Posters with discussion
S23 P39 P40
EPIDEMIOLOGY OF FEMALE SEXUAL DYSFUNCTIONS IN PREVALENCE OF THE ERECTILE DYSFUNCTION AND FRANCE Patrick de Colomby, Andre Bejin, Alfred Spira, Alain OF THE OTHER GENITOURINARY . SYMPTOMS: Jardin, Francois Giuliano Bidtre, France PRELIMINARY RESULTS OF THE SIMONA STUDY GROUP. Introduction : In 1992, a massive survey about sexual lifestyles has been conducted in France (Nature 1992, 360, 407-409}. This swvey La Peril G., Taggi F., Aloise L., Boffini A, Pescatori E., was applied to 20,055 people aged 18-69 years and was focused on a detailed descri(Xion of sexual practice and means of protection against Colombo F., Natali A, Andriani E., Calabrese M. and the AIDS contamination. More detailed questions, including those SIMONA Italy concerning sexual dysfunctions, were included in an aaditional The Italian National Health System provides all citizens questionnaire. The responses were studied in order to describe the with a General Practitioner. Each G.P. has a patient epidemiology of female sexual disorders. population of about 1000 people \-Vho represents a non Methods :The questionnaire including questions on sexual selected sample of tHe general population. In this survey dysfunctions lasted 30 min The presenl analysis is based on the 1037 we have recruited all men between 50 and 69 years from French adult women who answered the questions. 15 G.P.s through out Italy (north, center and south). So Results :percentage of sexual dysfunctions reported as «occurring far we have screened 256 men. The subjects have been often» fully investigated on the general health, smoking habits • Age(n 1036 Paffiful ack I insufficlen 18-24 and on the other known risk factors. The liEF, IPSS, 5-59 premature ejaculation and Peyronie'$ disease 0-69 13 questionnaires were given to all subjects by a trained Pvernll Results: these preliminary results show Anorgastma was reported as « occumng often }> by 8• Yo0f females that the prevalence of the E. D. is 14% betvveen 50 and aged 18-39 years (n=760) and by 13% 40-69 years {tr-276). Overall 54 years, 30% between 55 and 64 years and 51% after prevalence of anorgasmia was II %. The level of love for to the the 65 years; tHe prevalence of the premature ejaculation partner dramatically influenced occurrence of dysfunction reported by is 32% when Kaplan definition has been used and 9 % the women e .g.. among those who reported they were «not very or not when OMS V definition has been used (ejaculation before at all» in love with their partner 26% reported anorgasmia occuring 15 seconds). The prevalence of the Peyronie's disease «often>>, it decreased to 9% in women «very or quite>> in love with is 5,8%, the prevalence of the subjects with a Prostatic their JXU1ner. Symptom Score IPSS > 7 is 36%.The comparison of the Discussion : Prevalence of painful intercourse, lack or insufficiency of sexual desire and anorgasmia increase with age. Higher prevalence results of this study called SIMONA (Sistema Italiano di of painful intercourse in young women between years could MONitoraggio Andrologico) shows that the prevalence of reflect their inexperience. E. D. ts much less of the MMAS study in the U.S. States.
P41 P42 TiflE ASSOCIATION OF ALCOHOL, COFFEE AND SMOKING WITH ERECTlLE DYSFUNCTlON WITHDRAWN
AUTHOR(S) Koskimaki J, Hakama M, Tammela T.L.J. (Presentation by Dr. Tammela)
INSTI11Jl10N Tampere University Hospital, and School of Public Health, University of Tampere, Tampere, Finland
ABSTRACT Aim: To examine the association of alcohol, coffee and tobacco use on erectile dysfunction (ED). Method: A questionnaire was mailed to 3143 men SO, 60 and 70 years of age. They were asked to report any difficulties in the erectile function before or during the intercource as well as consumptions of alcohol, coffee and tobacco consumptions.The men who reported difficulties in erectile function were compared to those without any d1fficulties.The men were divided into 3 groups according to alcohol, coffee and tobacco consumptions. The association between exposure and outcome variable was estimated by logistic regression as prevalence odds ratio with 95% confidence intervals. Results: 2128 (68%) of the men were included into final analysis. Of the men under 30% reported no difficulties in erection. Of the men 34% were abstaining from alcohol, 45% used in a week and 21% over 150g in a week. Never-smokers were 33%, ex-smokers 44% and current smokers 23% of the men. Coffee was consumed as follows: 58% had coffee daily 1 to 5 cups, 26% more than 5 cups, while only 6% reported no coffee consucnption. The adjusted relative risk of ED among men who consumed alcoholl-lSOg in a week was 1.28(0 1.01-1.62) and 1.34(CI 1.01-1.79) among men who consumed over lSOg weekly when compared with men who abstained. The adjusted relative risks of ED were 1.17 (CI 0.93-1.48) among ex-smokers and 1.36 (Cl1.03·1.79) among current smokers when compared with never-smokers.The adjusted relative risk of ED was 1.12 (CI 0.74·1.70) among men who had coffee 1 to 5 cups a day and 1.56 (O 1.0-2.43) among men who had more than 5 cups a day compared to non-drinkers. Conclusion: Ak:ohol seems to be a significant risk of ED. The risk is not depended on dose. Smoking is also a significant risk factor of ED but cessation of smoking decreases the risk. Coffee was not associated significantly with ED.
International Journal of Impotence Research Posters with discussion
S24 P43 P44 THE PREYALENCE OF ERECTILE DYSFUNCTION IN A A PATIENT BASED EPIDEMIOLOGY STUDY TO FIND MALE DIABETIC POPULATION. THE PREYALENCE AND CORRELATES OF ERECTILE 1 2 Jette Louise Behrend , Torben Jorgensen and DYSFUNCTION (ED) IN TWO CITIES IN PAKISTAN. 1 1 Hans Perrild • : Bispebjerg University Hospital, Copenhagen and Syed S Hussain, Shariatullah Siddiqui, Muhammad A Razzaq, 2 : Centre of Preventive Medicine, Glostrup University Hospital, Muhammad T Razzaq, Syed A H Rizvi, Veena S Jaguste. 2600 Glostrup, Denmark. Karachi, Pakistan.
