Patient\'s preference of phosphodiesterase 5 inhibitor: side effects vs. efficacy?

CONCLUSIONS: In sexually active postmenopausal women, TER improved patients’ perceptions of the extent of their bladder problems and improved other measures of OAB symptom bother, HRQL, and sexual quality of life. Supported by: This research was funded by Pfizer Inc.

Changes over time were assessed for those subjects who completed all three interviews. Normality of the data was evaluated by the one-sample Kolmogorov-Smirnov test. Student’s t-tests were used for all inter-group comparisons. Demographic data for the groups were compared by chi-square, Fisher’s exact tests, and Student’s t-tests.

P-429 PATIENT’S PREFERENCE OF PHOSPHODIESTERASE 5 INHIBITOR: SIDE EFFECTS VS. EFFICACY? R. Raina, G. Pahlajani, A. Agarwal, C. D. Zippe. Urology, Mary Mount Urology (Cleveland Clinic Foundation), Cleveland, OH; Med-Peds, Metro Health Medical Center, Cleveland, OH; Urology, Cleveland Clinic Foundation, Cleveland, OH; Urology, Mary Mount Urology (Cleveland Clinic Foundation), Cleveland, OH. OBJECTIVE: To compare the frequency, duration and severity of side effects of the PDE5 inhibitors, and assess the importance of these side effects in the decision which PDE5 to use. DESIGN: Prospective study. MATERIALS AND METHODS: In this prospective study, 23 men with erectile dysfunction (ED) after nerve sparing radical prostatectomy who had responded to 100 mg of sildenafil were given 20 mg tadalafil (n ¼ 20) for 5 weeks and then 20 mg vardenafil (n ¼ 13) for 5 weeks. After 5 weeks of each PDE5 inhibitor, patients had one week without a PDE5 inhibitor. Each patient after a minimum of 4 attempts completed the Sexual Health Inventory for Men (SHIM) questionnaire. At completion of the study, patients where asked if they had a PDE5 inhibitor of choice and whether efficacy, side effect, or neither determined which PDE5 inhibitor they choose. RESULTS: Of 23 sildenafil responding patients, 20 completed a 5 week course of tadalafil, and 13 completed a five-week course of vardenafil. With sildenafil 14/23 (60.9%) experienced side effects: 4/23 (17.4%) headaches, 6/23 (26%) rhinitis, 2/23 (8.6%) flushing and 2/23 (8.6%) blue or blurred vision. The mean duration of side effects was 2.11 hours; the mean severity was moderate. With tadalafil 11/23 (47.8%) experienced side effects:3/23 (13%) backpain/myalgia, 3/23 (13%) rhinitis, 3/23 (13%) palpitation, 1/23 (4.3%) dyspepsia. The mean duration of side effects was 16 hours; the mean severity was moderate. The three patients that experienced palpitations discontinued tadalafil before completing trial; the three patients with backpain/myalgia discontinued after completion of the trial. With vardenafil 3/13 (23%) experienced side effects: 2/13 (15.4%) Rhinitis, 1/13 (7.7%) headaches. The mean duration of side effects was 1.3 hours; the mean severity was mild. When asked, 14/23 (61%) had a clear choice of PDE5 inhibitor they preferred. Eight of the 14 patients (57%) made their preference on side effects, (5 had comparable efficacy, and 3 had lesser efficacy but fewer side effects). Six of 14 (42.8%) made their preference on efficiency, with sildenafil being the preferred PDE-5 inhibitor. CONCLUSIONS: The side effect profile plays a significant role in the choice of a PDE5 inhibitor. When efficacy is equal, side effects determine the choice of the PDE5 inhibitor. The presence of severe side effects supercedes efficacy in the decision making. When side effects are negligible, the sidenafil has been the preferred PDE5. Supported by: None.

MENTAL HEALTH P-430 DIFFERENCES IN DEPRESSION AND ANXIETY SCORES DURING PREGNANCY BETWEEN WOMEN WITH SINGLETON VS. TWIN GESTATIONS FOLLOWING IN VITRO FERTILIZATION. F. Jahangiri, S. E. Gerber, S. C. Klock. Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL. OBJECTIVE: To prospectively compare depression and anxiety scores during pregnancy in women with singleton and twin gestations conceived via in vitro fertilization (IVF.) DESIGN: A cohort of subjects was recruited from a large university-based Reproductive Endocrinology and Infertility clinic at confirmation of pregnancy following IVF. Subjects were interviewed at baseline, and again by telephone at 10–12 weeks and 20–22 weeks of gestation. MATERIALS AND METHODS: Depressive symptomatology was evaluated using the Center for Epidemiologic Studies Depression Scale (CES-D) and anxiety symptoms with the Spielberger State and Trait Anxiety Inventory (STAI). Mean anxiety and depression scores of subjects with singleton pregnancies were compared to those of subjects with twins at each time point.

FERTILITY & STERILITYÒ

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RESULTS: Sixty-one subjects were recruited between five and eight weeks of gestation, including 48 singleton pregnancies and 13 sets of twins. Univariate analyses demonstrated no difference between the two groups in demographic data, except for a younger mean age among subjects with twin gestations (P¼0.017). There was no difference between the groups in depression scores at any of the three time points. STAI state scores were not different at baseline. However, at 10–12 weeks, there was a trend towards higher anxiety scores among subjects with twins, and this difference was significant at 20–22 weeks (P¼0.035). Within the twin group, anxiety scores did not differ throughout the study period, but scores for singletons decreased significantly from 10–12 weeks to 20–22 weeks (P¼0.027). CONCLUSIONS: In IVF pregnancies, anxiety scores, but not depression scores, are higher in women with twin gestations compared to those with singletons in the second trimester. Women undergoing infertility treatment should be counseled accordingly when discussing the risks associated with multiple gestations. Supported by: None.

P-431 TOPIC AVOIDANCE AND FAMILY FUNCTIONING IN FAMILIES WITH YOUNG ADULT CHILDREN CONCEIVED WITH DONOR INSEMINATION. M. S. Paul, R. Berger. School of Social Work, Adelphi University, Garden City, NY. OBJECTIVE: Despite worldwide growth in donor insemination, and theoretical and clinical literature on the negative impact of secrecy on family relationships, there have been few empirical studies exploring the relationship between levels of disclosure and family functioning in families conceived with donor insemination. This study examined the hypothesis that an inverse relationship exists between topic avoidance in general and topic avoidance relative to donor insemination in particular, and family functioning in families with young adult children who were conceived with donor insemination. DESIGN: A cross sectional non-experimental quantitative design was used. MATERIALS AND METHODS: A convenience self-selected sample of 69 predominantly female, educated, Caucasian donor conceived individuals, ages 21–34 completed a self-administered topic avoidance scale, the Beavers SFI and a background survey. SPSS was used for conducting of descriptive and inferential statistics including correlation and regression analysis. RESULTS: Participants reported that in their family of origin, secrecy was maintained by the strategy of topic avoidance to some degree regarding general issues, to a higher degree in relation to donor conception, and by fathers more than by mothers. A moderate inverse relationship existed between general and donor-assistance related topic avoidance and family functioning. Predictors of family functioning were mothers’ general topic avoidance, parents disclosing together and parents not divorced. No significant association was found between age at disclosure and family functioning. CONCLUSIONS: The results support disclosure, preferably by both parents jointly and suggest that disclosure is an ongoing process rather than

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