Decline In Erectile Function Research Articles

Stem cell therapy in diabetic men with erectile dysfunction: a 24-month follow-up of safety and efficacy of two intracavernous autologous bone marrow derived mesenchymal stem cells injections, an open label phase 2 clinical trial

BackgroundRecently we reported results of phase 1 pilot clinical trial of 2 consecutive intracavernous (IC) injection of autologous bone marrow-derived mesenchymal stem cells (BM-MSCs) for the first time in the treatment of diabetic patients with erectile dysfunction (DM-ED). In phase 2 of this study our aim is to evaluate long term safety and efficacy of IC injections of BM-MSC on additional eight patients with DM-ED.ResultsEach patient received 2 consecutive IC injections of BM-MSC and evaluated at 1, 3, 6, 12, and 24-month time points. Primary outcome was the tolerability and safety of stem cells therapy (SCT), while the secondary outcome was improvement of erectile function (EF) as assessed using the International Index of Erectile Function-5 (IIEF-5), Erection Hardness Score (EHS) questionnaires, and Color Duplex Doppler Ultrasound (CDDU). IC injections of BM-MSCs was safe and well-tolerated. Minor local and short-term adverse events related to the bone marrow aspiration and IC injections were observed and treated conservatively. There were significant improvement in mean IIEF-5, EHS, all over the follow-up time points in comparison to the baseline. At 24-month follow up there were significant decline in the mean IIEF-5, and EHS compared to the baseline. The mean basal and 20-min peak systolic velocity was significantly higher at 3-month after the IC injections compared to baseline.ConclusionsThis phase 2 clinical trial confirmed that IC injections of BM-MSC are safe and improve EF. The decline in EF over time suggests a need for assessing repeated injections.Clinical trial registrationNCT02945462

The impact of low-dose methotrexate on erectile dysfunction, sex hormone profile and spermiogram in male patients with psoriasis: a prospective study

Purpose Psoriasis, affecting approximately 2% of the world’s population, often necessitates systemic treatments, with methotrexate (MTX) as a cornerstone therapy. Despite documented systemic side effects of MTX, concerns about its impact on male reproductive health persist. We aim to investigate low-dose MTX effect on hormonal, cellular and functional ability of male reproductive system. Materials and methods Our prospective study on 40 male psoriasis patients receiving low-dose MTX (<15mg/week) comprehensively investigates its effects on erectile function, sex hormones, and spermiogram parameters. Results After six months of MTX treatment, a significant decline in erectile function (p < 0.001) decreased total testosterone levels (p = 0.03) were observed. No significant reduction in sperm count was noted after six months of MTX treatment. Conclusions Our study highlights a significant decline in erectile function following low-dose MTX therapy, warranting further investigation into this potential side effect. While reassuring for sperm quantity and quality, the findings emphasise the necessity for larger cohorts and longer follow-up times to validate results and comprehend the complex interactions between MTX and male sexual health.

Ejaculatory and erectile function outcomes following holmium laser enucleation of the prostate.

Holmium laser enucleation of the prostate (HoLEP) is a surgical treatment option for benign prostatic hyperplasia (BPH). Many men develop retrograde ejaculation postprocedure, but there is conflicting evidence regarding sexual function outcomes post-HoLEP. We sought to examine significant variations in patient-reported erectile and ejaculatory function within 12 months post-HoLEP. We conducted a retrospective study for patients who underwent HoLEP between Nov 2018 and Feb 2022. Of the reviewed patients, 277 patients met inclusion criteria and completed pre and postoperative questionnaires, which included the Male Sexual Health Questionnaire- Ejaculatory Dysfunction (MSHQ-EJD) and the International Index of Erectile Function/Sexual Health Inventory for Men (IIEF-5/SHIM). Surveys were provided to patients up to 12 months postprocedure. Demographics and comorbidities associated with sexual dysfunction were collected. Responses to each question were analyzed to detect sub-categorical variations in sexual function as the secondary objective. Data was analyzed by using a linear mixed model. There was a significant decline in total scores for the MSHQ-EJD (8.70 pre-HoLEP vs. 6.58 post HoLEP, p ≤ 0.001) including a significant decline (p < 0.005) in questions 1-3 which assess ejaculatory ability, strength, and volume. There was not a significant decline in question 4 which assesses bother (2.552 pre-HoLEP vs. 3.119 post-HoLEP, p = 0.526). There was not a significant decline in the IIEF-5/SHIM postoperatively (11.51 pre-HoLEP vs. 13.327 post-HoLEP, p = 0.498). Patients undergoing HoLEP do not experience a decline in erectile function. Patients do experience a decline in ejaculatory function but did not find this bothersome.