Aims: To determine the prevalence of erectile dysfunction (ED) As there is no recent data available, we sought to estimate the and relation to exposure in a male diabetic population. Materials prevalence of ED in a cross-sectional epidemiology survey of and methods: A patient cohort of 326 males (Type 1 diabetics: men seeking primary health care in two cities of Pakistan. n= 130; mean age 46,1, SD 16,3 years and Type 2 diabetics: n= 614 randomly selected men in Pakistan, between 25-70 yrs, 196; mean age 61,1, SD 15,6 years) answered a questionnaire seeking primary health care, were requested to fill a self about ED, diabetes regulation, concomitant illnesses and psychi administered questionnaire, collecting infonnation, in addition cal vulnerability. Results: For men$ 40 years (n=64) 7,8% had to sexual activity, on demography, health, habits, psychosocial problems obtaining a satisfactory erection. For men> 40 years aspects, physical activity, and help seeking behavior. 63,0% of type 1 diabetics (n=76, mean age 57,4, SO 11,6 years) Overall prevalence of ED was 70.6% in 585 evaluable and 71,7% of type 2 diabetics (n= 186, mean age 62,4, SO 10,7 patients (41±9 yrs). Prevalence of moderate and complete ED years) were suffering from ED. Logistic regression, after stepwise was 25.3% and 2.1% respectively. There was linear increase in exclusion, revealdth e e £11 o owmg. m"d epen d ent ns"k£ actors £EDor the prevalence of moderate and complete ED with increasing Variable Odds Ratio 95%CI age. Prevalence of moderate ED more than doubled from Age 41-55 >< < 40 years 7,39 2,17 25,19 22.9% in 31-40 yrs old, to 50% in 61·70 yr olds, and that of Age 56-65 >< < 40 years 13,32 3,53 50,25 complete ED increased from 1% to 13.6% in same age groups. 66-75 >< < 40 vears 11,20 2,61 48,08 Reduced>< normal vibration sense 1,63 0,68 3,91 After adjusting for age, a higher probability of ED was directly Ceased >
P45 P46
PREVALENCE OF ERECTILE DYSFUNCTION AMONG A PATIENT BASED EPIDEMIOLOGY STl!DY TO FIN]) URBAN AND RURAL POPULATIONS IN TURKEY. TilE PREVALENCE AND CORRELATES OF ERECTILE Emre Kadwglu, Adil Esen, Melunet Z. Sungur, Saban DYSFUNCTION (ED) IN EGYPT Doran, Ali Ergen, Temel Y1lmaz, Kadri Anafarta, Engin Ekcr, Halim Kamal Z Mahmoud, Said Abdel Azim, Gadallah. Hattat (furk.ish Erectile Dysfunction Prevalence Study Group) Hiiseyin Ahmed M. Ibrahim, Mosaad I. JVIorsi, Veena S Jagustc. Cairo, Akbulut (Pfizer, Turkey) Murat Hayran, Oktay Ozdemir (Omega CRO) Egypt Objective: Erectile dysfunction (ED) is a common problem among men over 40 years of age and the prevalence of ED has been determined in The objective of our study was to obtain cuncnt tlala nn several countries. The primary aim of this study was to determine the prevalence or ED and its important correlates in male prevalence and age-related distribution of ED in Turkey. outpatients seeking primmy health care in Egypt Methods. Prior to the sampling process, Turkey was divided into 5 599 randomly selected males, between J0-70 yrs, were geographical regions and 17 different locations. each location the In requested to fill a self-administered questionnaire collccling studied individuals were proportionally sampled among the urban and infom1ation on sexual aclivily, demography, habib, rural population. The survey was based on a household random sample and subsequent door-to-door interviews. A total of 2,158 men of the economics, physical activity, disenses, drugs and help seeking required age were interviewed. After data quality control, we ended up behavior with 1,982 individuals who make up our sample Mean age of the evaluable population (N=594) was J9J:8 yrs Results: 64.3% of men over 40 reported some degree of ED (35.7% The combined prevalence or mild, moderntc, 8:.. complete EIJ minimal, 23% moderate and 5.6% complete ED) and the prevalence of was 54.9% (32.3%, 20.'"1%, 2.2% respect) The prevalence of ED increased by age. A preliminary analysis of the factors associated moderate ED increased from 15.9% in J0-'10 yr age group to with the presence of erectile dysfunction revealed an increased JS.7% in 61-70 yr group, while thnt of complete ED increased prevalence in urban versus rum! populations, and among subjects rmm 0.8% to 21.4% in the same age groups. Aller for carrying prostate diseases, diabetes and cardiovascular diseases. age, a higher probability of ED was directly conclated with Age No ED Minimal ED Moderate ED Complete ED diabetes, heart disease, depression, G I Ulcer, and prostate group (%) (%) (%) (%) surgery 40-49 50.1 42.3 7.2 0.4 Almost 60% of the respondents said that they would be 50-59 25.2 41.5 30.4 2.9 uncomfortable talking Hbout their FD to a dt)Ctor Their 60-69 13.7 16.1 58.2 12.0 preferred consultants for seeking help included ])ermato 70+ 5.3 4.6 41.2 48.9 venercologists, Andrnlogists, a11d Total 35.3 35.7 23.0 5.6 Family Physicians Conclusions. Erectile dysfunct10n 1s a frequent condition among men m ED shows high prevalence in Egyptian patient JHipulation we Turkey. It is associated with increasing age as well as ·with specific diseases. Our results need to be further analyzed and compared with studied, is strongly associated with age, and commoll chmnic results from other countries in order to detect any differences related to diseases such as diabeles, henn disease, depression, G. I. Ulcer, cultural envirorunent and life-style habits & prostate surgery, which could be its independent correlates
International Journal of Impotence Research Posters with discussion
