MP39-16 EXPEDITED ALGORITHM FOR IPP FOLLOWING RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy II (MP39)1 Apr 2020MP39-16 EXPEDITED ALGORITHM FOR IPP FOLLOWING RADICAL PROSTATECTOMY Alfredo Suarez-Sarmiento, Matthew Brennan, Alfredo Suarez-Sarmiento, and Paul Perito Alfredo Suarez-SarmientoAlfredo Suarez-Sarmiento More articles by this author , Matthew BrennanMatthew Brennan More articles by this author , Alfredo Suarez-SarmientoAlfredo Suarez-Sarmiento More articles by this author , and Paul PeritoPaul Perito More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000888.016AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Erectile dysfunction (ED) following radical prostatectomy (RP) is a postoperative result which greatly affects a patient’s quality of life. The recovery of potency following RP varies wildy from 16% to 90%. Several factors contribute to decline in erectile function after RP, classified as vasculogenic, neurogenic, and psychological. Current guidelines recommend patients wait up to 24 months before IPP surgery. No proper algorithm or guideline has been established for the expedited management of ED. We are proposing an expedited algorithm for patients who fail PDE-5 inhibitors at the 3 month follow-up after RP. METHODS: Patients who underwent IPP surgery over a 36 month period with history of RP were identified from our IRB approved database. All patients completed an IIEF-5 questionnaire and had a penile doppler ultrasound (PDUS) performed preoperatively. Scoring for erectile function was performed with the International Index of Erectile Function (IIEF-5), and the Sexual Health Inventory for Men (SHIM). The relationships, according to PDUS diagnosis, IIEF-5 score, and SHIM scores were evaluated as well as surgical outcomes. Logistic regression and Wilcoxon rank sum tests were performed. RESULTS: 605 patients were evaluated, 78 met inclusion criteria. PDUS determined that 60 (76.92%) suffered from veno-occlusive disease, while 12 (15.4%) had arterial insufficiency. 58 (74.4%) had RALP vs 16 (25.6%) who received an open RP. The mean time between RP and IPP was 72 months, with the mean ages of RP and IPP being 59 and 66 years respectively. Increased time between RP and IPP were correlated with lower shim scores. Additionally, each month that passed caused a decrease of 1.5% in SHIM scores (p< 0.05), as well as a greater likely hood of developing vasculogenic ED (p= 0.036). Increased age at IPP was correlated with lower shim scores (p= 0.049), while RALP was found to be a predictor of higher patient satisfaction (p= 0.02). CONCLUSIONS: Our expedited algorithm proposes that patients who fail PDE-5 inhibitors following RP be evaluated by PDUS 3 months post-operatively. Those patients found to have venoocclusive etiology should have early surgical intervention limiting patient suffering and known penile atrophy regardless of rehabilitation protocol. If etiology is arterial insufficiency or unknown, then neuropraxia should be considered and patients can be informed to wait for definitive therapy. Early intervention can be fully endorsed for veno-occlusive patients once a prospective study is designed to determine whether they worsen or improve and addresses nerve-sparing status. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e582-e583 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alfredo Suarez-Sarmiento More articles by this author Matthew Brennan More articles by this author Alfredo Suarez-Sarmiento More articles by this author Paul Perito More articles by this author Expand All Advertisement PDF downloadLoading ...