PD28-05 DIRECT-TO-CONSUMER PDE-5 INHIBITOR TELEMEDICINE MARKETING PLATFORMS OVERLOOK CRUCIAL PATHOLOGY: QUANTIFYING THE VALUE ADDED OF THE UROLOGY OFFICE CONSULTATION

Abstract

INTRODUCTION AND OBJECTIVE: Erectile dysfunction (ED) is increasingly recognized among young men. Direct-to-consumer (DTC) telemedicine platforms have emerged to market prescriptions for oral PDE-5 inhibitors to young men without formal evaluation. We hypothesized that internet platforms miss crucial pathology or conditions that warrant further assessment. We aimed to evaluate the benefits of a urology office visit in young men, the target demographic for DTC platforms., METHODS: With IRB approval, we retrospectively reviewed medical records of men age =40 evaluated for ED at an academic andrology clinic during 1/2016-3/2019. Exam findings, lab results, and prescribed treatments were extracted. Descriptive statistics were calculated., RESULTS: We identified 388 patients. Mean age was 29.5 years (SD 5.0). BMI was measured for 366 men; 56 (15%) had BMI30. Metabolic lab results including hemoglobin A1c, total cholesterol, LDL, and triglycerides are in Table 1. Hormone lab results including total testosterone (T), estradiol (E2), LH, FSH, and prolactin were measured. Men with low T or elevated FSH are in Table 1. E2 among 364 men was 23.79 pg/dL (SD 12.89). LH among 342 men was 5.41 miU/mL (SD 3.23). Semen analysis was completed by 64 men; 26 (40%) were abnormal based on WHO 5thedition criteria. Varicoceles were identified in 35% of cohort; stratification by grade is in Table 1. 371 men were treated medically; 328 (88%) received tadalafil daily; 52 (14%) received sildenafil PRN; 122 (33%) received clomiphene; 45 (12%) received anastrozole or letrozole; and 36 (9.7%) received testosterone replacement therapy., CONCLUSIONS: Office consultation identified young men with obesity, dyslipidemia, diabetes, hypogonadism. These data support ED as a sentinel risk factor for cardiovascular comorbidities, neglected by DTC online platforms. A considerable proportion of young men had risk factors for subfertility, such as varicocele or elevated FSH, also not captured by DTC platforms. Despite these findings, telemedicine platforms increase access to care. Urologists should increase their involvement and oversight of these platforms., (C) 2020 by the American Urological Association, Inc.