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Introduction Erectile dysfunction (ED) has been demonstrated to be reasonably prevalent among young men (≤40 yr). Objective We aimed to i) assess changes in patterns of reported ED in men ≤ 40 yr, and ii) compare the sociodemographic and clinical characteristics of ED men ≤ 40 yr vs. > 40 yr of age over a 8-yr period at a single academic centre. Methods Comprehensive data of 1179 patients seeking first medical help for ED and assessed by a single Sexual Medicine expert between 2013 and 2021 were analysed. Health-significant comorbidities were scored using the Charlson comorbidity index. All patients completed the International Index of Erectile Function (IIEF) at baseline. Descriptive statistics tested the sociodemographic and clinical characteristics of ED men ≤ 40 yr vs. > 40 yr of age. Within the two groups, multivariable linear regression models tested the association between advancing age and IIEF scores. Local polynomial regression models were applied to explore and graphically display ≤ 40 yr patients’ likelihood to report ED over the analysed time frame and to display changes of the IIEF-EF scores over increasing age between the two groups (≤ 40 yr vs. > 40 yr). Results Overall, median (IQR) age was 52 (41-62) yr. Median (IQR) IIEF-EF was 18 (15-22) at baseline. Of all, 268 (22.7%) were ≤ 40 yr whereas 911 (77.3%) were > 40 yr at baseline. Rates of severe ED according to IIEF-EF did not differ between men ≤ 40 yr and >40yr (60 (22.4%) vs. 155 (17%)). No significant differences were found for the IIEF domains (-IS, -OS, -SD) but IIEF-OF domains, which scored higher in younger men (9 () vs. 8 (), p=0.002). At baseline, younger patients reported less comorbidities, less active smoking, lower BMI, higher total testosterone (tT) levels than older patients (all p 40 yr, increasing age was linearly correlated with decreasing IIE-EF (all p 40 yr). Conclusions We observed that one out of five men seeking first medical help for ED at a single academic centre were younger than 40 yr. This trend has remained stable over the last 8-years, but slightly lower than the previous decade. Increasing age among younger patients is not associated with worse erectile function as oppositely occurs among patients > 40 yr. Disclosure No

Introduction The Masturbation Erection Index (MEI) has been recently validated in the setting of the investigation of men presenting with erectile dysfunction (ED). Objective We sought to analyze the correlation between MEI and the findings of the widely used International Index for Erectile Function (IIEF) in a cross-sectional study in men seeking medical help for ED. Methods Data from the last 87 consecutive men presenting for ED at a tertiary referral centre were analyzed. All patients were asked to complete both IIEF and MEI at the same time. Complete sociodemographic and clinical data were collected. ED severity was defined according to Cappelleri’s criteria. Linear regression model tested the association between MEI, IIEF total and IIEF domains scores. Violin plot was used to display distribution of MEI scores into IIEF-EF categories. Loess curve was applied to investigate the probability of MEI to predict ED as a function of age. Results Median (interquartile range [IQR]) age at presentation was 44 (3.5-53.5) years. According to IIEF-EF scores, ED severity was: no ED in 9 (10%), mild ED in 14 (16%), mild-to-moderate ED in 19 (22%), moderate ED 12 (14%) and severe ED in 33 (38%) patients, respectively. The more severe the ED, the higher the MEI scores (Figure 1); indeed, median MEI scored 7 (3-8) in men with no ED and 19 (10-26) in men with severe ED (p Conclusions As expected, there is a strong association between IIEF and MEI scores, which does not lower with aging. Of all, one out of 5 patients presented with lower overall and intercourse satisfaction notwithstanding high MEI scores, thus outlining the clinical relevance of both investigations in the real-life setting. Disclosure No