S25 P47 P48 TITLE PREY ALENCE OF ERECTILE DYSFUNCTION (ED) AND PREVALENCE OF ERECTILE DYSFUNCTION IN FINLAND ITS CORRELATES IN MOROCCO A POPULATIOt\ AUTHOR{S) J. Koskimaki, M. Hakama AND T.L.J. Tammela BASED EPIDEMIOLOGY STUDY INSTITUTION Nadia Kadiri, Soumya Berrada, Samia Tahiri, Chakib Nejjari, Division of Urology, Tampere University Hospital and School Soumya El guassem, Mostafa Benmimoun, Veena S Jaguste. of Public Health, University of Tampere, Tampere, Finland Casablanca, Morocco ABSTRACT
A1m· To examone the preveler.ce ol&rectole dysflJnc:IIOn in Finland Mell1od The »>PUiatoon of the study c.ons.sted of res»t>r>dents to 111e epldem•olog1c:al As till now, no published population based studies on Cf055-0edlonat coi100 slUdy about urct<>lllcal problems on F1nn1Sh men A quest1onnatre was ma1led to ell SO-. 60- or 7CI-year--old men 1n the c:ity ofTM1pere 911d •n ele•en prevalence of ED are available in Morocco, we tried to obtain mun1C1pal1ties in lhe Oilme counly. Altogell1er 3143 men reoeooed 111e quesl10nna.re Tl"le men were asked lwO questions about erection before an onten:oun:e and dunng an current data on prevalence of ED, its correlates and help ontercource 1) Do you
P49 P50
EPIDEMIOLOGY OF ERECTILE DYSFUNCTION (ED) THE VALUE OF VISUAL SEXUAL STIMULATION (VSS), AND ITS CORRELATES A PATIENT BASED STIJDY IN AND VISUAL SEXUAL STIMULATION PLUS NIGERIAN POPULATION INTRACAVERNOSAL INJECTION (VSS' ICIJ TESTS ON Segun Dogunro, Dominic Osegbe, Veena S Jaguste. Lagos, DETERMINING PSYCHOGENIC EREC..IILE DYSFUNCTION Nigeria. BU.lent Ozti.irk, Glirdallnal, Serkan GOkkaya, Ozglir Ugurlu, Ali Mesut (ctinkaya Ankara Numune Education and Research Hospital, Urology In this, perhaps the first study in black population, we tried to Clinic, assess the prevalence and correlates of ED in Nigerian males Ankara, Tlirk.iye needing primary health care, & their help seeking behavior OBJECTiVE: Tile aim ofthis study was yo determine the role and 1000 randomly selected Nigerian males between 35-70 yrs, in validity of Visual Sexual Stimulation (VSS) and VSS plus need of primary health care, were requested to complete a self lntracavernosal l.njectlOn (VSS+ICl)m diagnosis of psychogenic administered questionnaire collecting information on habits, erectile dysfunction (ED) demography, socio-economics, diseases, drugs, physical MATERiALS AND METHODS: 4J patients were included in the activity, in addition to sexual activity study. Each patient was evaluated for ED with sexual history, 917 persons were evaluable (ave age 43±8) Total prevalence physical examination, VSS, VSS 1-JCI, 2 nights of ambulatory of ED was 50.7% (mild 40.5%, moderate 9.9%, complete RigiScan monitonng, penile doppler ultrasouography and 0.2%). Prevalence of moderate ED increased from 6.8% in 35- pharmaco-cavemosometric study- cavernosography when needed 40 yrs to 46.8% in 61-70 yrs old Lower prevalence of Patients were divided into two groups as psychogenic (n=-24) aud complete ED was reported as compared to MMAS. After organic (n:::l9) ED adjustment for age, diabetes, hean disease, depression, G.I VSS, VSS+lCl & NPTR results of the two groups were compared Ulcer, dislipidemia were significant, independent correlates of RESULTS: While VSS tests were positivll in 5 of the 24 pat tents with psychogenic ED (Sensitivity 100%, specifity 50%), VSS 1 ICI ED, while hypertension was not. No significant correlation was tests were positive for 13 of the same 24 patients (Seusitivity 87%, found between ED and alcohol consumption, smoking, BMI, specifity 61%). When NPT was applied m the same group, 19 marital status, education and religion. Only 50% men said that patients gave positive responses (Scnsit•vtty 83%, specifity 75%) they would be comfortable discussing their ED with the doctor Positive productive values of tluee tests were 11, 54, 79% Family physician (64%), Andrologists (20%), and Urologists respectively. (7%) were the top three choices among preferred consultants CONCLUSION: TI1e majority of the patients whose VSS tests ED shows high prevalence in black Nigerian patient were positive, had psychogenic ED. By Pcrtbrmmg ICI togcther population studied, with age as its most significant predictor. It with VSS, we can prevent more than half of pm1ents from mortJ is also associated with many chronic diseases which are invasive tests and tl1e diagnosis can be achieved with lower costs independent correlates, thus making it an important health concern
International Journal of Impotence Research Posters with discussion
S26 P51 P52 Assessment of the Residual Relaxant Capacity of Cavernous WILL INCREASING OF INTRACAVERNOUS PRESSURE BE A SIGN OF CHANGES OF CAVERNOUS TISSUE NATURE ? Bodies- Ahmet Erbai!CI, Kcrnal Sanca, Faruk Yagc1, SlUla Erklhf*, Okan Uysal, Canan Comparison Between Drug-induced Cavernosometry/ Korkrnaz• graphy and ViagraR-Test at Home DepartmCTits of Urology and Pathology•. University ofGuianlep, Medical school Aim: To find basic parameters which show prognosuc \'alues of cavernO\Is tissue's nature orland make easily diagnosis of impotence in some related Hartmut Porst, Urological Office, Hamburg,Germany pathologies
