Theophilopoulos, Alexander

Abstract Introduction Erectile Dysfunction (ED) is becoming increasingly recognized as a potential marker of chronic medical conditions. Recent research has examined the association between ED and Parkinson’s disease. In fact, recent findings indicate that men with ED have upwards of a fourfold higher risk of developing Parkinson’s disease compared to those without a diagnosis of ED. Objective Our research investigates associations between self-reported ED severity and neurobiological factors, including measures of cognitive function and neuroimaging of dopaminergic integrity. Methods We performed a retrospective analysis of 93 male research participants with ED extracted from an observational cohort study of aging and Parkinson’s disease biomarkers. Though some patients experienced some age-related mild cognitive changes, all participants were classified as clinically neurologically healthy. Patients received cognitive testing through the Montreal Cognitive Assessment (MoCA), with scores ranging from 0-30. Neuroimaging of the bilateral caudate and putamen, components of the striatum implicated in Parkinson’s disease pathology and dopaminergic binding, was measured through dopamine transporter SPECT imaging (DaTScan) binding ratios. ED was self-reported using questions 22-23 on the Scales for Outcomes in Parkinson’s Disease – Autonomic Dysfunction (SCOPA-AUT). Question 22 stated “In the past month, have you been impotent (unable to have or maintain an erection?)” and question 23 stated “In the past month, how often have you been unable to ejaculate?”. SCOPA-AUT scores ranged from 0 (sometimes) to 3 (often) and were averaged across both questions. Patients taking dopaminergic Parkinson’s disease medications or PDE5 inhibitors at baseline were excluded due to potential confounding. Due to violations of normality assumption, numerical associations utilized an age-adjusted partial spearman correlation coefficient. Descriptive statistics are displayed as median (IQR). Results Of the 93 selected participants, one individual was excluded due to incomplete neuroimaging DaTScan data. Therefore, 92 patients were included in our analysis. The median age of participants was 67.3 years (61.4 – 73.0) and the median MoCA score was 27.2 (26.0, 28.7) which represents minimal cognitive impairment. Age-adjusted spearmen correlation coefficient showed no association between MoCA measured cognitive performance and ED severity (r = -0.116, p = 0.275). Age-adjusted associations of striatal DaTScan showed a significant, mild relationship between ED severity and both right caudate dopamine binding ratios (r = 0.236, p=0.0242) and left putamen dopamine binding ratios (r = 0.262, p = 0.0121). However, associations between ED severity and both left caudate (r = 0.150, p = 0.155) and right putamen (r = 0.143, p = 0.176) dopamine binding ratios did not reach statistical significance. Conclusions Although no association was observed between ED severity and cognitive function, greater ED severity was significantly associated with increased striatal dopaminergic binding. This positive, age-adjusted association may reflect a compensatory dopaminergic response similar to that seen in the early stages of Parkinson’s disease. Overall, our findings suggest that ED could serve as a potential marker of central dopaminergic and autonomic alterations, even in the absence of clinically evident neurological disease. Disclosure No

Abstract Introduction Sperm cryopreservation is becoming increasingly accessible and cost-effective. One of the most common indications for cryopreservation remains prior to gonadotoxic therapies and surgeries. However, it may be used by patients undergoing vasectomy as an alternative to potential future more invasive procedures including reversal or sperm retrieval. Objective To characterize demographic and individual factors associated with the utilization of cryopreservation prior to vasectomy. Methods We conducted a retrospective review of all patients from January 2023 to May 2025 at a single academic medical center who underwent a vasectomy. All 186 patients who completed the pre-vasectomy questionnaire were included in our analysis. At the time of vasectomy consultation, patients were informed of the procedure’s permanent nature and, per guidelines, were educated on future fertility options, including vasectomy reversal and sperm retrieval for use with in vitro fertilization. All patients were also separately offered sperm cryopreservation. Demographic and questionnaire data was collected and analyzed. Pre-vasectomy questionnaire information included age, relationship information, familial information, and reason for vasectomy, among other factors. Numerical variables were described as medians with interquartile range and categorical variables were described in counts. Due to violation of the normality assumption, Fisher’s Exact test was used for categorical variables and the Kruskal-Wallis rank sum test was used for numerical variables. Results 186 patients completed the pre-vasectomy questionnaire and were used in our analysis. Of these individuals, 5.4% (n=10) utilized cryopreservation at the time of vasectomy. Individuals utilizing cryopreservation had a median age 5 years younger than those who did not utilize the same service (p = 0.046). Moreover, 40.0% (n=4) of individuals in the cryopreservation group had children compared to 83.5% (n=147) in the no cryopreservation group (p=0.004). Current relationship length was significantly longer for individuals who did not utilize cryopreservation, with a median reported relationship length of 11 years as compared to a median length of 5 years for individuals utilizing cryopreservation (p=0.025). The shorter relationship length is likely related to an additional finding that the percentage of individuals who utilized cryopreservation were married approximately 30% less often than individuals who did not use the same service (p=0.039). Conclusions While only a small proportion of patients undergoing vasectomy choose to pursue cryopreservation despite counselling at their visit, significant differences in demographic and individual characteristics were observed for those who did. These individuals tended to be younger, married at lower rates, without children, and in shorter relationships. With improved access to reproductive services, further work is needed to understand decision choices for men offered sperm cryopreservation prior to permanent sterilization. Disclosure No