Introduction The ASCVD (Atherosclerotic Cardiovascular Disease) risk score is a validated and standardised algorithm predicting the individual 10-year risk of developing acute cardiovascular events (CVs). Patients with erectile dysfunction (ED) are at greater risk of CVs; Objective we aimed to i) apply the ASCVD score at a homogenous cohort of men undergoing dynamic penile color doppler duplex ultrasound (CDDU) for ED, and ii) explore its predictive ability to identify patients with arteriogenic and venogenic ED at CDDU. Methods Complete data of 188 consecutive patients undergoing CDDU for ED were analysed. Health-significant comorbidities were scored using the Charlson comorbidity index. All patients completed the International Index of Erectile Function (IIEF) at baseline. Serum hormones (total testosterone (tT) and luteinising hormone (LH)) were dosed for every patient. The ASCVD score was applied to the entire cohort. According to the ASCVD, patients were segregated into low (≤7.5%) vs. intermediate/high risk (> 7.5%). Descriptive statistics was used to explore differences between the two groups. Logistic regression models tested the potential predictive role of ASCVD scores to predict pathological CDDU parameters (peak systolic velocity (PSV) < 35 cm/s and/or resistance index (RI) ≤ 0.70). Local polynomial smoothing models graphically displayed the probability of pathological CDDU parameters at different ASCVD scores. Results Overall, median (IQR) age was 54 (43-60) yr. Of all, 52 (27.7%) patients reported severe ED, as for IIEF-EF ≤ 11. Overall, 80 (42.6%) showed a pure arteriogenic ED and 15 (8%) pure venogenic ED at CDDU. Intermediate/high-risk patients (52.7%) were found to have lower IIEF-EF scores, higher BMI, higher CCI and presented with a greater rate of PDE5i non-responders compared to those with low-risk (47.3%) according to ASCVD (all p Conclusions The ASCVD risk score can be used as a valuable tool to identify patients with arteriogenic ED at CDDU in real-life settings. Since vasculogenic ED may anticipate CVs even by some years, the accurate identification of patients with deficient cavernosal arterial flow would certainly allow earlier and more effective cardiovascular prevention in this subset of patients. Disclosure No

Introduction Patients with low urinary tract symptoms (LUTS) frequently complain some sexual dysfunction and sometimes even episodes of bothersome urinary incontinence (UI). Objective We aimed to assess the relationship between UI (as measured with the ICIQ-UI-SF), and sexual disfunction (as measured with the IIEF), in men presenting with LUTS at a tertiary-referral centre. Methods In this cross-sectional study, data were retrospectively retrieved from 938 consecutive patients aged >18 years seeking first medical help for self-reported LUTS (i.e., all patients had IPSS≥1). All patients had a complete clinical assessment and completed the IPSS, the ICIQ-UI-SF, the OAB-q and the IIEF questionnaires. Patients were stratified into “no UI” (ICIQ-UI-SF=0), “mild UI” (ICIQ-UI-SF=1-7), “moderate UI” (ICIQ-UI-SF=8-13) or “severe UI” (ICIQ-UI-SF=14-21). ANOVA test assessed differences in baseline characteristics among these groups. Spearman correlation test was applied to evaluate the correlation between ICIQ-UI-SF and IIEF domain scores. A linear regression analyses tested putative risk factors associated with increased ICIQ-UI-SF scores. Results Of 938, 589 (63%) patients had no UI, 237 (25%) had mild UI, 76 (8%) moderate UI and 36 (4%) severe UI. There were no substantial differences in total PSA levels and uroflowmetry parameters among UI groups, whereas prostate volume, IPSS and OAB-q scores were higher as UI symptoms increased (all p≤ 0.03). A negative correlation was found between IIEF-total, IIEF-Erectile Function, IIEF-Intercourse Satisfaction and IIEF-Overall Satisfaction scores and ICIQ-UI-SF scores (i.e., the worse UI symptoms, the worse the overall sexual function (rho= -0.12; p Conclusions In patients presenting with LUTS, the presence of urinary incontinence was associated with worsening of overall sexual function (i.e., erectile function, intercourse satisfaction and overall satisfaction). Disclosure No

