (MS) and non-metabolic syndrome (NMS).
Materials and Methods: We retrospectively reviewed the records of 626 study
patients who visited our health promotion
center and had their serum testosterone
checked at least twice between February
2006 and December 2011. The metabolic
syndrome was diagnosed using the modified NCEP definition with the Asian-specific waist circumference cutoff (> 90cm
for men). We classified the 626 patients
as follows: group I: weight reduction in
MS; group II: no weight reduction in MS;
group III: weight reduction in NMS; and
group IV: no weight reduction in NMS.
Results: The mean follow-up period of
all patients was 26.5±14.8 months, and
the mean patient age at the first screening was 53.7±7.7 years. A total, of 186
study patients (30%) were diagnosed
with MS and there were no differences
between the MS group and the NMS
group in the mean patient age or followup period’s length. There were 108(58%)
weight reduction patients in the MS
group and 245(56%) in the NMS group.
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MODERATED POSTERS
The mean testosterone levels of both
initial and last times were significantly
lower in the MS group compared to NMS
group (4.53 Vs. 5.06ng/ml; p=0.001,
4.63 Vs. 5.08ng/ml; p<0.001). During the
follow-up period, in group I the testosterone level was increased 0.27±1.37ng/
ml, although in group II the testosterone
level was decreased 0.17±1.67ng/ml
(p=0.042) and the men in group I lost
on average 2.2±0.2Kg of body weight
but in group II they gained 2.3±3.2Kg.
In group III, the testosterone level increased 0.20±1.83ng/ml and in group IV
it decreased 0.20±2.06ng/ml (p=0.032)
and the men in group III lost on average
1.6±1.5Kg of body weight but in group
IV they gained 1.8±1.7Kg.
Conclusion: Life style change like weight
reduction could increase the level of
testosterone not only in NMS population
but also in the men with MS.
MP-03.11
The Association between
Androgenic Hormone Levels
and the Risk of Developing
Coronary Artery Disease (CAD)
Pourmand G1, Allameh F1, Mehrsai A1,
Bozorgi A2, Nekuie S3, Namdari F1
1
Urology Research Center, Tehran
University of Medical Sciences, Tehran,
Iran; 2Tehran Heart Center, Tehran
University of Medical Sciences, Tehran,
Iran; 3Urology Research Center, Sina
Hospital, Tehran University of Medical
Sciences, Tehran, Iran
Introduction and Objectives: To evaluate the relationship between the serum
levels of androgens and CAD in an Iranian population.
Materials and Methods: Male individuals who were admitted to Tehran Heart
Center and Sina Hospital were categorized
into CAD and control groups based on
selective coronary angiography. Baseline
demographic data, including age, BMI,
diabetes, and a history of hypertension
were recorded in the data collection form.
Patients were also assessed for their serum
levels of total testosterone, free testosterone, estradiol, Dehydroepiandrosterone
S58
Sulfate (DHEA-S), and Sex Hormone Binding Globulin (SHBG). Data analysis was
carried out chi-square and ANOVA tests as
well as logistic regression analysis.
Results: Two hundred patients were in
the CAD group and 135 individuals were
in the control group. In the CAD group,
69 had single-vessel disease, 49 had twovessel disease, and 82 had three-vessel
disease. Statistically significant differences
were observed between the individuals
in the two groups with respect to age
(P<0.0001), diabetes (P<0.0001), and
a history of hypertension (P=0.018).
The serum levels of free testosterone
(P=0.048) and DHEA-S (P<0.0001) were
significantly higher in the control group
than in the CAD group; however, the
serum level of SHBG was higher in the
CAD group than in the control group
(P=0.007). Results of the logistic regression analysis indicated that only age
(P=0.036) and diabetes (P=0.004) had
significant relationships with CAD.
Conclusion: Although the serum levels of
some of the androgens were significantly
different between the two groups, no association was found between androgenic
hormone levels and the risk of CAD, due
mainly to the effect of age and diabetes.
MP-03.12
New Low-profile Flat Reservoir
for Inflatable Penile Prostheses
(IPP): Preliminary Implant Data
Amend B1, Rojas-Cruz C2, Kruck S1, Gakis
G1, Bedke J1, Stenzl A1, Ruiz-Castane E2,
Sievert K1
1
University Hospital, Tuebingen,
Germany; 2Fundacio Puigvert Urology
and Nephrology Institute,
Barcelona, Spain
Introduction and Objectives: Hydraulic
penile prosthesis implantation remains
the treatment option in patients with severe erectile dysfunction (ED). When the
IPP is placed, in combination with a lowprofile reservoir, it provides an opportunity for easier placement for patient-specific requirements and reduces the risk of
intraabdominal organ injury. We report
the preliminary results of newly-released
flat reservoir (Conceal®) placement.
Materials and Methods: A total of 14
patients with ED, who had failed previous conservative therapy, received the
3-piece IPP (AMS700®) combined with
Conceal® through a penoscrotal incision.
Traditional (intra-abdominal/retropubic)
or extra-abdominal wall (ectopic) placement was decided as a result of previous
abdominal surgery.
Results: Mean age of patients was 3373 (mean 60.6, SD±10.5) years. Mean
procedure time ranged between 45-93
(mean 62, SD±17.4) minutes. Seven
patients underwent laparoscopic/robotic
radical prostatectomy, 3 open-radical
prostatectomy, one cystectomy with peritonectomy, one bilateral herniorraphy
and the final two were diabetic without
any prior surgery. The patient BMI ranged
from 17.2-32.6 (mean 27.2, SD±3.8).
Thirteen reservoirs were placed in the
extraperitoneal space and 1 retropubic.
The one in the Retzius’s space was filled
with 60ml and all ectopic ones were filled
with 50-75 (mean 63.9, SD±5.3) ml. No
implant or other related complications
were noted within the mean follow-up of
12.6m. Four of 13 patients with ectopic
placement reported a palpable reservoir
after penile prosthesis desufflation. All
reservoirs were fully functional and 89%
of all patients (traditional and ectopic)
were very satisfied without body-image
concern; the others were satisfied (one
after laparoscopic, one after robot assisted radical prostatectomy). Additional
investigations revealed that the low-profile reservoir maintained its flat shape up
to a filling volume of 75 ml.
Conclusion: Although the new flat reservoir was FDA-approved only for intra-abdominal/retropubic placement, an ectopic implantation can avoid complications
especially in patients with lower abdominal surgeries. The early results demonstrated excellent functional outcome and
patient satisfaction if the needed filling
volume is kept below 76ml.
UROLOGY 82 (3 Supplement 1), September 2013