(049) FIRST TIME ROBOTIC ASSISTED LAPAROSCOPIC BILATERAL VESICULECTOMY FOR POST ORGASMIC ILLNESS SYNDROME: A CASE REPORT

Abstract Introduction Post Orgasmic Illness Syndrome (POIS) is a rare disorder characterized by feeling ill after ejaculation. Many people experience flu-like or allergy symptoms that last 2-7 days, on average. POIS was first described in the literature in 2002 by Dr. Waldinger, who described the 5 diagnostic criteria and 7 clusters of symptoms. Currently, it is most widely believed that this syndrome is an autoimmune or allergic reaction to semen or seminal fluid. However, with recent case-reports, various proposed mechanisms have sprouted in the literature including that it is an opioid receptor disorder, cytokine and neuroendocrine response disorder, hormonal imbalance or sympathetic dysregulation. Various treatment options have been suggested in the literature including antihistamines, anti-depressants, prednisone, NSAIDs, hormone replacement, and alpha agonists. Overall, the literature that exists is composed of case reports without a clear-cut understanding of pathophysiology or the best treatment modality for POIS. Objective To describe a difficult to manage POIS case in a patient that opted to pursue bilateral vesiculectomy for treatment without success after failing conservative measures. Methods A 44-year-old man presented to our institution with intermittent symptoms of POIS since the age of 20. His symptoms were as follows: about 5-6 hours after orgasm, he had tachycardia, chest wall pain, cough, myalgia, runny nose, and muscle aches that could last about 7 days. He denied any history of genital trauma or surgery, erythrocytosis, VTE, MI, erectile dysfunction, or stroke. He did have a history of hypogonadism. He is a former smoker with 10 pack years and was not currently consuming alcohol. He did not have any pertinent family history. His physical exam was overall normal and unremarkable. Prior to visiting our institution, he had tried buspirone and clonazepam without success. Initially, he started on Claritin daily and precoital Diphenhydramine which was partially helpful. He was also prescribed hydroxyzine, Tamsulosin and prednisone in later visits, in addition to his current regimen, but his symptoms persisted. His POIS symptoms were causing him extreme depression and anxiety and the patient wanted to escalate his treatment efforts. The patient was counseled extensively on a bilateral vesiculectomy, including that he may not see benefits from the procedure and that this would be the first time this procedure would be carried out as treatment for POIS. Results The patient decided to undergo a robotic assisted laparoscopic bilateral vesiculectomy. His seminal vesicles were sent to pathology and overall were unremarkable bilaterally. At his 1-month follow-up, the patient continued to have POIS symptoms with sneezing, chest pain and heart palpitations. He was diagnosed with epididymoorchitis and was prescribed Bactrim. A follow up at 8 months was scheduled. Conclusions This study suggests that pathophysiology for POIS is not necessarily an allergic reaction to seminal fluid for all patients. POIS continues to be poorly understood with some patients exhausting their options. Given the impact POIS can have on quality of life, it is important for physicians to gain a better understanding of this syndrome to spare patients unnecessary distress and invasive procedures. Disclosure No.