Material & Methods: 23 patients' cavcmosal tissue specimens derived from 44 patients not-responding to i.e. vasoactive drugs and failing in penile prosthesiS surgery were evalualcd histopathologically for muscle conlaintment of corpus cavcrnO!lurn_ All patients were examined psyrogenic and self-injection therapy at home were previously considered physical aspects which involves imensive neurologic evaluation. Visual penile candidates for penile implants or vacuum therapy but did not turnecencc test, colour flow doppler ultrasonography, intracavemous vasoactive injection test and hormonal parameters for impotence were searched. accept these therapeutic options. All patients underwent Cavernosornetry±cavcmosography evaluation were applied to the patients with MMS urod}namic systems software and hardware After 1 mmHg air pressure phannaco-cavernosometry/graphy after preinjection of 40 Jig calibratioTI has been done, basal intracavemous pressure was measured. PGE or Trimix and 35 showed venoocclussive dysfunction of ITI relation with pathologic dasification, patients "ere subdivided three groups 1 according to muscle containment of cavernosal tisse with linear percentage mild (ME-flow 20-50 ml/min, moderate (ME-flow 50- evaluation and dasified as !ow(<33%},suspected.( 33·45%}, nonnal(>45%} Mean age of the patients were 61{53·65} years. The causes of SO ml/min, n=9) or severe (ME-flow> 80 ml/min, n= I 5) degree. impotance were !6/23 of diabetes mellitus{neuropathy+vascu!opathy}, 2129 of No venoocclussive dysfunction (ME-flow < 20 mllmin.) was Tieurogcnic, 5123 of pw-c vasulogenic found in 9 patients. All patients were provided with 6 ViagraR Results:lntraca\·ernous pressure ill:ross subdivided histopathologic group were submitted With table below: tablets, two tablets each dose and returned in order to evaluate Cu·ernosal Muscle Tissue Com onents the outcome of the ViagraR-trial. I I INonna1(>45"1o) n:\0 n:7 n:6 Results: Mild venoocclusive dysfunction: positive ViagraR-Test 117.5mmHg lll.SmmHg 15.4mmHg 6/11, moderate venoocclusive dysfunction: positive ViagraR-test basal ressure CondUSIOII. Wtth prchmmary rcsul!s of th1s on·go1ng study, mtraca\crnous 7/9, severe venoocclusive dysfunction: positive ViagraR-test Ill pressure showed good iTiverse proportion 1\lth cavernous tissues muscle containment Etiologic causes of low cavemosal muscle groups involved mostly 15, no venoocclussive dysfunction: positive ViagraR-test 7/9. diabetic patients and normal cavcrnosal muscle groups hlld more vasculogcTiic Conclusion: This trial provides convincing evidence that in terms etiologies tban comparing the others_ Alhough the number of patients was Tiot enoogh to make real decission, but abtlity of corpus cavemosum is of evaluation of the maximal cavernosal relaxant capacity a belong to incredient of rete cavcrnosum arra11ged by certain amount of collogen,elastin and muscle apart from mecbaTiical force of blood streern and ViagraR-test at home is of considerably more diagnostic value veTIOOCclusive mechanism. Increasing fibrous containment changes this cquatation than drug-induced cavernosometry/graphy under in-office to increase mtracavemous because of difficult !Issue perfusion.Howevcr, diabetic pillicnts seem very easy·going condition for this pathologu:s in d11Terent conditions &-. P53 P54
TITlE AND COMPliANCE OF ARTI'RlES IN MEN WITH ERKTllE OV5FUNUION ERECTILE DYSFUNCTION IN THE AGED PATIENTS: HYSTOMORPHOMETRIC AND FUNCITONAL ASPECTS.
A. Motsa, A.M. l OE!JECTlVES: We sought Ill = !he "lie of ondrogerls ABSTRACT "' aoveiTIO MATEI!lltLS aod MET!iDOS: In 5ludy we factors such as the fncreilse of the male mean age , the lncn!IISI!d number of diagnoses analyzed endoairle fuf'IC!lon (LH, total and free of erectile dysfunction (ED) , the efforts of scientific research towards less and less !eS!O<:disorderi,ool'!....,..,usedforstao=! All of them underwent the mmmon first-level diagnostic procedures (hystory, 10 test , anoly"' doppler ultrasound). Corpus cavemosum (c.c.) biopsy was performed on office or surgical basis and specimens analyzed by hystomorphometric technique , RESIJL TS- Acalrdl"9 to PBFS, paOent> were d;,lded International Journal of Impotence Research Posters with discussion S27 P55 P56 THE ROLE OF NEUROPHYSIOLOGICAL CFFf:CTS OF CASTRATION ON HUMAN PENILE INVESTIGATION IN ERECTILE DYSFUNCTION VASOACTIH INTESTINAL I'EPTIDE (VIP). 1 2 1 Melih «;ulha , Htisnii Efendi , Mehmet Oguz Acar , Luigi Cormiu, l. Gesualdo. C Bettocchi, E Maiorano, V Zizzi, 1 1 Mustafa Eralp , Ali Gokalp G Grandaliann, :\ Traficante, FP Schena, FP Selvaggi Department of Urology1 and Neuroloro? School of Medicine, I >eparlme/11 1!/ ( !ruloKJ:, D1 I 'enae Teaching Hospital, 70122 Kocaeli University, Kocaeli, Turkey Han.('arhmuml Objective: An intact pelvic cavernous nerve pathway and the integrity of cavernous smooth muscle fibers are essential for Vasoactive intestinal peptide (VIP) is colocalised with nitric normal penile erection. Malfunction of the somatic and/or oxide synthase (NOS) within the nerve fibers of the 'human autonomic nervous system in regard to penile innervation was corpus cavernosum (CC); while NO initiates trabecular smooth evaluated. muscle relaxation, VIP maintains it The aim of this study was to Material and Method: 64 men with erectile dysfunction and determine whether castration reduces VIP content in the human 20 healthy volunteers without complaint were evaluated. Mean CC, since castration has been shown to reduce NOS in rat CC. ages were 53.4 and 49. I in study and control group From may I (J P57 P58 SEXUAL DYSFUNCTION IN HIV INFECTED MEN TITLE B Cuzin, Ph Sutet, JP Galaup, JM Dubemard, Department of Urology and UROLOGIST AND PSYCHIATRIST IN THE MANAGEMENT OF ERECTILE Trnnsplantation, E Herriot HospitaL Lyon. Frnnce DYSFUNCTION: AN INTEGRATED APPROACH AUTHOR(S) Tritherapy has changed vital prognosis and Michele Nicolai, Gianluca Mastroprimiano, Giovanni Cipollone, Manarosaria Grimaldi", Annamaria Pacilli*, Franco Addona•, Simona Scire", Massimo Di Giannanton1o", Filippo quality of life of HIV infected patients, asking the question of M. Ferro• and Raffaele L. Tenaglia. sexuality in those patients. We report herein charateristics of INSTITUTION sexual dysfunction in HIV infected outpatients. Department of Urology, • Department of Psychiatry, "G. D'Annunzio" University, Chieti• 15 HIV infected patients treated with Italy tritherapy has been referred to one andrologist physician between ABSTRACT January 1998 and March 1999. Routine endocrine evaluation has Since the beginning of the century, under the influence of the N"eud!an thought it was included testosterone, prolactin, LH measurements. believed that psychotherapy could have an important role in the management of er!tclile dysfunction (ED). Subsequently, thanks to the improvements in the knowledge of Mean age of patients was 45 years (range erectile physiology, it has been possible to assess a more important role of organic 32·69 years). 