UP-3.120: Changes in Various Hormone Levels Before and After Androgen Replacement Therapy for Late-Onset Hypogonadism (LOH) Syndrome (original) (raw)
Introduction and Objectives: ED affects quality of life in elderly men. We evaluated PDE5 inhibitors, intracavernous injections and penile prosthesis in men over 65 years. Materials and Methods: There were 505 patients who consulted a single urologist for ED between 2004 and 2008 at our institution, of whom 96 (19%) were older than 65. ED severity, aetiology and treatments efficiency were retrospectively reviewed. The treatment was considered successful when erection allowed penetration. The first line therapy was PDE5 inhibitors, except after radical prostatectomy. Intracavernous injections (ICI) were used in case of failure. Penile prosthesis was proposed if necessary. Mean follow up was 23.2 months. Results: Mean age was 69.1 Ϯ 3.8 years. ED was complete in 60.3%. Aetiology was organic in 89.6% (42.7% after pelvic surgery) and multifactorial in 59.4%. Furthermore, half of ED (51.7%) were partially drug-induced. PDE5 inhibitors were contraindicated in 5.2% of patients. PDE5 inhibitors mean success rate was 27.4% but 29.4% of satisfied patients stopped oral therapy because of its cost. After exclusion of pelvic surgery postoperative ED patients, PDE5 inhibitors mean success rate was 36.4%. Mean ICI success rate was 64% and 70.7% after pelvic surgery. However 37.5% of ICI responders interrupted the treatment because of difficulty to use, pain or priapism. Penile prosthesis was implanted in 16 patients (17.2%) with a satisfaction rate of 87.5%. Only 46.5% of patients were satisfied with first line therapy. No successful ED treatment was found in 39.2% of patients (50% after pelvic surgery and 32.7% in other aetiologies). Conclusions: After 65, PDE5 inhibitors were found to be less successful than described in younger patient. History of cardiovascular disease, pelvic surgery and treatments adverse effects hamper ED treatment success rate. According to these results, the current treatment algorithm for ED might be adjusted in the elderly.
Loading Preview
Sorry, preview is currently unavailable. You can download the paper by clicking the button above.