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Novel treatments options for refractory erectile dysfunction, including penile shockwave therapy, have recently been introduced. Despite uncertain clinical efficacy, direct-to-consumer marketing has resulted in increased patient interest in these treatments, often associated with high out-of-pocket costs. In the current study, we sought to assess outcomes in men with refractory erectile dysfunction undergoing penile shockwave therapy, as well as patient's perception of treatment outcomes. Community-dwelling men receiving care at a local county hospital were prospectively recruited to undergo penile shockwave therapy for treatment of refractory erectile dysfunction. Men underwent a total of six treatment sessions free of charge. Response to therapy was tracked utilizing the Sexual Health Inventory for Men (SHIM), with successful response defined as an increase in average SHIM score following treatment, as compared to baseline scores. Upon completion of treatment, defined as 4 out of 6 sessions or more, men were asked about their subjective perception of treatment benefit, including whether they would repeat treatment and recommend treatment to others. Logistic regression and Pearson's chi-squared test were used to determine whether objective treatment effect predicted men's attitudes towards penile shockwave therapy. A total of 23 men were prospectively recruited to our study. Of these, 19 patients (83%) completed 4 out 6 shockwave treatments. Based on increase in SHIM score, 13 men (68%) were deemed responders to therapy, while 6 men (32%) were deemed non-responders. Amongst all-comers, the median change in SHIM score before and after treatment was 0.7 points (interquartile range: 3 points). Amongst responders, the median increase was 1.3 points, while non-responders experienced a median decrease in SHIM score of 2 points after completion of treatment. No statistically significant differences were noted between responders and non-responders with regard to important patient characteristics such as age, BMI, and smoking status, as well as comorbidities including diabetes, peripheral arterial disease, and history of myocardial infarction. Amongst patients completing treatment, 50% noted subjective improvements, while 93% stated they would repeat treatment and recommend treatment to others. On univariate logistic regression, objective response to therapy, based on increase in SHIM score, failed to predict patient's subjective sense of improvement (OR=5, 95% CI 0.3-72.8, p=0.24) and the frequency subjective improvement was not statistically different amongst responders and non-responders (Pearson's chi-squared; p=0.22). Objective, clinically significant improvement in SHIM scores was not seen amongst men undergoing penile shockwave therapy for erectile dysfunction. Despite this, men experienced subjective improvement and a high rate of desire to continue treatment and recommend treatment to others, which could not be predicted by objective response to treatment. Increased patient education is required in order to set treatment expectations for costly novel therapies. No [ABSTRACT FROM AUTHOR]

Men commonly turn to the internet for information prior to seeing a physician about erectile dysfunction (ED)[1]. Reddit is a popular and influential social media platform consisting of over 52 million users engaged in discussions regarding a vast array of topics[2]. Reddit can serve as a source of information for urologic conditions[3], but social media has been shown to contain unreliable information when it comes to erectile dysfunction[4]. References: 1. Ferguson, Tom, and Gilles Frydman. "The first generation of e-patients." (2004): 1148-1149. 2. Reddit by the Numbers." Reddit, www.redditinc.com/press. 3. Du, Chris, et al. "I leaked, then I Reddit: experiences and insight shared on urinary incontinence by Reddit users." International urogynecology journal 31.2 (2020): 243-248. 4. Fode, Mikkel, et al. "Quality of information in YouTube videos on erectile dysfunction." Sexual Medicine 8.3 (2020): 408-413. We sought to identify and characterize the types of ED therapies being discussed by users of the highly influential Reddit website. Two sub-reddit pages, "Ask Men" and "erectile dysfunction", were chosen for analysis. Posts within the erectile dysfunction sub-reddit were sorted by most popular over all time, and the top 50 threads discussing ED management with at least 2 comments were chosen for analysis. Within the Ask Men sub-reddit, the posts were filtered to include the words "erectile dysfunction". Of these threads, 35 were found to contain discussions relevant to ED treatment, and were thus selected for analysis. Each thread was evaluated for any recommendations for an ED therapy made by the users within the comments, and each therapy was evaluated for congruence with the American Urologic Associated (AUA) guidelines statements for the treatment of ED. The "erectile dysfunction" and "Ask Men" sub-reddit forums consist of 8,100 and 2.7 million members, respectively. A total of 57 different ED therapies were recommended within the 85 posts that were analyzed. Recommendations for changing sexual habits were the most common (29.8%), followed by seeking assistance from a medical professional or use of medications (21.2%), lifestyle changes (17.0%), and exercise practices (13.4%) (Figure 1). Less commonly recommended therapies included the use of supplements (10.7%), herbal remedies (3.9%), and dietary changes (3.9%). Specific therapies that were recommended most often included counseling from a physician, lowering anxiety or stress reduction, reducing porn, reducing masturbation, and discussing ED openly with a partner. Of the 57 specific treatments that were discussed, only 14 (24.6%) were in line with current AUA guidelines for the treatment of ED (Table 1). ED treatments are commonly discussed on Reddit, with a wide range of therapies being self-reportedly successful among users. Most of the treatments discussed are not supported by strong clinical evidence. An understanding of commonly discussed treatments is valuable for the physician, as this may represent an opportunity to educate the population and guide patient counseling. No [ABSTRACT FROM AUTHOR]