2/3 of the patients were homosexual men. Sexual compared to psychogenic etiology and vice versa for each single case, with the aim to choose the best therapeutical approach. The purpose of our study is to propose a dysfunction was mainly erectile dysfunction (12 patients) psychodiagnostics evaluation and a psychotherapy for singles and couples. after the associated with a loss of libido in 5 cases. 2 patients had isolated exclusion of organic factors. Forty male patients affected by ED with a mean age of 47 years (26-66 years) were exam1ned. All patients underwent Rigiscan test for 213 nights; loss of libido, and one an isolated premature ejaculation. 5 patients dynamic penile doppler; laboratOIY tests to assess metabolism and hormonal status, and complained about genital paresthesia. 8/15 patients had a the International Index of erectile Function (liEF). Moreover, in patients without orgamc factors, after a psychic exam, two tests were administrated in two different moments: the decreased testosterone level with a nonnal prolactinemia. Chosen MMPI (Minnesota Multiphasic Personality Inventory) and the SESAMO (Sexuality therapy was androgen therapy (8 cases), oral therapy (6 cases) Evaluation Schedule Assessment Monitoring). Psychogenic EO was diagnosed in 15/40 and intracavemous injection (1 case). Success rate of androgen (37.5%) patients. The liEF only allowed a measure of the ED. while from the scores of MMPI it has come up in an evident high percentage (79%) an increase in the D scale therapy was 50%. Genital paresthesia have not been treated with (depression) and the Hs scale (hypOChondria) (65%). The SESAMO highlighted three efficacy. During the follow up, some psychological components significant areas: the 1A (social environmental data), the 1 E (first sexual activity) and the 3E (sexual communicativeness). The importance of a multidisciplinary approach for were frequent: difficulties to adapt sexuality to the pathological the management of EO is evident from this study, particularly the SESAMO has allowed state, ambivalence in the request of a recovery of sex:ual activity us to achieve two important obi&ctives: 1) to make a psychosexual and social·affective profile of the patient; 2) to suggest etiologic hypotheses and to point out the Sexual dysfunction in HIV infected men is dysfunctional aspects of sexuality of a single and a couple. represented mainly by impotence. Our results confirm the high rate of hypotestosteronemia and genital paresthesia published in the literature. Psychological component of sexual dysfunction is particularly complex and required a perfect coordination between medical team. International Journal of Impotence Research Posters with discussion S28 P59 P60 SATISFACTION WITH SEXUAL LIFE IS NOT CORRELATED ERECTILE DYSFUNCTION IN SCLERODERMA WITH THE LEVEL OF SEVERITY OF SEXUAL DYSFUNCI'ION IN Simon T.R Holden, Robert J. Morgan, Michael Jarmulowicz, MALES Andre Bejin., Patrick de Colomby, Alfred Spira, Alain Jardin and Carol M. Black, Leslie Berger. Francois Giuliano Bicetre, France. Department of Urology, Royal Free Hospital, Pond Street, London NWJ 2QG U.K. Introduction : A large-scale survey of sexual lifestyles has been conducted in France funded by ANRS (Nature 1992, 360, 407-409) in IN1RODUCTION: Scleroderma (Systemic sclerosis) is a response to the spread of the AIDS epidemic. This survey was conducted in 20,055 people aged 18-69 years and was focused on a detailed chronic debilitating multi-organ disease. One common description of sexual practices and means of protection against IDV manifestation in up to 60% male sufferers is erectile dysfunction infection.. Questions concerning sexual dysfunction and satisfaction with (E.D.). Vascular changes and corporeal fibrosis have been sexual life were included in an additional questionnaire. An analysis was proposed as causes. This study aims to correlate penile blood flow, conducted on the relationship between sexual dysfunction in males and histology and response to treatment. overall satisfaction with their sexual life. Our analysis is OOsed on the METIIODS: Male scleroderma patients with ED. between the responses of 1335 French adult men. ages of 20 and 70 were invited to participate. Those with other Methods : Results of the pre-test evaluation led to adoption of a possible causes ED were excluded. Study patients had blood taken telephone survey method with a notifying letter sent beforehand ll1.e for hormonal profile, penile Doppler evaluation of blood flow and additional questionnaire including questions on impotence and premature needle core biopsy of the corpus cavemosum. Patients were then ejaculation and also on satisfaction with sexual life, was completed in offered treatment for erectile dysfunction. Biopsies were stained approximately 30 minutes by 1335 adult men We analyzed responses of men who reported themselves •• not at all" or ·• poorly " satisfied with with Haematoxylin and Eosin and Masson's trichrome. Fibrosis their sexual life. was estimated by light microscopy and a video image analyser was Results : 17% of men who reported impotence as occuring " often " used to calculate the fibrotic tissue:smooth muscle ratio. (n=69) and 25% of men who reported impJtence as occuring RESULTS: 7 scleroderma patients with normal hormonal "sometimes" (n=l62) were put of this group. 