MP51-10 SEXUAL FUNCTION OUTCOMES FOLLOWING HOLEP

You have accessJournal of UrologyCME1 Apr 2023MP51-10 SEXUAL FUNCTION OUTCOMES FOLLOWING HOLEP Chinade Roper, Austen Slade, Ronald J. Caras, Thomas Shelton, and Marcelino Rivera Chinade RoperChinade Roper More articles by this author , Austen SladeAusten Slade More articles by this author , Ronald J. CarasRonald J. Caras More articles by this author , Thomas SheltonThomas Shelton More articles by this author , and Marcelino RiveraMarcelino Rivera More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Holmium laser enucleation of the prostate (HoLEP) is the platinum standard surgical procedure for treatment of benign prostatic hyperplasia (BPH). As is common with BPH surgeries, many men develop retrograde ejaculation post-operatively. There is some conflicting evidence regarding the sexual function outcomes of this procedure. We sought to examine sexual outcomes post-HoLEP to assess changes in ejaculatory and erectile function. METHODS: With IRB approval, we conducted a retrospective study of patients who underwent HoLEP between Nov 2018 and Feb 2022. 346 patients met inclusion criteria and had completed pre and post operative questionnaires, which included the Male Sexual Health Questionnaire – Ejaculatory Dysfunction (MSHQ- EJD) and the 5 question International Index of Erectile Function/Sexual Health Inventory for Men (IIEF-5/SHIM). Both surveys were provided to patients up to 12 months post procedure. Patient demographics and comorbidities associated with sexual dysfunction were collected. Responses to each question were analyzed to detect sub-categorical improvements or declines in sexual function as the secondary objective. An autoregressive heterogeneous linear mixed model was performed in SPSS 28 to analyze the data. RESULTS: There was a significant decline in the total scores for the MSHQ-EJD from a mean of 7.48 pre-HoLEP to 6.23 post HoLEP (p=0.001) including a significant decline (p<0.005) in questions 1-3 which assess ejaculatory ability, strength, and volume; but there was not a significant decline in question 4 which assesses bother in ejaculatory function with a mean of 2.494 pre-HoLEP compared to 2.922 post-HoLEP (p=0.291). There was not a significant decline in the IIEF-5/SHIM post-operatively with mean pre-HoLEP score 9.21 vs 8.87 post-HoLEP (p=0.98). CONCLUSIONS: These findings suggest that patients undergoing HoLEP do not experience a decline in erectile function. Patients do appear to experience a decline in ejaculatory function post-operatively, but do not find the decline to be more bothersome. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e696 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chinade Roper More articles by this author Austen Slade More articles by this author Ronald J. Caras More articles by this author Thomas Shelton More articles by this author Marcelino Rivera More articles by this author Expand All Advertisement PDF downloadLoading ...

Predictors of Worsening Erectile Function in Men with Functional Erections Early After Radical Prostatectomy

Prior studies suggest that men with good erectile function shortly after radical prostatectomy (RP) can subsequently have worsened erectile function. To determine the prevalence and predictors of early erectile function recovery post-RP and of worsening erectile function after initial erectile function recovery. We retrospectively queried our institutional database. Men who underwent RP during 2008-2017 and who completed the International Index of Erectile Function erectile function domain both pre-RP and serially post-RP, constituted the population. Functional erections were defined as International Index of Erectile Function (IIEF)-6 erectile function domain scores ≥24. We analyzed factors predicting functional erections at 3 months post-RP as well as factors predicting a decrease in functional erections between 3 and 6 months, defined as ≥2-point drop in the erectile function domain. Multivariable logistic regression models were used to identify predictors of early erectile function recovery and also of subsequent decline. Erectile function recovery rates at 3 months post-RP and predictive factors; rates of erectile function decline between 3-6 months and associated predictors. Eligible patients comprised 1,655 men with median age of 62 (IQR 57, 67) years. Bilateral nerve-sparing (NS) surgery was performed in 71% of men, unilateral NS in 19%, and no NS in 10%. Of this population, 224 men (14%; 95% CI 12%, 15%) had functional erections at 3 months post-RP. On multivariable analysis, significant predictors of early erectile function recovery included: younger age (OR 0.93, P < .001), higher baseline erectile function domain score (OR 1.14, P < .001) and bilateral NS (OR 3.81, P=.002). The presence of diabetes (OR 0.43, P=.028) and a former smoking history (OR 0.63, P=.008; reference group: never smoker) was associated with the erectile dysfunction at 3 months post-RP. Of the men with early functional erections, 41% (95% CI 33%, 48%) had a ≥ 2-point decline in erectile function between 3 and 6 months. No factors were identified as predictors for this decline. Only a small proportion of men have functional erections at 3 months post-RP and a notable number of them will experience a decline in erectile function between 3 and 6 months. Strengths: large patient population and the use of validated questionnaire. single-center retrospective study. A minority of men had functional erections 3 months post-RP, about half of whom had a decline in erectile function by month 6. We recommend appropriately counseling post-RP patients on the risk of such a decline in erectile function. Salter CA, Tin AL, Bernie HL, et al. Predictors of Worsening Erectile Function in Men with Functional Erections Early After Radical Prostatectomy. J Sex Med 2022;19:1790-1796.

