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Objectives: Vasoactive intestinal peptide (aviptadil) with phentolamine mesylate (Invicorp) was first used for erectile dysfunction (ED) in 1992. The advent of oral phosphodiesterase-5 inhibitors and the availability of intracavernosal alprostadil injections (ICAI) compounded by regulatory issues for Invicorp have limited the use and availability of this medication. Invicorp causes less pain on injection and may have a role following failure of ICAI but contemporary experience is limited. Methods: Single centre retrospective review of all patients referred for trial of Invicorp after failing ICAI due to pain or poor efficacy following titration to at least 40mcg. The first injection was performed in clinic with either a half (12.5mg aviptadil/1mg phentolamine) or full (25mg aviptadil/2mg phentolamine) dose followed by a telephone call in 6 weeks. Efficacy was assessed by patient history after 3 months. Results: 163 men with a median age of 60 years (IQR 53-67) were referred after failing median ICAI dose of 20mcg (IQR 10-40). Aetiology of ED was post radical prostatectomy in 49% and diabetes in 31.9%. All men had failed oral phosphodiesterase-5 inhibitors and 75% found vacuum erection devices inadequate. 61% found ICAI too painful and were unable to titrate their dose higher while others reported poor response. Almost two-thirds (63.2%) found Invicorp effective and allowed sexual activity to resume (Table 1). Some (15%, n=24) stopped Invicorp despite good efficacy because they wanted to stop using injectables or experienced improvement in their erectile function over time (post radical prostatectomy). Fifty-three (32.5%) men developed adverse reactions following injection, primarily facial flushing (92%). No episodes of iatrogenic priapism were reported. Conclusions: Invicorp offers an effective and acceptable third line option for men who have failed most non-surgical treatment for ED in the largest study to date. Many (63%) were given an alternative to penile prosthesis insertion by being offered Invicorp. Invicorp was well-tolerated and only 4 patients in this cohort (2.5%) stopped due adverse effects. Conflicts of Interest: Nil [ABSTRACT FROM AUTHOR]

Objectives: Penile prosthesis (PP) insertion is recommended for patients with ischaemic priapism of long duration in order to restore erectile function; but little has been published regarding quality of life (QOL) for those with implants post-priapism. This the largest study to date assessing QOL outcomes in these patients. Methods: Within our department, 167 patients had a PP inserted following priapism between 2002-2022. We identified 42 patients that had PPs inserted for priapism between 2007-2021. Clinical and demographic details were recorded on an electronic log. Of these 42, 18 (43%) were contactable and agreeable to email or telephone questionnaire. The validated Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaire was administered and responses were recorded. Two additional questions were asked regarding regret over PP insertion and feelings regarding their future with a PP. Results: The median time to implant insertion post-priapism was 15 days. Of the 18 patients who responded, 16/18 (89%) were actively using their prosthesis. Half of these patients (9/18) had an inflatable device inserted primarily. The median duration of PP insertion was 36.5 months. No patients (0/18, 0%) regretted their decision to have a PP inserted at the time of priapism, and 13/18 (72%) would be satisfied living the remainder of their life with a PP. Regarding pleasure, 12/18 (67%) of respondents felt their PP was satisfactory half the time or more, and 76% (13/17 responses) felt their PP had met expectations. Of the 16 men who responded regarding partner satisfaction, 10 (63%) felt their partner was satisfied with the PP half the time or more. Conclusions: PP insertion is a suitable surgical technique to maintain sexual function in select patients post-priapism. We demonstrated that the majority of men who underwent PP insertion post-priapism were satisfied with the results, and all would choose to have a PP inserted were they to return to their priapism event again. Conflicts of Interest: Nil [ABSTRACT FROM AUTHOR]