12% of men who reported profiles completed all investigations. Penile Doppler showed premature ejaculation as occuring" often" (n=l22) and 15% of men who arterial insufficiency in 2, venous leak in 2 and was normal in 3. premature ejaculation as occuring " sometimes" (n=332) were Light microscopy showed considerable fibrosis in all. Image part of this group. analysis showed the fibrosis to range from 53% to 88% Discussion : Impotence and pemature ejaculation reported as occuring irrespective of Doppler diagnosis. To date 5 patients had treatment " often " seem to have a weak impact on satisfaction with sex life in the with either MUSE or intracavernosal PGE • One had successful vast majority of males. Surprisingly, males who reported impotence and 1 treatment with MUSE, I partially successful and 3 failed MUSE, 2 premature ejaculation occuring " sometimes •• reported less satisfaction with their sex life than those reporting these dysfunctions as occuring of whom also failed intracavernosal injection trial. " often ". These results suggest that the level of severity of sexual CONCLUSIONS: Irrespective of blood flow scleroderma dysfunction has a complex relationship with the subjective perception of patients develop intracavernosal fibrosis which impedes corporeal sexual satisfaction by the patient. relaxation. This makes treatment with vasoactive agents difficult. P61 P62 OXYTOCINERGIC (Of) CONTROL OF ERECTION IN PARAPLEGIC THE PARAVENTRICULAR NUCLEUS IS IMPORTANT TO INITIAT RATS ERECTION Florence veroru.:au-Longueville, 13lXjll International Journal of Impotence Research Posters with discussion S29 P63 P64 SENSORY INNERVATION OF THE CORPORA CAVERNOSA VARIABILITY OF RESPONSES INDUCED BY PGE1 ON HUMAN (CC) IS PARTLY CONVEYED BY THE CAVERNOUS NERVE IN PENILE SMOOTH MUSCLE. THERAPEUTIC ADVANTAGES OF RATS. Yi Tang, Olivier Rampin, Stephane Droopy, Gerard Benoit, COMBINING PGE1 WITH S-NITROSO GLUTATHION Javier Angulo, Ignacio Moncada, Antonio Martin·Morales, Antonio Allona, Alain Jan1in and Fram;ois Giuliano, Bicetre,. France (Presented by Dr. Argentina Fernandez. Sonia Gabancho, Pedro Cuevas, Ifiigo SAenz de Tejada. Giuliano). FWldaci6n para Ia InvestigaciOn y el Desarrollo en Andrologfa. Madrid, Introduction: The cavernous nerve (CN) conveys parasympathetic Spain. proerectile fibers to the penis. Neurogenic impotence after radical prostatectomy is attributed to the lesion of the parasympathetic outflow Erectile dysfunction has been successfully treated with intracavemosal to the penis conveyed by CN. In contrast the role of the sensozy injection of prostaglandin E1 (POE1) but it has been shown ineffective for innervation of the CC has not been expertized so far. some patients. The aim of this work was, on one hand to characterise the PGE -induced relaxation of human penile smooth muscle, arterial and Methods: Adult rats were assigned to i) control group (n = 6), ii) CNx 1 trabecular, and its correlation with the clinical response to this drug. On the group (n = 5) with a bilateral section of the CN, ill) DPNx group (n = 4) other hand, we tested the effects of the combination of POE1 with S-nitroso with a bilateral section of the dorsal penile nerve. On the same day, the glutathion (SNO-Glu), a nitrosothiol, on relaxation of human corpus neuronal tracer horseradish peroxidase-wheat germ agglutinin (HRP cavemosum strips and penile resistance arteries. A great variability in the WGA) was injected in the CC. After a survival period of 3 days, dorsal relaxation response of human penile smooth muscle to PGE1 was observed, root ganglia (DRG) Tl2 to Sl were removed HRP-WGA detection was and the magnitude of these relaxations was related to the degree of clinical realized on 25 J.1.1t1 thick sections of the DRG. response to intracavemosal PGE1 in the same patients. SNO-Glu produced Results: Mean number of HRP-WGA labeUed cell bodies per DRG consistent relaxation of human corpus cavemosum strips and penile arteries, perrnt even when the tissue responded poorly to PGE1. The combination of PGE1 and SNO-Glu caused significantly greater relaxations than PGE1 (EC50 0.006±0.001 vs 0.083±0.050 p by the combination ofPGE1 and SNO-Giu revealed synergistic interaction of CNx caused a decrease of labelling in L 1 and L2 DRG (p<0.05). DPNx both drugs in the relaxation of trabecular (p<0.05) but not of arterial tissue. caused a decrease oflabellinginLl, L2 andL6DRG. Determination of cyclic nucleotide accumuJation in human corpus cavemosum tissue showed that the administration of the combination of Discussion: There is a significant population of sensory fibers issued PGE and SNO-Glu simultaneously increased the levels of both cAMP and from the CC in both CN and DPN. This sensory infonnation could 1 cGMP. Our results suggest that the clinical effectiveness of intracavemosal adaptate the proerectile outflow to the penis by reporting on the activity administration ofPGE1 is related to the variability of the relaxation responses of the erectile tissue to the spinal cord Lesioning CN alters this sensory of human trabecular tissue and penile arteries to this drug. Thus, the feed-back, thus puticipating to lhc tnthophysiology of erectile combination of PGE1 and SNO-Giu, couJd be an advantageous therapeutic dysfunction following CN injuries. tool for the treatment of erectile dysfunction. P65 P66 INTRA VENOUS VASCULAR ENDOTHELIAL GROWTH NITRIC OXIDE DEPENDENT RELAXATION AND CYCLIC FACTOR RESTORES BOTH ENDOTHELIAL