Ball, C

ABSTRACT Introduction The prevalence of erectile complaints in the US is estimated to be more than 50%. Most of the time ED complaints are evaluated and treated in the primary care setting. However, when first line measures are not efficient, patients are referred to general Urologists or to a specialized center. Objective The primary aim of this study is to describe the characteristics of patients referred to a tertiary center for evaluation of erectile complaints not responding to traditional first line therapies and, or patients with an associated complaint of penile deformity (rule out Peyronie's Disease/PD). Methods We retrospectively analyzed a cohort of patients between 2005 and 2019, detailing primary complaints, sexual histories, self-assessment scores, medical history and results of in office intracavernous injection followed by Color Doppler Duplex Ultrasound (CDDU). CDDU findings were recorded following injection of low dose alprostadil (10-20 mcg) and again after a period of privacy and visual sexual stimulation. CDDU findings including peak systolic velocities (PSV), and resistive indices (RIs) were recorded. Arterial insufficiency (AI) was defined as either a post-stimulation PSV < 25 (severe) or a PSV 25-34.9 with RI ≥ 0.9 (moderate). Cavernous venous occlusion disease (CVOD) was defined as post-stimulation PSV ≥35 with RI < 0.9. Vascular normal was defined as post-stim PSV ≥ 35 with RI ≥ 0.9. Results A total of 1490 patients with a median age of 60 (range, 18 – 88), median BMI of 28.4 (range, 15.9 – 56.8) and median Sexual Health Inventory for Men (SHIM) score of 10 (range, 0-25). In our cohort, 257/1489 (17.3%) patients had heart disease, 656/1489 (44.1%) patients had hypertension, 520/1489 (34.9%) patients had diabetes, and 203/1488 (13.6%) patients had a past medical history of hypertriglyceridemia. Smoking history was present in 853/1478 (57.7%) of patients and complaint of PDE-5 failure was made by 945/1201 (78.7%) patients who reported using it. 900 patients (60.4%) had a complaint of penile deformities and ED, 461 (30.9%) had a complaint of ED only, and 129 (8.7%) had a complaint of PD only. Prostate surgery history was noted in 316 men: radical retropubic prostatectomy 108, robotic assisted prostatectomy 134 and endoscopic resection or enucleation 74. Following CDDU we confirmed 767 (51.5%) patients with both ED and PD, 351 (23.6%) with ED only, and 310 (20.8%) PD only. We found 62 men (4.2%) had normal vascular erectile response to low dosage PGE1 (diagnosed as psychogenic ED vs. post-prostatectomy neurogenic ED). Among the 351 patients with ED only on Doppler, 132 (37.6%) had AI, 124 (35.3%) had CVOD, and 95 (27.1%) had a mixed vascular diagnosis. Among patients with vascular ED on diagnoses by CDDU, 73/351 (20.8%) had heart disease, 192/349 (55.0%) had smoking history, 273/311 (87.8%) complained of PDE5-inhibitor failure, 130/351 (37.0%) had diabetes, and median SHIM score was 7 (range 1-25). Conclusions This summary describes the characteristics in 1490 men who presented for evaluation of erectile complaints and or complaints of penile deformity to a tertiary care center. Patients referred to Urologists have complex ED, defined as refractory to PDE5-Inhibitors, associated with penile deformities, and multiple medical / surgical risk factors. Disclosure No

ABSTRACT Introduction Peyronie's Disease (PD) can coexist with erectile dysfunction (ED). International guidelines recommend that management of PD include an assessment of each patient's ability to initiate and sustain erection. PD causes significant stress to the patient and his partner; that distress may limit their ability to assess adequacy of penile rigidity. Further complicating evaluations based on history is the fact that PDE5-Inhibitor use is common. Objective The primary aim of this study is to non-invasively assess vascular erectile integrity in the setting of PD. Methods 1490 patients who underwent intracavernous injection (ICI) followed by Color Doppler Duplex Ultrasound (CDDU) at our institution were retrospectively analyzed. CDDU findings were recorded following injection of low dose alprostadil (10-20 mcg) and again after a period of privacy and visual sexual stimulation. CCDU findings including peak systolic velocities (PSV), and resistive indices (RIs) were recorded. Arterial insufficiency (AI) was defined as either a post-stimulation PSV < 25 cm/sec (severe AI) or a PSV 25-34.9, RI ≥ 0.9(mild AI). Cavernous Venous Occlusion Disease (CVOD) was defined as post-stimulation PSV ≥ 35 cm/sec with RI < 0.9. Mixed was defined as post-stimulation PSV 25-34.9 with RI < 0.9. Vascular normal was defined as post-stim PSV ≥ 35 with RI ≥ 0.9. Results Our cohort of 1490 patients included 900 (60.4%) with a complaint of both PD + ED; 461 (30.9%) with complaint of ED only and 129 (8.7%) with complaint of PD only. Following ICI with PGE1, 310 men were found to have PD and 767 were found to have PD + ED. Patients with a CDDU confirmed diagnosis of PD alone were younger (median: 56.9 vs. 60.8 y, p < 0.001), less likely to have hypertension [103/310 (33.2%) vs. 365/767 (47.6%), p < 0.001], less likely to have used PDE-5 inhibitor [219/310 (70.6%) vs. 616/767 (80.3%), p < 0.001], and less likely to have failed to a PDE-5 inhibitor [142/219 (64.8%) vs. 484/616 (78.6%, p < 0.001]. Diabetes was slightly more common in men with PD + ED compared to PD [270 (35.2%) vs. 94 (30.3%), p = 0.063], but not statistically significant. CDDU diagnoses for men with ED + PD were: AI 262/767 (34.2%), CVOD 305/767 (39.8%), mixed vascular ED 200/767 (26.1%). By definition all men with PD alone were vascular normal. Self-assessments by SHIM scores were abnormal in both groups ED + PD and PD [median(interquartile range): 10 (5 – 17) vs. 14 (8 – 20), p< 0.001]. Conclusions By history alone, patients with ED + PD vs. PD only can't reliably be identified. This is likely related to the distress caused by PD and the tendency to physicians to treat or patients to self-medicate all erectile complaints with PDE5-Inhibitors. For non-invasive treatments distinguishing between ED + PD vs. PD is not critical. Before any patient is triaged to surgical intervention an evidence-based assessment of vascular erectile integrity should be performed. In our cohort of men, Doppler analysis demonstrated that at least 6 out of 10 PD patients have some form of vascular ED. Disclosure No