126 The frequencies and characteristics of men receiving medical intervention for erectile dysfunction: Analysis of 6.2 million patients

Abstract

INTRODUCTION AND OBJECTIVES: After RP, climacturia is a prevalent and potentially distressing problem. To date, no specific predictors of this problem have been identified. In this analysis, we sought to find pelvic MRI parameters that were associated with climacturia. METHODS: We identified all men in our departmental database who (i) had climacturia post-RP (ii)underwent a pre-RP endorectal probe MRI and (iii) had no radiation or androgen deprivation therapy. Soft tissue and bony dimensions were measured by 2 raters blinded to clinical and pathological data. Given the fact that most men experience climacturia on at least 1 occasion following RP, we included only patients who had 3 episodes.MRI parameters measured included: maximum height, width and apical depth of prostate, prostate volume, urethral width, urethral length, lower conjugate of pelvic midplane, bony femoral width, outer and inner levator distances and levator ani thickness. Point-biserial correlations were run to test the univariate associations. Logistic regression was used in a multivariable analysis with all measured MRI parameters being run in the model. RESULTS: 258 consecutive pre-RP MRI studies were reviewed (60 men with and 198 men without climacturia). Mean age 60 7 years, average time post-RP at assessment for climacturia 7 7 months. Of the MRI parameters, urethral width (r 0.13, p 0.03) and lower conjugate (r 0.12, p 0.05) were associated with presence of persistent climacturia. Two other MRI variables met the criteria to be included in the multivariable analysis, depth of prostate and outer levator distance. Of the non-MRI parameters (age, nerve sparing status, BMI, and incontinence), none were significantly related to climacturia presence and only BMI met the criteria to be included in the multivariable analysis. On multivariable analysis, only urethral width was associated with climacturia presence (OR 1.23, 95% CI: 1.011.49, p 0.04), the wider the urethra, the greater the chance of climacturia. CONCLUSIONS: By idenfiying pre-operative risk-factors, such as urethral width on MRI, we may be able to better understand the pathophysiology of this condition and furthermore, this may permit us to better counsel men regarding this outcome.