DEPENDENT GMP FORMATION ENHANCED BY SILDENAF1L IN THE AND INDEPENDENT CORPORAL SMOOTH MUSCLE DIABETIC RABBIT CORPUS CA VERNOSUM RELAXATION Faiz Mumtaz, Masood Khan, Cecil Thompson, Dimitri Robert R. Byrne, Gerard D. Henry, TTT Huynh, Anne M. Mikhailidis, Robert Morgan. Royal Free Hospital, London, UK. Pippen, Brian H. Annex, Per-Otto Hagen, Craig F. Donatucci (Duke University Medical Center, Durham NC) Introduction: Erectile dysfunction due to alterations in the nitric oxide (NO) pathway is well recognised in diabetes Objectives: The route of administration can affect the efficacy mellitus (DM). Recent studies have shown that sildenafil, a of treatments for erectile dysfunction, as is seen in the difference specific inhibitor of cGMP phosphodiesterase V, enhances between intrauretheral and intercavernosal alprostadil. We human and rabbit cavemosal smooth muscle (CSM) relaxation. determined the effects of intravenously delivered VEGF on both We investigated the eiTects of sildenafil on NO-mediated CSM endothelial-dependent and endothelial-independent corporal relaxation and cGMP formation in DM and control (CT) rabbits. smooth muscle relaxation. Methods: After 3 and 6 months, CSM tissues from CT and Methods: in 12 New Zealand White rabbits fed a 1% DM rabbits were prepared. CSM relaxation to electrical field cholesterol diet, who received a single intravenous bolus of either stimulation (EFS) and sodium nitroprusside (SNP) were VEGF (0.9mg) or VEGF-vehicle after 6 weeks. Ten days after assessed in the presence and absence of sildenafil. Formation of injection isometric tension studies were performed on corporal cGMP in response to SNP, calcium ionophorc A23187 and tissue. Sensitivity and maximal relaxation to acetylcholine (ACH) acetylcholine using radioimmunoassays was also measured. and sodium nitroprusside (SNP) were compared between Results: SNP-mediated relaxation was impaired (p International Journal of Impotence Research Posters with discussion S30 P67 P68 EFFICACY AND SAFETY OF SILDENAFIL IN ELDERLY NITRIC OXIDE MEDIATED CAVERNOSAL SMOOTH PATIENTS MUSCLE RELAXATION IS IMPAIRED IN DIABETES Juza Chen, Nicola J. Mabjeesh, Alexander Greenstein, and Haim Jon Cartledge, Ian Eardley, John FB Morrison Matzkin Pyrah Dept of Urology StJames's University Hospital Leeds Dept. of Urology, Tel-Aviv Sourasky Medical Center, Tel-Aviv UK University, Tel-Aviv, Israel. Introduction: ED is common in diabetic men. We have Objectives: To evaluate the efficacy and safety of Sildenafil previously shown that HbAlc impairs NO mediated relaxation in treating erectile dysfunction (ED) in patients over of normal corpus cavemosal tissue by generation of the age of 70 years. superoxide anions. We set up experiments to examine NO Materials and Methods: Thirty patients (mean age 74.9 years, mediated relaxation in cavernosal smooth muscle in diabetes. range 71 to 85) suffering from ED of various etiologies were Methods: Diabetes was induced in adult male Wistar rats by treated with an escalating dose (from 25 to lOOmg) ofViagra for IP injection of streptozotocin. After 8 weeks animals were 6 months. The International Index of Erectile Function (liEF) culled and corpus cavemosal tissue strips obtained. Young questionnaire rated the success of the drug. All patients were also adults and age matched controls were examined in an identical asked about any side effects during the treatment. manner. Using a standard organ bath technique strips were Results: Therapy was considered positive if post-treatment contracted with Noradrenaline (NAd) prior to the scores were higher than pre-treatment for all five domains of the addition of acetylcholine (ACh) or electrical field stimulation .IIEF (Ta.IJle). (EFS). Relaxation responses were repeated in the presence of i1EF c3o) L-arginine (lOO).lM), indomethacin (101-lM) or superoxide Domain Pre-treatment Post-treatment No of dismutase (SOD) (120iu/ml). (Mean scores± SD) P Value responders(%) Results: 8 weeks uncontrolled diabetes causes a 55% and EF 6_9 ± 4.5 21.7 ± 9 4 < 0.0001 26 (87) OF 4.0 ± 3.0 6_9 ± 2 3 < 0.0001 22 (73) 45% impairment in mean relaxation responses to ACh over SD 6.0 ± 1.9 6_3 ±I 6 N.S. 14 (47) control and age matched controls respectively (p P69 P70 PHARMACOLOGICAL EFFECTS OF ENDOTHELIN-l IN TREATMENT OF ATHEROSCLEROTIC VASCULOGENIC THE RABBIT CAVERNOSAL SMOOTH MUSCLE IMPOTENCE IN A l\tODEL Faiz Mumtaz, Masood Khan, Cecil Thompson, Dimitri Mikhailidis, Robert Morgan. Royal Free Hospital, London, UK. Khalt!ti.M.Badr.Tarek .,1f.Hashem *,ami A/(lfz./1-LBndr • Urolov· Dt!parllll International Journal of Impotence Research Posters with discussion ffi S31 P71 P72 APOPTOSIS IN THE ERECTILE TISSUES OF. DIABETIC DECREASED TRABECULAR SMOOTH MUSCLE AND AND HEALTHY RATS CAVEOLIN-1 EXPRESSION IN PENILE TISSUE OF Bulent Ahc1, Kora.Y. •, Hamdi Ozkara, Emre Akkua, AGED RATS GU!deren Demirel •• Famk Yencilek, Halim Hattat Mustafu E. Bakircioglu, Karl-Dietrich Sievert, Angie Lau, Ching I.U. Cerrahp* Medical Faculty, Urology Dept., Sexual S. Lin and Tom F. l.ue (Department of Urology, U-518 San Dysfunctions Center and Biochemistry Dept. •, Pakize Tarzi CA 94143-0738 Laboratories••, Istanbul, Turkey. Purpose: Because decreased trabecular smooth muscle content is reportedly associated with vasculogenic impotence in men, we Objective: Apoptosis has been defined as an active, physiological. undertook this rodent study to investigate the effect of aging on cell death. Apoptosis plays an important role both in normal trabecular smooth muscle content and caveo lin-I protein mammalian development and in the developrrierit of severaJ expression in penile smooth muscle cells. diseases. The aim of this study was to compare apoptosis in erectill: Methods: In 6 young (3 months) and 6 old (24 months) rats, tissue in chronic diabetic and healthy rats. erectile function was evaluated by cavernous nerve stimulation. Materials and Methods: Forteen chronic diabetic and 10 healthy At sacrifice, penile tissue samples were collected for western blot Spraque-Dawley rats were sacrificed and penises were harvested analysis, Masson's trichrome staining, caveolin-1 immunostaining, and preserved at - 70° C until staining 11nd flow cytometric analysis and electron microscopy. The percentage of smooth muscle in for apoptosis were done. The cell suspension was obtained from trabecular tissue was assessed by computer-assisted image penile tissue by scraping inside of cavernosum with scalpel and analysis. 