Page 16 - CUA 2020_Sexual Dysfunction and Transplant

Moderated Posters 11: Urinary Incontinence, Voiding Dysfunction, Sexual Dysfunction, Transplant

MP-11.13. Table 1. Patient characteristics MP-11.13. Table 2. Univariate and multivariate analyses
Patient characteristic Number Number Median SHIM of patient factors associated with wanting treatment for
(%) wanting score (IQR) erectile dysfunction
treatment (%) Unadjusted p Adjusted OR p
Age (years) OR (95% CI) (95% CI)*
40–50 47 (17.8) 11 (23.4) 22 (16–24) Age
51–60 75 (28.4) 32 (42.7) 17 (11–24) 40–50 years 0.7 (0.3–1.8) 0.497 1.1 (0.4–2.8) 0.853
61–70 84 (31.8) 38 (45.2) 11.5 (6–20) 51–60 years 1.8(0.9–3.7) 0.115 2 (0.9–4.4) 0.075
>70 58 (22.0) 17 (29.3) 7.5 (5–15) 61–70 years 2 (1.0–4.1) 0.057 2.3 (1.1–4.8) 0.032
Comorbidities >70 years Reference Reference
DM 74 (28.0) 38 (51.4) 10 (6–16) DM 2.3 (1.3–4.0) 0.003 1.9 (1.0–3.4) 0.040
Hypertension 154 (58.3) 68 (44.2) 13 (7–20) Hypertension 2.1 (1.2–3.6) 0.005 1.6 (0.9–2.9) 0.105
COPD 30 (11.4) 15 (50.0) 13.5 (6–17) COPD 1.8 (0.8–3.9) 0.125 1.8 (0.8–4.1) 0.152
CAD 37 (14.0) 17 (46.0) 9 (6–16) CAD 1.5 (0.8–3.1) 0.233 1.4 (0.7–3.1) 0.382
CKD 11 (4.2) 4 (36.4) 10 (7–13) CKD 0.9 (0.3–3.4) 0.950 0.9 (0.2–3.3) 0.865
Reason for visit *Adjusted for age, DM, hypertension, COPD, CAD, and CKD.
BPH 135 (51.1) 60 (44.4) 13 (6–19)
Hematuria 26 (9.9) 7 (26.9) 19.5 (8–25) MP-11.14
Oral testosterone practice patterns and management: A
Renal lesion 2 (0.8) 1 (50.0) 9 (4–14) population-based analysis of a large healthcare database
Incontinence 19 (7.2) 6 (31.6) 7 (5–21) Zack Li , Jason Scovell , Sarah McGriff , Christopher J.D. Wallis , Yonah
2
3
2
1
4
1
Nephrolithiasis 16 (6.1) 5 (31.3) 20 (15–23.5) Krakowsky , Premal Patel , Ranjith Ramasamy 5
Section of Urology, Department of Surgery, University of Manitoba,
1
Orchalgia/pelvic 44 (16.7) 14 (31.8) 16 (10–23) Winnipeg, MB, Canada; Scott Department of Urology, Baylor College of
2
pain Medicine, Houston, TX, United States; Department of Urologic Surgery,
3
4
Vasectomy 3 (1.0) 1 (33.3) 19 (12–24) Vanderbilt University, Nashville, TN, United States; Department of
5
UTI 1 (0.4) 0 – Urology, University of Toronto, Toronto, ON, Canada; Department of
Urology, University of Miami, Miami, FL, United States
Infertility 1 (0.4) 0 – Introduction: Oral testosterone has been available in Canada since 1992.
Penile lesion 4 (1.5) 1 (25.0) 10 (7–18) This contrasts with the U.S., where it was not approved due to its adverse
1,2
Elevated PSA 13 (4.9) 3 (23.1) 21 (18–24) effects on the liver. An oral testosterone with a different mechanism of
action was approved in the U.S. in 2019. We hypothesized that prescrib-
ing and management patterns for oral testosterone differ from other routes.
Older patients were more likely to want ED treatment and had lower SHIM Methods: We performed a population-based study of men aged 66 or
scores. However, above the age of 70 years there is a decline in the num- older that were newly treated with testosterone replacement therapy (oral,
ber of patients wanting treatment (Table 1). On univariate analysis, both injection, gel, and patches) from 2008–2015 in Ontario using the Ontario
diabetes mellitus (DM) and hypertension were significantly associated Drug Benefit database and the Canadian Institute for Health Information,
with the patient’s desire to have ED treatment. On multivariate analysis, as oral testosterone was approved for use during this time period. Age,
DM was associated with wanting ED treatment, but hypertension was not therapy type, practitioner type, and laboratory values, including liver
(Table 2). Eighty-one patients (82.7%) were offered oral phosphodiester- function tests aspartate transaminase (AST) and alanine aminotransferase
ase type 5 inhibitors, nine patients (9.2%) were offered intracavernosal (ALT) were extracted. Comparisons between these values across year were
injection, one patient (1.0%) was offered vacuum erection device, and evaluated. Proportional data was evaluated using a chi-squared test on
seven patients (7.1%) were offered penile prosthesis insertion. PRISM8 (GraphPad Software Inc.).
Conclusions: SHIM questionnaire is a useful tool in the general urology Results: A total of 4187 men over the age of 65 received oral testosterone
clinic, as the urologist is the most capable person of treating ED. It can from 2008–2015, representing 27% of total testosterone prescriptions
serve as an efficient tool to screen for and quantify ED in patients present- during this time period. Practitioners were less likely to check liver func-
ing for other urological issues. The maximum benefit is seen in patients tion tests for oral testosterone when compared to other modalities (75%
between the age of 51–70 years and in diabetic patients. vs. 78%; p<0.001). Oral testosterone prescriptions did not increase from
2008–2015 despite increased prescriptions for other modalities. Oral
prescription used differed by practitioner type — oral (79% general/family
practitioner [GP/FP]; 18% urology; 2% endocrine) vs other routes (75%
GP/FP; 17% urology; 8% endocrine; p<0.01). There was no difference
in prescription pattern by patient age or rural/urban setting (p>0.05).
Conclusions: Oral testosterone utilization rates have remained low
despite increasing testosterone prescription rates using other modalities.
Monitoring of liver function tests is not routinely performed in men receiv-
ing oral testosterone despite its risk of liver dysfunction.

CUAJ • June 2020 • Volume 14, Issue 6(Suppl2) S147