Expedited algorithm for IPP following Radical Prostatectomy

ABSTRACT Introduction Erectile dysfunction (ED) following radical prostatectomy (RP) is a postoperative result that negatively impacts patient quality of life. The recovery of potency following radical prostatectomy varies depending on a multitude of factors including but not limited to surgical technique, surgeon experience and patient comorbidities. There are several factors that contribute to this decline in erectile function as a result of oncologic control after RP which may be classified as vasculogenic, neurogenic, and psychological. Current guidelines recommend patients wait up to 24 months before IPP surgery. However, no definitive algorithm or guideline has been established for the expedited management of ED in the postoperative setting following radical prostatectomy. Objective We are proposing an expedited algorithm for patients who fail PDE-5 inhibitors at the three-month follow-up following RP. Methods Patients who underwent inflatable penile prosthesis (IPP) surgery for the treatment of ED over a 36-month period following RP were identified from our IRB approved database. All patients completed an IIEF-5 questionnaire and had a penile doppler ultrasound (PDUS) performed preoperatively. Validated scoring for erectile function was performed with the International Index of Erectile Function (IIEF-5), and the Sexual Health Inventory for Men (SHIM) was defined. The relationships, according to Doppler diagnosis, IIEF-5 score, SHIM scale, and erection score were evaluated as well as surgical outcomes and patient comorbidities. Logistic regression and Wilcoxon rank sum tests were performed. Results 1,158 patients were evaluated in this series, of whom 121 met inclusion criteria. PDUS determined that 88 (72.8%) suffered from veno-occlusive disease, while 19 (15.7%) had arterial insufficiency. 101 (83.4%) had a RALP vs 20 (16.6%) who received an open RP. The mean time between RP and IPP was 20 months, with the mean ages of RP and IPP being 58 and 64 years respectively. Ages of patients ranged from 40 to 82 years old. Increased time between RP and subsequent IPP was correlated with lower SHIM scores. Additionally, each month that passed caused a decrease of 1.8% in SHIM scores (p&amp;lt; 0.05), as well as a greater likelihood of developing worsening vasculogenic ED (p= 0.042). Increased patient age during RP and subsequent IPP was also correlated with lower SHIM scores (p= 0.049), while RALP was found to be a predictor of higher patient satisfaction (p= 0.02). Conclusions As a result of the overwhelming diminishing SHIM scores over the 20 month postoperative course following RP as well as the significant prevalence of veno-ccclusive disease in this common patient population, we are strongly recommending a baseline PDUS at the 3 month followup. Furthermore, if veno-occlusive disease is identified upon the 3 month baseline PDUS, we encourage frank discussion of IPP placement with the patient. Equally important is it to consider discussing the degree of veno-occlusive disease and resultant ED will worsen as the postoperative period lengthens. Those patients found to have veno-occlusive etiology should have early surgical intervention mitigating further severity of the subsequent veno-occlusive disease. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast and Boston Scientific

Using the Movember Foundation's GAP3 cohort to measure the effect of active surveillance on patient-reported urinary and sexual function-a retrospective study in low-risk prostate cancer patients.

BackgroundActive surveillance (AS) for low-risk prostate cancer (PCa) is intended to overcome potential side-effects of definitive treatment. Frequent prostate biopsies during AS may, however, impact erectile (EF) and urinary function (UF). The objective of this study was to test the influence of prostate biopsies on patient-reported EF and UF using multicenter data from the largest to-date AS-database.MethodsIn this retrospective study, data analyses were performed using the Movember GAP3 database (v3.2), containing data from 21,169 AS participants from 27 AS-cohorts worldwide. Participants were included in the study if they had at least one follow-up prostate biopsy and completed at least one patient reported outcome measure (PROM) related to EF [Sexual Health Inventory for Men (SHIM)/five item International Index of Erectile Function (IIEF-5)] or UF [International Prostate Symptom Score (IPSS)] during follow-up. The longitudinal effect of the number of biopsies on either SHIM/IIEF-5 or IPSS were analyzed using linear mixed models to adjust for clustering at patient-level. Analyses were stratified by center; covariates included age and Gleason Grade group at diagnosis, and time on AS.ResultsA total of 696 participants completed the SHIM/IIEF-5 3,175 times, with a median follow-up of 36 months [interquartile range (IQR) 20–55 months]. A total of 845 participants completed the IPSS 4,061 times, with a median follow-up of 35 months (IQR 19–56 months). The intraclass correlation (ICC) was 0.74 for the SHIM/IIEF-5 and 0.68 for the IPSS, indicating substantial differences between participants’ PROMs. Limited heterogeneity between cohorts in the estimated effect of the number of biopsies on either PROM were observed. A significant association was observed between the number of biopsies and the SHIM/IIEF-5 score, but not for the IPSS score. Every biopsy was associated with a decrease in the SHIM/IIEF-5 score of an average 0.67 (95% CI, 0.47–0.88) points.ConclusionsRepeated prostate biopsy as part of an AS protocol for men with low-risk PCa does not have a significant association with self-reported UF but does impact self-reported sexual function. Further research is, however, needed to understand whether the effect on sexual function implies a negative clinical impact on their quality of life and is meaningful from a patient’s perspective. In the meantime, clinicians and patients should anticipate a potential decline in erectile function and hence consider incorporating the risk of this harm into their discussion about opting for AS and also when deciding on the stringency of follow-up biopsy schedules with long-term AS.

Patient-reported outcomes after buccal mucosal graft urethroplasty for bulbar urethral strictures: results of a prospective single-centre cohort study.