6 was filtered through a mesh. Cell suspension (0.5 x 10 ) was Results: In the aged rats, intracavernous pressure was decreased stained with Annexin V (Pharmingen, USA) and Propidium Iodido: (70 ± 8.8 vs. I 07 ± 12.3 em H 20) and the latency period increased (PI) (Molecular Probes, USA). Incubated for 15 minutes at room (7.8 ± 1.2 vs. 4.5 ± 0.5 sec) significantly (P < 0.001). '!be ratio of temperature and analyzed on PROFILE II (Coulter, USA) flow trabecular smooth muscle to connective tissue was likewise cytometer. DNA content analysis was performed for each sample significantly altered (27 ± 2.9 vs. 42.1 ± 5.1% in the young; p < which were prepared with DNAPrep (Coulter,USA). 0.001 ). Irnmunostaining for caveolin-1 was noted in each group in Results: In normal erectile tissue, an average of 6,2% ofcells wene the sarcolenuna of smooth muscle cells and endothelium of stained with Annexin V, while only 2, 7% were stained with ·PI. trabecular sinusoids, but the staining pattern was less dense and DNA content analyses showed 7,5% of hypodiploid cells, On the the percentage of smooth muscle positive for caveolin-1 was other hand, 19,5% of cells were stained with Annex in V and 5,2%. decreased in the aged rats (17.9 ± 2.5 vs. 27.5 ± 3.6%; p < 0.001). with PI in diabetic rats. 22,9% hypodiploid cells were recognised in Moreover, young trabecular smooth muscle cells were noted to DNA content analyses of diabetic rats. have more caveolae in sarcolenuna on electron microscopy and a Condulion: Ratio of apoptotic cells in the erectile tissues of higher expression of caveolin-1 protein on Western blot analysis. diabetic rats was significantly increased when compared to normal Conclusion: In these aged rats, the decreased ratio of trabecular rats. In our opinion, high apoptosis rate in diabetic rats may play a. smooth muscle to collagen and the reduced expression of role in the pathophysiology of erectile dysfunction. caveolin--1 may contribute to their erectile dysfunction. P73 P74 BlOMECHANICAL MODELING OF THE NORMAL AND EFFECTS OF DOXAZOSIN ON ISOLATED RABBIT DIABETIC PENIS DURING PROSTHESIS-AIDED ERECTION CORPUSCAVERNOSUM 1 2 1 Amit Gefen , Juza Chen and David Elad 1Dept. of Biomedical Engineering, Tel Aviv University, Tel Aviv Acun Sayhk, Saban Sankaya, Ramazan Esra Saglam, 69978, ISRAEL, e/[email protected] and 2Dept. of Urology, Tel Aviv-Sourasky Medical Center, Tel Aviv 64239, Israel. Ersin Recep Buyiikalpelli, A. F aik Y!lmaz. Departments of Urology and Pharmacology, Ondokuz Mayts University The prevalence of impotence in diabetes ranges as high as 75%. Samsun, Turkey Insertion of an inflatable penile prosthesis (IPP) is an accepted treatment in this group of patients. Clinical studies have Introduction and objectives: Recently, alpha-blockage demonstrated that severe post-implantation penile pain during gained popularity in the treatment of lower urinary tract erection with IPP is a common complication among diabetic men. A biomechanical model was developed to simulate stress symptoms. Adrenergic receptors are also present in corpus distributions due to interaction of the IPP with normal and diabetic cavemosum. Whether the alpha blockers selective for the penile tissues (Fig. I). The model was solved using a commercial lower urinary tract affect corpora cavernosa concomitantly is finite element software for intraluminal inflation pressure of the the subject of this study. prosthetic cylinders. Elevated mechanical stresses during erection Methods: In this in vitro study, the effects of doxazosin on (Fig. 2) were found in the dorsal and lateral aspects of the diabetic noradrenaline (NA) induced contractions in the strips of rabbit tunica albuginea (normal 5.1+31.5 KPa, diabetic 5.1 +70 KPa corpora cavemosa and bladder neck were investigated and post-implantation). These intensified stresses are transferred to the compared with those of prazosin. Student t test was used for nerves within the tunica albuginea and to the dorsal nerves. Thus, it is reasonable to assume that during IPP-aided erection in statistical analysis. diabetics, intensified stresses around the nerve roots may lead to Results: Both doxazosin and prazosin inhibited the NA discomfort or sensation of pain. These stresses may also obstruct induced contractions non-competitively in both tissues (p< blood supply to the penile tissues and cause ischaemic pain. 0.05) Prazosin caused stronger inhibition than doxazosin in Donoal A'tU) ... \ 't .. both tissues (p< 0.05). Inhibitions with doxazosin and prazosin D.nala.n-. .... were superior in bladder neck than those in corpus cavernosum ' strips (p< 0.05). Conclusion: The inhibitory effects of doxazosin on adrenergic contractions of corpus cavemosum smooth muscles should be considered when treating the patients with lower urinary tract symptoms. International Journal of Impotence Researcherated rnts (S) underwent a lamin