Introduction Patients with erectile dysfunction (ED) may have an increased risk to report concomitant premature ejaculation (PE) Objective We aimed to explore the trend of reporting PE across three different age groups of a homogenous cohort of men seeking first medical help for ED (< 40 yr, 40-60 yr, > 70yr) over a 16-year period at a single tertiary academic centre. Methods Complete data of 1258 men consecutively assessed for ED as primary complaint by a single Sexual Medicine expert between 2005 and 2021 were analysed. Patients were divided into three age categories: i) Results Overall, median (IQR) age was 51 (40-61) years. Of all, 326 (25.9%) reported either life-long or acquired PE at time of first clinical assessment. Among the three age groups (70) there were no significant differences in terms of baseline IIEF domains. Younger patients reported higher rates of PE in respect to older ones (0.5% vs. 0.4% vs. 0.3%, p=0.001). Logistic regression analysis showed a statistically significant trend of reporting PE over the years among the < 40yr (OR: 1.4; 95%CI: 1.3-1.5) and 40-69yr (OR: 1.3; 95%CI: 1.2-1.4) groups respectively (all p Conclusions Almost one out of four patients seeking first medical help for ED also reports to suffer from PE. The probability of reporting PE (either primary or secondary) has been exceptionally increasing over the last 15 years among young ( Disclosure No

Introduction The interrelationship between male sexual desire and erectile dysfunction (ED) has been variously investigated. Objectives We aimed to investigate the prevalence of and the predictors of unrecognized low sexual desire (LSD) in a cohort of men seeking medical help for new onset ED in the real-life setting. Methods Data from 1509 men seeking first medical help for new-onset ED at a single andrology centre between 01/2010 and 01/2020 were analyzed. Patients were assessed with a thorough medical and sexual history. Comorbidities were scored with the Charlson Comorbidity Index (CCI). All participants were asked to self-report the presence of LSD. Moreover, patients completed the International Index of Erectile Function (IIEF) and the Beck Depression Inventory (BDI). Depressive symptoms were defined as BDI ≥11. The median value of the IIEF-Sexual desire domain (IIEF-SD) was used to categorize the cohort in low SD (IIEF-SD Results Overall, 312 (20.7%) patients self-reported LSD and were excluded from further analyses. Of 1197 patients not self-reporting LSD, 369 (30.8%) had IIEF-SD Conclusions One out of three men seeking first medical help for ED showed unrecognized LSD according to the IIEF-SD domain scores. Men with unrecognized LSD were older, had higher rates of severe ED and depressive symptoms and lower tT values despite not suggestive for hypogonadism than men with normal SD. A detailed investigation of sexual desire should be always included in the diagnostic work-up of men with ED, in order to better tailoring patient therapeutic management. Disclosure Work supported by industry: no.

Introduction Patients with low urinary tract symptoms (LUTS) frequently complain some sexual dysfunction and sometimes even episodes of bothersome urinary incontinence (UI). Objective We aimed to assess the relationship between UI (as measured with the ICIQ-UI-SF), and sexual disfunction (as measured with the IIEF), in men presenting with LUTS at a tertiary-referral centre. Methods In this cross-sectional study, data were retrospectively retrieved from 938 consecutive patients aged >18 years seeking first medical help for self-reported LUTS (i.e., all patients had IPSS≥1). All patients had a complete clinical assessment and completed the IPSS, the ICIQ-UI-SF, the OAB-q and the IIEF questionnaires. Patients were stratified into “no UI” (ICIQ-UI-SF=0), “mild UI” (ICIQ-UI-SF=1-7), “moderate UI” (ICIQ-UI-SF=8-13) or “severe UI” (ICIQ-UI-SF=14-21). ANOVA test assessed differences in baseline characteristics among these groups. Spearman correlation test was applied to evaluate the correlation between ICIQ-UI-SF and IIEF domain scores. A linear regression analyses tested putative risk factors associated with increased ICIQ-UI-SF scores. Result Of 938, 589 (63%) patients had no UI, 237 (25%) had mild UI, 76 (8%) moderate UI and 36 (4%) severe UI. There were no substantial differences in total PSA levels and uroflowmetry parameters among UI groups, whereas prostate volume, IPSS and OAB-q scores were higher as UI symptoms increased (all p≤ 0.03). A negative correlation was found between IIEF-total, IIEF-Erectile Function, IIEF-Intercourse Satisfaction and IIEF-Overall Satisfaction scores and ICIQ-UI-SF scores (i.e., the worse UI symptoms, the worse the overall sexual function (rho= -0.12; p Conclusion In patients presenting with LUTS, the presence of urinary incontinence was associated with worsening of overall sexual function (i.e., erectile function, intercourse satisfaction and overall satisfaction). Disclosure Work supported by industry: no.