To describe patient-reported outcome measures (PROMs) after buccal mucosa graft (BMG) urethroplasty. We prospectively collected PROMs in patients who underwent BMG urethroplasty for bulbar urethral strictures between October 2009 and February 2017. Preoperatively and at the first, second and third postoperative follow-up visits, patients completed five PROM questionnaires: the International Prostate Symptom Score (IPSS); the IPSS Quality of Life questionnaire; the Urogenital Distress Inventory Short-Form questionnaire (UDI-6); the International Index of Erectile Function (IIEF)-5 questionnaire, combined with IIEF-Q9 and IIEF-Q10 for assessing ejaculatory and orgasmic functions; and the International Consultation on Incontinence Questionnaire Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTS-QOL) questionnaire. In addition to using these questionnaires, we evaluated maximum urinary flow rate (Qmax ), post-void residual urine volume and total voided urine volume at each follow-up visit. Buccal pain and discomfort were assessed using a visual analogue scale (VAS). Comparison of questionnaire scores was performed using a paired Wilcoxon rank-sum test. Treatment failure was defined as any need for urinary diversion or urethral instrumentation after surgery. A total of 97 patients met the inclusion criteria. The first postoperative follow-up visit was at a median of 2.1months (n = 97/97), and the second and third visits were after a median of 7.8 (n = 82/97) and 17.0months (n = 70/97), respectively. Significant improvements compared to baseline were observed in IPSS, and IPSS-QOL, UDI-6 and ICIQ-LUTS-QOL scores at the first follow-up, and remained improved during the follow-up period (P ≤ 0.001). Patients with mild to no baseline erectile dysfunction experienced a significant decline in erectile function at the first follow-up (median [interquartile range {IQR}] preoperative IIEF-5 score 23.0 [21.0-25.0] vs median [IQR] IIEF-5 score at first follow-up 19.5 [16.0-23.8]; P ≤ 0.001). This decline fully recovered during further follow-up (median [IQR] IIEF-5 score at third follow-up 24.0 [20.5-25.0]; P = 0.86). No significant changes in median orgasmic and ejaculatory function were noted. The first postoperative median (IQR) VAS score was 3.0 (2.0-4.45), and a significant improvement in local pain and discomfort was observed during the follow-up (median [IQR] VAS at third follow-up: 0.0 [0.0-1.0]; P ≤ 0.001). Nine patients (9/97; 9.3%) had treatment failure. Stratifying recurrence based on a difference of <10mL/s vs ≥10mL/s between preoperative and postoperative Qmax could not demonstrate a significant difference (P = 0.06). Significant improvements in voiding symptoms and quality of life after surgery were reported. Patients with good baseline erections recovered erectile function during follow-up, although a significant decrease in erectile function was observed at the first follow-up. This study highlights the importance of PROMs in urethral reconstructive surgery, emphasizing that success should not be defined only by stricture-free survival.

MRI-Guided Ultrafocal HDR Brachytherapy for Localized Prostate Cancer: Median 4-Year Results of a feasibility study

For the treatment of localized prostate cancer, focal therapy has the potential to cure with fewer side effects than traditional whole-gland treatments. We report an update on toxicity, quality of life (QoL), and tumor control in our magnetic resonance imaging (MRI)-guided ultrafocal high-dose-rate brachytherapy cohort. Disease status was evaluated by systematic biopsies and 3T multiparametric MRI. The brachytherapy implant procedure under fused transrectal ultrasound/MRI guidance was followed by a 1.5T MRI for contour adjustments and catheter position verification. A single dose of 19Gy was delivered to the tumor with a margin of 5mm. Genitourinary (GU) toxicity, gastrointestinal (GI) toxicity, and erectile dysfunction (ED) were graded with the Common Terminology Criteria for Adverse Events version 4.0. QoL was measured with RAND-36, European Organisation for Research and Treatment of Cancer QLQ-C30 and PR25. International Prostate Symptom Scores and International Index of Erectile Function scores were obtained. Prostate-specific antigen level was monitored, with biochemical recurrence defined as nadir + 2ng/mL (Phoenix). Thirty patients with National Comprehensive Cancer Network low- (13%) to intermediate-risk (87%) prostate cancer were treated between May 2013 and April 2016. Median follow-up was 4years. Median age was 71years (interquartile range, 68-73) and median initial prostate-specific antigen level was 7.3ng/mL (5.2-8.1). Maximum Gleason score was 4+3=7 (in 2 patients). All tumors were radiologic (MRI) stage T2. No grade >2 GU or >1 GI toxicity occurred. International Prostate Symptom Scores only deteriorated temporarily. Mild pretreatment ED deteriorated to moderate/severe ED in 50% of patients. Long-term clinically relevant QoL deterioration was seen in sexual activity and tiredness, whereas emotional and cognitive functioning improved. At 4years, biochemical disease-free survival was 70% (95% confidence interval, 52%-93%), metastases-free survival was 93% (85%-100%), and overall survival was 100%. Of intraprostatic recurrences, 7 of 9 were out of field. Ultrafocal high-dose-rate brachytherapy conveys minimal GU or GI toxicity and has a marginal effect on QoL. An early decline in erectile function was seen. Tumor control outcomes are poor (biochemical disease-free survival of 70% [52%-93%] at 4years), most likely as a result of poor patient selection.

Excision and Primary Anastomosis for Bulbar Urethral Strictures Improves Functional Outcomes and Quality of Life: A Prospective Analysis from a Single Centre.

