MP48-16 EMPIRICAL VS. RISK-BASED APPROACH TO INTRACAVERNOSAL INJECTION THERAPY: A PROSPECTIVE STUDY

Abstract

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Medical and Non-surgical1 Apr 2014MP48-16 EMPIRICAL VS. RISK-BASED APPROACH TO INTRACAVERNOSAL INJECTION THERAPY: A PROSPECTIVE STUDY Robert Segal, Brian Le, Kristen Burns, Arthur L. Burnett, and Trinity Bivalacqua Robert SegalRobert Segal More articles by this author , Brian LeBrian Le More articles by this author , Kristen BurnsKristen Burns More articles by this author , Arthur L. BurnettArthur L. Burnett More articles by this author , and Trinity BivalacquaTrinity Bivalacqua More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1490AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Intracavernosal injection (ICI) therapy is widely used for ED. Employing it in practice is largely empirical and has not been validated with evidence-based approaches. This study compares two strategies for ICI to determine whether a risk-based approach is more efficacious, increases satisfaction and/or results in fewer treatment complications. Methods After obtaining IRB approval, a prospective database of patients enrolled in the ICI program at the Johns Hopkins Hospital from May 2012-present was amassed. Demographic information, treatment outcomes and subjective patient evaluations of sexual function (IIEF, QEQ, SQoL and EDITS questionnaires) were obtained at baseline, 3 and 6 months. Two approaches were compared. Group 1 consisted of empiric ICI treatment. Patients were treated with Prostaglandin E1 10mcg, irrespective of ED etiology or severity, and only if poor response noted at test injection, then initiated on bimix or trimix. Group 2 was a risk-based approach, where using an algorithm that factored in: organic vs. neurogenic ED, number of ED risk factors, prostatectomy, nerve-sparing status, time from surgery and radiation status, patients were treated with either bimix, low- or high-dose trimix. Dose titration was permitted in both groups. Statistical analysis was carried out using t-test and chi-squared analysis. Results 156 patients were enrolled (55 in Group 1, 101 in Group 2) with 3 and 6 month f/u at 57% and 35% respectively, and similar between groups. Baseline patient characteristics and sexual function questionnaire responses were similar between groups 1 and 2, (mean age 62 vs. 61.3 p=0.73, IIEF-EF 8.25 vs. 7.30 p=0.20, and SQoL 37.8 vs. 39.8 p=0.27), though Group 1 reported higher quality erections at baseline (QEQ 14.59 vs. 7.36 p=0.02) and had a lower proportion of post-prostatectomy patients 56% vs. 72% (p=0.02). In both groups, quality of erections (QEQ) improved with treatment (mean 10.98 vs. 60.24, p<0.05), SQoL improved (38.77 vs. 50.60, p<0.05), and IIEF-EF improved (7.78 vs. 18.85, p<0.05). However, between groups at 3 and 6 months, there were no statistically significant differences in responses for IIEF, QEQ, SQoL or EDITS, and no difference in failure or medication switch rates. There were no significant differences in complication rates, though at 3 months group 2 reported a higher incidence of priapism and pain (23% vs. 7.4% p=0.08). Conclusions Both approaches resulted in significant improvements across multiple domains of sexual function. Complications rates, satisfaction and efficacy overall were similar between both approaches. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e533 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Robert Segal More articles by this author Brian Le More articles by this author Kristen Burns More articles by this author Arthur L. Burnett More articles by this author Trinity Bivalacqua More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...