Introduction Peyronie's disease is a benign condition involving the tunica albuginea of the corpora cavernosa of the penis. Objectives To investigate whether patients’ age has an impact in terms of Peyronie's disease (PD) clinical characteristics at presentation. Methods Data from a group of 110 consecutive patients aged >18 and 45 years) patients at presentation. Linear and logistic regression analyses tested the association between age and PDQ subscales (Pain, Bother and Symptoms) or IIEF-erectile function domain scores (IIEF-EF ≤26), after adjusting for Charlson Comorbidity Index (CCI), Body Mass Index (BMI), duration of PD (as self-reported by the patient) and smoking habit. LOWESS curve was used to graphically investigate the association between age and PDQ pain score. Results Of 110, 28 (25%) patients were ≤45 years old. Young patients had lower BMI [median (IQR) 24.3 (22.5-25.6) vs. 25.2 (23.7-27.8); p=0.01] and CCI [CCI≥1 in 1 patient (3.6%) vs. 23 (28%); p=0.014) compared to older patients. No differences were found between groups in terms of severity of the penile curvature, PD duration and plaque size. PDQ pain score was 6 (2.8-12.8) for young and 3 (0-8) for older patients (p=0.03). No differences were found in terms of PDQ-symptoms and bother scores, and for IIEF domain scores. At regression analysis, younger age was associated with significant higher PDQ-pain scores at presentation (Coeff 4.45; 95%CI 1.06:7.84; p=0.011). No further associations were observed between age and the other questionnaires. The figure depicts the higher PDQ-pain scores in young compared to older age. Conclusion Younger PD patients are at higher risk of complaining penile pain at presentation. No difference in terms of symptoms, PD-associated bother, erectile function and other clinical and morphometric characteristics were found between younger and older patients at first assessment. Disclosure Work supported by industry: no.

Introduction Erectile dysfunction (ED) is defined according to three different aetiological groups: organic, psychogenic and mixed. As most cases have mixed aetiology, EAU guidelines suggests using the terms "primary organic" or "primary psychogenic". Objectives We aimed to stratify a homogenous cohort of patients seeking medical help for ED for the first time according to the newly suggested classification, and to compare sexual function in the two groups. Methods Complete sociodemographic and clinical data from 2009 consecutive patients were analysed. All patients completed the International Index of Erectile Function (IIEF) at baseline. According to the presence of risk factors for ED (e.g., age≥ 40 yr, obesity, history of hypogonadism, hypertriglyceridemia and/or hypercholesterolemia, hypertension, cardio-vascular, peripheral vascular, neurological, chronic kidney and hepatic disease, diabetes type 1/2, COPD, hyperthyroidism, low D vitamin, use of recreational drugs, thiazides, b-blockers, antipsychotics, SSRIs and depression or anxiety under medical therapy), patients were categorised into primary organic (≥1 risk factor) or primary psychogenic (0 risk factors) ED. Linear regression analysis assessed the association between the number of risk factors and IIEF severity. Lastly, locally scatterplot smoothing (LOESS) method graphically explored the relationship between number of risk factors and IIEF. Results 1836 (91.4%) were identified with primary organic ED whereas 173 (8.6%) with primary psychogenic ED. Median (IQR) age was 52 (42-61) vs. 30 (25-36) yr, respectively (p 30 (15%) and total testosterone Conclusions One out of ten patients suffer from primary psychogenic ED in the real-life settings. The increasing number of risk factors was linearly associated with lower IIEF scores at presentation.