Background Excision and primary anastomotic (EPA) urethroplasty remains the gold standard definitive treatment for short urethral stricture disease. For patients, postoperative erectile function and quality of life are the main goals of the surgery. Patient-reported outcome measures (PROMs) are therefore of major importance. Objective The objective of this study was to prospectively analyse functional outcomes and patient satisfaction. Design, Settings, and Participants We prospectively evaluated 47 patients before and after EPA from August 2009 until February 2017. The first follow-up visit occurred after a median of 2.2 months (n = 47/47), with the second and third follow-ups occurring at a median of 8.5 months (n = 38/47) and 20.2 months (n = 31/47). Before surgery and at each follow-up visit, the patients received five questionnaires: the International Prostate Symptom Score (IPSS), the International Prostate Symptom Score with the Quality of Life (IPSS-QOL) score, the Urogenital Distress Inventory Short Form (UDI-6) score, the International Index of Erectile Function-5 (IIEF-5) score, and the ICIQ-Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTS-QOL) score. Surgical Procedure Surgery was performed in all cases using the same standardized EPA technique. Outcome Measurements and Statistical Analysis Voiding symptoms, erectile dysfunction, and quality of life were analysed using paired sample t-tests, with a multiple-testing Bonferroni correction. Any requirement for instrumentation after surgery was considered treatment failure. Results and Limitations Patients with mild or no baseline erectile dysfunction showed significant decline in erectile function at first follow-up (mean IIEF-5 of 23.27 [standard deviation; SD: 2.60] vs. 13.91 [SD: 7.50]; p=0.002), but this had recovered completely at the third follow-up (IIEF-5: 23.25 [SD: 1.91]; p=0.659). Clinically significant improvements were noted in IPSS, IPSS-QOL-score, UDI-6-score, and ICIQ-LUTS-QOL-score at the first follow-up (p<0.0001). These improvements remained significant at the second and third follow-ups (p<0.0001) for all PROMs. Three of the patients experienced stricture recurrence. The main limitations of this study were incomplete questionnaires, loss to follow-up, and low number of patients. Conclusions EPA results in an initial decline in erectile function, but full recovery occurred at a median of 20 months. Voiding improved significantly, and a major improvement in quality of life was noted, which persisted for up to 20 months after surgery. Patient Summary This study showed the importance of patient-reported outcome measures in indicating the actual outcome of urethral stricture disease surgery.

MP67-11 PATIENT REPORTED OUTCOMES ON SEXUAL FUNCTION AFTER SURGICAL TREATMENT OF PEYRONIES DISEASE

You have accessJournal of UrologySexual Function/Dysfunction: Peyronie's Disease I1 Apr 2018MP67-11 PATIENT REPORTED OUTCOMES ON SEXUAL FUNCTION AFTER SURGICAL TREATMENT OF PEYRONIES DISEASE Daan Mohede, Alida Weidenaar, Mels Van Driel, Harry van de Wiel, and Igle De Jong Daan MohedeDaan Mohede More articles by this author , Alida WeidenaarAlida Weidenaar More articles by this author , Mels Van DrielMels Van Driel More articles by this author , Harry van de WielHarry van de Wiel More articles by this author , and Igle De JongIgle De Jong More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2195AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Long-term outcomes of surgical interventions in patients with Peyronies disease (PD) on the course of sexual function is limited. We studied patient reported sexual function after 5 years follow up in order to improve preoperative counseling. METHODS The International Index of Erectile Function (IIEF)-scores of new patients with PD were collected at first presentation between 2007-2016. In autumn 2016, data was complemented by a questionnaire including the IIEF. A total of 170 patients (56.1% ) responded with a mean follow up of 5.3 ± 3.7 years. The development of sexual function (IIEF), satisfaction with the treatment and specific treatment outcomes (e.g. penile sensibility loss and shortening) were determined in conservatively and surgically treated patients. RESULTS Of 170 patients, 93 were treated conservatively and 77 underwent surgical treatment: 56 Nesbit correction, 13 plaque incision and grafting (PIG) and 8 penile prosthesis. Within the surgically treated group patients treated with PIG were more dissatisfied (61.5%) compared with Nesbit (30.9%) and penile implant (50.0%). Penile rigidity and sensibility loss were higher in patients treated with PIG. Patients who received an implant were often troubled by hindered intromission. IIEF-scores on the domain intercourse satisfaction at presentation were lower in surgically treated patients than in conservatively treated. Compared with base line orgasmic function and sexual desire decreased in the entire cohort at follow-up. The conservatively treated group showed a decline in erectile function, orgasmic function, sexual desire and intercourse satisfaction. On the contrary, overall satisfaction in the surgically treated group had increased. At follow-up, no differences were seen in sexual function between surgically and conservatively treated patients on all IIEF domains. CONCLUSIONS After surgical treatment of PD, sexual function of men improved to the level of conservatively treated patients. However, results vary between the different interventions in a way that patients after PIG reported high dissatisfaction rates in comparison with Nesbit correction or a penile implant. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e911 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Daan Mohede More articles by this author Alida Weidenaar More articles by this author Mels Van Driel More articles by this author Harry van de Wiel More articles by this author Igle De Jong More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Intracavernous Injections of Bone Marrow Mononucleated Cells for Postradical Prostatectomy Erectile Dysfunction: Final Results of the INSTIN Clinical Trial

