(843) Sexual Dysfunctions After Surgery for Abdominal Aortic Aneurysms and Their Impact on Patients’ Sexual Life and Satisfaction

Introduction Erectile Dysfunctions (ED) and Ejaculatory Dysfunction (EjD) are often neglected sequelae of open surgery for abdominal aortic aneurysm (AAA). The most frequent EjD, retrograde ejaculation, is mostly due to to lesions of periaortic sympathetic fibers, whereas ED has probably multifactorial etiology. There is a lack of studies that explore these sequelae and quantify their impact with validated instruments. Objective The study aims to evaluate the prevalence of sexual dysfunctions after surgery for AAA, using questionnaires validated for ED, EjD, desire, frequency of intercourse, sexual satisfaction, subjective dyscomfort, and verify whether the dysfunctions correlate with preoperative or surgical risk factors. Methods 58 patients (<80 years) who underwent open surgery for AAA between 2021 and 2024 consented to participate to the observational study and filled preoperatively the IIEF (International Index of Erectile Function) and MSHQ (Male Sexual Health Questionnaire; in 2024-2025 were contacted again for the administration of the same questionnaires. Medical history, surgical and postoperative clinical data were recorded; angioTC scans were reviewed by a vascular surgeon to establish patency of the hypogastric axes. Scores were compared and correlated with clinical and surgical parameters: age, type and duration of surgery, obstruction of hypogastric arteries, risk factors for ED, benign prostatic hyperplasia (BPH). Statistical analysis: Shapiro Wilk test, Wilcoxon test, Kruskal-Wallis test, linear regression. Software: STATA 13. Results 42 patients (mean age 71) were available at follow up and consented to fill the questionnaires. 24 patents underwent aorto-aortic repair, 18 aorto-iliac. The distribution of vascular risk factors for ED was: hypertension (59.5%), dyslipidemia (59.5%), smoking (52.4%) and ateromasia of the hypogastric arteries (21.4%). 13 patients (30%) showed DE at the preoperative IIEF, 30 (71%) at the postoperative IIEF (p<0.05); the mean scores at IIEF and MSHQ-DE showed a reduction of 3.3 and 8.3 points respectively (p<0.05). Ejaculatory function domain of MSHQ scores decreased from 33 to 18 (p<0.05); 61.9% of patients developed de-novo EjD. No preoperative or intervention-related variable resulted significantly associated with worsening scores of erectile and ejaculatory functions, included obstruction of one hypogastric axis. The only variable associated with worsening ejaculation was the presence of BPH (p=0.023), probably due to alpha blockers therapy. Perceived dyscomfort was found to be relevant, with 69% of patients reporting bother and 31% releavant bother from the dysfunction. The MSHQ scores for desire, frequency of sexual activity and satisfaction from intercourse dropped significantly ( p<0.05) of -2.3, -0.9, 2.4 points respectively. The regression analysis showed a significant correlation between satisfaction and erectile function (β=1.63; R2=0.537; p<0.001), and satisfaction and ejaculatory function (β=0.76; R2=0.447; p<0.001). Conclusions The study confirms with the aid of validated inventories the negative effect of open surgery for AAA on ED and EjD, and highlights the related dyscomfort which determines an overall worsening in satisfaction from sexual activity. However, the exact pathogenesis of ED, probably favored by vascular risk factors, still remains controversial and requires further studies. The high impact of sexual dysfunctions brings out the need for the greatest possible preservation of perivascular autonomic nervous structures and for close pre - and postoperative andrological Disclosure No