Introduction High serum estrogens levels have been associated with higher rates of heart attacks, strokes, and prostate cancer. Moreover, hyperestrogenism is believed to be harmful to male sexuality. Objectives We aimed to investigate the prevalence of and the impact of hyperestrogenism on sexual functioning in a cohort of men seeking medical attention for new onset erectile dysfunction (ED) in the real-life setting. Methods Data from 481 men seeking first medical help for new-onset ED at a single andrology centre were analyzed. Patients were assessed with a thorough medical and sexual history. Comorbidities were scored with the Charlson Comorbidity Index (CCI). All patients completed the International Index of Erectile Function (IIEF) and the IIEF-Erectile function (IIEF-EF) domain was categorized according to Cappelleri's criteria. Circulating hormones were measured in every patient. Hyperestrogenism was defined as estrogen (E2) levels >42.6 pg/mL (Tan RS et al. 2015). Descriptive statistics and logistic/linear regression models tested the association between hyperestrogenism and IIEF scores. Results Overall, 88 (18.3%) patients had serum estrogen levels suggestive for hyperestrogenism. Men with hyperestrogenism were older [median (IQR) 46 (34-58) vs. 44 (32-55) years; p Conclusions One out of five men seeking first medical help for ED showed elevated serum E2 values in the real-life setting. Hyperestrogenism was associated with health significant comorbidities, orgasmic function impairment and higher severity of ED. Disclosure Work supported by industry: no.

Introduction There is a current lack of effective conservative treatments for Peyronie Disease (PD). Surgery represents an effective treatment, despite being associated with bothering complications, including erectile dysfunction (ED). Objective We investigated patients wish of being operated for PD at a single center. Methods Data were prospectively collected for patients managed for penile curvature because of PD in 2016-2020. Baseline data included age, time from PD onset, penile pain, curvature degree, difficulty at penetration, concomitant hour-glass deformity and ED. All patients were offered conservative treatments, including oral therapy or topical injections regardless of curvature degree. Tunical shortening or lengthening procedures were offered as an alternative to conservative treatments. Penile prosthesis implantation was offered to those with concomitant ED. Patients compliance with surgery was recorded. Logistic regression analyses tested the profile of patients who were more likely to comply with surgery. Results Data were available for 218 patients. Median(IQR) age was 57(49,63) yrs and length of PD after onset was 14(3,28) months. Median curvature was 30°(20,45); of 218, 8(3.7%) patients had concomitant hour-glass deformity. Pain was complained by 30(14%) patients, while difficulty at penetration and ED were reported by 62(28%) and 87(40%) patients. Of all, 78(32%) patients had been treated with tadalafil OaD; 41(19%) patients received iontophoresis with verapamil; 35(16%) SWT; and, 31(14%) CCH injections. A significant improvement (defined as a curvature reduction≥20°) was reported in 52(24%) cases. Overall, only 59 (27%) patients were willing to eventually undergo surgery for PD. Younger patients (OR:0.95, 95%CI: 0.92,0.98;p=0.003) and patients with more severe curvatures (OR:1.03; 95%CI: 1.01,1.04;p=45° of curvature (Fig1). Conclusions Compliance to surgery is low among patients with PD, thus further stressing the urgent need for effective conservative treatments. Surgery should be comprehensively discussed with younger patients with a severe curvature. Disclosure Work supported by industry: no.