We recently reported stage I of a phase 1/2 clinical trial of cell therapy to treat postradical prostatectomy erectile dysfunction (INSTIN, INtra-cavernous STem-cell INjection clinical trial, NCT01089387). In this first stage, four doses of intracavernous autologous bone marrow mononuclear cells (BM-MNCs) were tested in 12 patients. Here, we report the results of stage II, in which six additional patients received the optimal dose identified in stage I (109 BM-MNCs), and the long-term results in the 12 patients included in stage I. The objectives were to assess the safety and efficacy of this new treatment. In stage II, no patients had side effects, and the erectile function improvements were similar to those seen in stage I: after 6 months, significant improvements versus baseline were noted in International Index of Erectile Function-15 intercourse satisfaction (7.8±3.1 vs 2.2±3.4, p=0.033) and erectile function (18±8.3 vs 3.7±4.1, p=0.035) domains. In stage I patients, after a mean follow-up of 62.1±11.7 mo, there were no prostate cancer recurrences, and erectile function scores were somewhat lower compared with the 1-yr time point. These findings suggest that intracavernous BM-MNC injections are safe and improve erectile function. The decline in erectile function over time suggests a need for assessing repeated injections. Patient summaryWe report a phase 1/2 pilot clinical trial of cell therapy consisting in intracavernous injection of bone marrow mononuclear cells to treat postradical prostatectomy erectile dysfunction. Erectile function was improved after 6 mo in the patients given 1×109 cells. No serious side effects (life threatening or requiring hospitalisation) occurred after a mean follow-up of 62.1 mo in the first 12 patients.

Salvage external beam radiotherapy for locally recurrent prostate cancer after definitive brachytherapy

PurposePatients with locally recurrent prostate cancer after definitive prostate brachytherapy have few evidence-based salvage options. We evaluate the efficacy and treatment-related side-effects of salvage external-beam radiotherapy (EBRT) after definitive prostate brachytherapy (PBT). Methods and MaterialsEleven patients previously treated with definitive PBT and with biopsy-proven local-only recurrence received salvage reirradiation with EBRT. Genitourinary (GU) function was assessed with International Prostate Symptom Scores. Treatment-related toxicities were graded using CTCAE v 4.03. ResultsMedian follow-up was 26.5 months (range, 1–53.6 months); median age at EBRT salvage was 67 years (range, 61–81 years). Salvage EBRT included the whole pelvis in 8 patients. Two patients were treated with 3D-CRT; 9 underwent IMRT. Five patients (45%) received androgen deprivation therapy concurrent with salvage EBRT as part of long- or short-course hormone therapy. The median prostate dose was 70.2 Gy (range, 64.8–75.6 Gy). Actuarial 3-year overall and biochemical failure–free survival were 77% and 69%, respectively. Five patients (45%) had worsening GU symptoms, and 9 (82%) experienced a decline in erectile function. One patient experienced acute grade 2 GU toxicity. Four patients (36%) experienced late grade ≥2 GI/GU toxicities, including 2 who experienced grade 3 toxicities (rectourethral fistula/incontinence, bladder outlet obstruction). No grade 4/5 toxicities were noted. ConclusionsOur data suggest that salvage EBRT can provide similar disease control and treatment-related toxicity to more established salvage therapies. This approach warrants further investigation on a larger scale.

The effect of urethral transection on erectile function after anterior urethroplasty.

To prospectively assess the effect of urethral transection on erectile function after anterior urethroplasty. From February 2012 to December 2014, 104 patients were enrolled in a prospective study assessing erectile function (EF) after anterior urethroplasty. Participants completed the International Index of Erectile Function (IIEF) questionnaire preoperatively and 6months postoperatively. Outcome measures were the incidence of erectile dysfunction (ED) defined by ≥5-point change in EF and mean change in the EF domain. Factors examined were urethral transection, stricture location, patient age and other demographics. Fisher's exact test, Student's t test and linear regression were used to evaluate associations when appropriate. Seventeen patients were excluded because of poor EF, leaving 87 patients for analysis. Twenty-two patients (25.3%) had urethral transection during urethroplasty, while 65 underwent non-transecting techniques (74.7%). For the entire cohort, IIEF scores remain unchanged (20.16 versus 20.14; p=0.98). Eighteen patients (20.7%) developed ED, while 15 (17.2%) experienced an improvement in EF. Urethral transection was not associated with ED (p=0.22) or mean change in EF (-0.8 versus +0.2; p=0.71). Stricture location was not associated with ED, but patient age ≥50 was associated with a decrease in mean postoperative EF (-2.84 versus +1.85; p=0.04). On linear regression analysis patient age remained independently associated with adverse change in EF (p=0.05). Urethroplasty can result in a decline in erectile function in some patients but overall is associated with minimal change in erectile function. Urethral transection is not associated with adverse change in erectile dysfunction after urethroplasty however, advanced patient age is.

MP76-20 PROSPECTIVE LONG-TERM OUTCOME OF ERECTILE FUNCTION IN MEN TREATED BY PROSTATE BRACHYTHERAPY

You have accessJournal of UrologySexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy I1 Apr 2016MP76-20 PROSPECTIVE LONG-TERM OUTCOME OF ERECTILE FUNCTION IN MEN TREATED BY PROSTATE BRACHYTHERAPY Richard Stock and Nelson Stone Richard StockRichard Stock More articles by this author and Nelson StoneNelson Stone More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1871AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate cancer patients receiving brachytherapy are known to have a decline in erectile function (EF) long after treatment. We prospectively assessed EF in a cohort of men managed by prostate seed implant and followed a minimum of 5 years. METHODS 1754 men with a median age of 66 years (IQ 61-71) were followed a mean of 10 years (median 9.5, range 5-22) after treatment. Patients received implant alone or implant plus HT or external beam radiotherapy (EBRT) or implant plus HT plus EBRT by risk group. EF was prospectively assessed by the 4 point Mount Sinai Sexual Function Inventory (MSSFI, 0-no EF, 1-EF inadequate for penetration, 2-penetration possible but suboptimal EF and 3-normal EF) and by the 25 point SHIM. The SHIM was grouped into 4 categories- 1-7, no EF, 8-11 minimal to moderate EF, 12-16 moderate EF and 17-25 normal EF. Baseline (pre-implant) scores were compared to 2 and 5 year and last evaluation scores. Independent variables included age (<60, 60-<70, 70+), radiation dose, hormone therapy (HT: 53.5%, median 6 months), testosterone level (T) and pre-treatment function. Associations were compared by ANOVA and Chi-square. Survival function was estimated by Kaplan Meier (KM) method with comparisons by log rank and cox regression proportion hazard rates (HR). RESULTS Of the 1709 (97.4%) with MSSFI 340 (19.9%) had a score of 2 and 886 (51.8%) a score of 3 (total with adequate EF (AEF) 71.7%) before treatment. Similar SHIM results in 810 (47.4%) were 70%. At 2, 5 and last follow-up years AEF was present in 229 (22.9%), 227 (19.6%) and 227 (19.6%) of men presenting with MSSFI 2 and 309 (30.9%) 202 (26.2%) and 245 (17.3%) of the MSSFI 3s (p<0.001). SHIM data was similar (p<0.001). KM estimates for preservation of AEF in men with 2 at presentation was 75.5% at 5 and 35.5% at 10 years, while with 3 was 92.2% and 57.3% (p<0.001), respectively. 10-year AEF in the 3 age groups was 68.3%, 54.1% and 32.2% (p<0.001). AEF was further increased in these men not receiving HT to 73.4%, 62.7% and 41.6% (p<0.001). Radiation dose and T did not influence AEF. Cox HR demonstrated older age group (p<0.001, HR 2.27), addition of HT (P=0.015, HR 1.32) and low MSSIF (p<0.001, HR 1.73) as significant. CONCLUSIONS Adequate EF (MSSFI and SHIM) was preserved in a high percentage of men treated by brachytherapy with long-term follow-up. Three-quarters of patients who present with normal EF (and no HT) and were younger than 60 years at the time of treatment have adequate EF for penetration 10 years later. 41.6% of those initially treated with AEF at age 70 years are estimated (KM) to have AEF in their eighties (no HT). © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1015 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Richard Stock More articles by this author Nelson Stone More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Effect of aging and long-term erectile function after iodine-125 prostate brachytherapy.

To evaluate long-term erectile function (EF) in men treated with iodine-125 prostate brachytherapy (PB) and to determine factors predictive for erectile dysfunction (ED), including natural decline because of aging. Two thousand nine hundred twenty-nine patients (implanted July 1989-June 2012) with baseline EF and greater than 10-month followup (FU) are included. About 78.9% had full and 7.9% had partial EF at baseline. EF was assessed on a physician-reported three-point scale. Poisson regression with generalized estimating equations was used to assess predictors of ED and Kaplan-Meier curves time to ED. The effect of aging was calculated from the declining rate of baseline EF seen in sequential 5-year age cohorts and from the Massachusetts Male Aging Study. The median age was 66years and median FU 3.5years (maximum 14 years). About 1142 patients had more than 5years of FU, and 43% had received 6 months of androgen deprivation therapy (ADT). Significant drop in EF was seen at 6weeks after PB, with gradual decline thereafter. EF preservation at 5years for age younger than 55, 56-59, 60-64, 65-69, and 70year and older was 82%, 73%, 58%, 39%, and 23%, respectively. Comparisons of the 5-year age-related and treatment-related EF decline show that 50% of the long-term EF decline is related to aging. On univariate and multivariate analyses, age at implant, length of FU, hypertension, diabetes, and use of ADT (all p<0.01) were significant predictors of ED. More than 80% of young men have EF preserved 5years after PB. Age, ADT, history of hypertension, and the natural decline in EF have negative impact on long-term EF after PB.

Update on Greenlight laser vaporization (PVP) 2014.

To asses the (1) outcomes and (2) intraoperative, perioperative, and long-term complications of photoselective vaporization of the prostate (PVP) with Greenlight laser. A systematic review of outcomes and complications of PVP was conducted. The article selection process was performed according to PRISMA guidelines and included publications published between 2009 and 2014. All generations of PVP (80, 120, 180 W) lead to a significant improvement of micturition symptoms (IPSS, QoL) and voiding parameters (Q max, PVR volume) during follow-up. Data on sexual function are heterogeneous and suggest a trend toward decline in erectile function in men with sustained preoperative erection. The rate of intraoperative complications is low. Data on peri- and postoperative complications show a large variation that mainly can be attributed to heterogeneity in documentation. PVP leads to a statistically significant and clinically relevant improvement of voiding parameters and micturition symptoms in patients with prostates <100 ml. The technique is characterized by a high degree of intra- and perioperative safety. Long-term evidence on functional outcomes and complications beyond 3 years from RCTs is currently missing for all generations of the Greenlight laser.