Introduction The routine use of dynamic duplex ultrasound of the penis (DDUP) to detect vasculogenic erectile dysfunction (V-ED) has been questioned because of a related patient’ discomfort and costs issues. Objective to investigate clinical factors which could guide the physician in selecting candidates for DDUP in routine practice. Methods Data were collected for 119 patients with ED who underwent DDUP regardless of their clinical history, to rule out V-ED at a single centre. Baseline data included: age, comorbidities (as scored with the Charlson Comorbidity Index (CCI)), BMI, recreational habits and the International Index of Erectile Function–6 (IIEF-6). DDUP was performed after intracavernous injection of alprostadil 20 ug and self sexual stimulation. V-ED was defined as a peak systolic velocity (PSV)3 cm/s and a resistance index (RI) Results Median (IQR) age was 54(43-60) years and IIEF-6 was 15(8-21). Of 119, 44 (37%) patients had comorbidities (CCI≥1), with cardiovascular disease (CVDs) and diabetes in 13(11%) and 16(14%) patients. Of all, 18(15%) patients were current smokers and 58(49%) had no regular physical activity. At DDUP, median right and left PSV were 36.7(25.7-43.9) and 36.1(25.3-44.9) cm/s. V-ED was detected in 50(42%) patients. Age (OR:1.05;95%CI 1.01–1.08; p=0.004) and smoking history (OR:3.33; 95%CI 1.13–9.8; p=0.02) were associated with a higher risk of V-ED, while physical activity was a protective factor (OR:0.43; 95%CI:0.20-091; p=0.03). Conversely, BMI, IIEF-6, CVDs, diabetes and CCI were not associated with V-ED. The model including age, smoking and physical activity had a fine accuracy to predict V-ED (AUC:0.70;95%CI:0.60- 0.79). At DCA (fig 1), the use of those clinical factors to select candidates for DDUP would result in the best clinical strategy if a threshold risk of V-ED≥35% is considered as a reasonable value to trigger the investigation. Conclusions Clinical factors including age and lifestyle habits could be used in the everyday clinical practice to better select patients for DDUP, if the use of this test is considered clinically reasonable for patients with ≥35% risk of V-ED. Disclosure Work supported by industry: no.

Introduction The Sexual and Reproductive Health guidelines of the European Association of Urology (EAU) suggest stratifying patients complaining of haemospermia into low versus high-risk categories for treatable aetiologies. Objective To validate EAU guidelines in a homogeneous cohort of men with haemospermia and to identify a novel and better performing risk stratification compared to EAU guidelines. Methods Data from 283 consecutive patients complaining of a single episode/recurrent haemospermia were retrospectively analysed. Patients were stratified into low vs. high-risk according to EAU guidelines, whose diagnostic performance was then validated. We identified a new risk stratification model based on clinical factors associated with i) positive semen culture and ii) prostate cancer (PCa) and bladder cancer (BC). Diagnostic accuracy of the two predictive models (EAU vs. New) was assessed and decision curve analyses (DCA) tested their clinical benefit. Results Overall, 259 (91.5%) were high-risk and 24 (8.5%) low risk according to the EAU guidelines. Recurrent haemospermia was reported by 134 (47.4%) patients. 126 (44.5%) had baseline CCI score ≥ 1. At MVA logistic regression analysis, history of recurrent genito – urinary tract infections was identified as a predictor for positive semen culture (OR: 3.39, 95% CI: 1.77 – 6.57, p=0.002). Likewise, baseline CCI ≥ 1 was identified as a predictor for PCa and BC (OR: 1.55, 95% CI: 1.17 – 2.04, p=0.009). Sensitivity, specificity, and AUC of the EAU guidelines were 13.3%, 89.2% and 51% respectively, whereas the new model performed substantially better: 98.9%, 58% and 78% respectively. Conclusion The application of the EAU risk stratification does not ensure proper identification of high-risk patients complaining of haemospermia. We propose a novel, better performing and easily implementable risk stratification. Disclosure Work supported by industry: no.