Short-term Functional Outcomes and Complications Associated With Transperineal Template Prostate Mapping Biopsy

To assess the complications and erectile and urinary functional outcomes of transperineal template mapping biopsy (TTMB) of the prostate. We retrospectively reviewed the records of 84 patients undergoing TTMB at our institution and recorded complications and functional outcomes. Erectile and urinary functions were measured at baseline, 2 weeks, and 6 ± 2 weeks after TTMB using the International Index of Erectile Function short version (IIEF-5) and International Prostate Symptom Score questionnaires. Erectile and urinary function parameters were compared between baseline and 2 and 6 weeks after TTMB in a paired fashion. A subanalysis of erectile function was performed in preoperatively potent men (IIEF-5 >17). Sixteen patients (19%) experienced complications. The most common events were transient urinary retention (6%), prostatitis (4%) and local events, including perineal hematoma, bruising, or perineal pain (5%). One patient with hematuria required intervention. IIEF-5 scores at baseline, 2 weeks, and 6 weeks were 20 (interquartile range [IQR], 16-23), 18 (IQR, 12-22), and 18 (IQR, 12-22), respectively (P= .096 and P= .034). Among preoperatively potent men, IIEF-5 scores at baseline, 2 weeks, and 6 weeks were 22 (IQR, 20-24), 21 (IQR, 18-24), and 22 (IQR, 18-24), respectively(P= .011 and P= .018). International Prostate Symptom Scores were 6 (IQR, 3.5-11) at baseline, rose to 10 (IQR, 4.8-15) at 2 weeks (P= .012), and returned to 7 (IQR, 3.5-13) at 6 weeks (P= .628). TTMB has a favorable morbidity profile, with mostly mild and transient complications. Urinary retention occurred in 6%, and only 1 patient required intervention with bladder irrigation. Despite a statistically significant decline in erectile function from baseline, the median change in IIEF-5 score was 1 point. Urinary symptoms worsened initially but returned to baseline within 6weeks.

Quality of Life after Radical Radiotherapy for Prostate Cancer: Longitudinal Study from a Randomised Trial of External Beam Radiotherapy Alone or in Combination with High Dose Rate Brachytherapy

AimTo compare prospective, long-term quality of life in patients randomised to external beam radiotherapy (EBRT) alone or with a boost of high dose rate (HDR) brachytherapy. Materials and methodsIn total, 216 patients participating in the UK randomised trial of EBRT ± HDR brachytherapy were included in this analysis. EBRT delivering 55 Gy in 20 fractions was compared with EBRT followed by HDR brachytherapy of 2 × 8.5 Gy. Quality of life was assessed using the Functional Assessment of Cancer Therapy-Prostate (FACT-P) and FACT-G (General) questionnaires, administered before radiotherapy, at 6 months and bi-annually thereafter. Differences in mean FACT global scores and erectile function between treatment arms were compared using chi-squared tests. ResultsOver a 10.5 year follow-up, no difference in FACT-G, FACT-P or Trial Outcome Index (TOI) scores was seen between treatments and means were similar to their pretreatment values. Mean erectile function scores in arm 2 were similar to arm 1, but were significantly lower than the pretreatment mean (P ≤ 0.002). There was no evidence that quality of life deteriorated with increasing follow-up time in any of the four FACT domains. ConclusionsThe improved biochemical control of disease seen in these patients with EBRT + HDR brachytherapy coupled with equitoxic early and late urinary and bowel morbidity, indicate a therapeutic advantage, which has now been confirmed by the results for general and prostate-related quality of life changes, despite a decline in erectile function.

EFFICACY ASSESSMENT OF &lt;i&gt;KAEMPFERIA PARVIFLORA&lt;/i&gt; FOR THE MANAGEMENT OF ERECTILE DYSFUNCTION

Age-related decline in erectile function is a noted phenomenon worldwide. A variety of medicinal plants have been identified as having strong aphrodisiac p roperties along with the ability to improve erectil e functioning. Kaempferia Parviflora (KP) has famous as a Thai Viagra and use it to incr ease male impotency. However, there is limited scientific evi dence regarding the efficacy of this herb on this i ssue in aging healthy men. This study therefore investigate d the effect of KP extract administration on erecti le response of male elderly volunteers. Total 45 male healthy elderly volunteers will be divided into 3 s eparated groups including placebo and the different doses of ethanolic extracts of KP (25 and 90 mg) once daily at a period of 2 months. The erectile function tests inc luding the response latency time to visual erotic s timuli, size and length of penis both in flaccid and erection st ates were assessed after single administration, 1 a nd 2 months of treatment. In order to investigate the possible underlying mechanism, we also determined the alteration of testosterone, FSH and LH concentrations. KP at a do se of 90 mg day -1 treated group exhibited a significant enhanced all parameters after 1 and 2 months of tre atment. Moreover, the penile length at erection st ates and the response latency to sexual erotic stimuli appea red to be the parameters that showed significant ch anges during the delay period. Unfortunately, our study f ailed to show the significant changes on hormones concentration. Our study clearly demonstrates that KP is a potenti al resource for the development of nutraceutical compound against aged related male er ectile dysfunction.