You have accessJournal of UrologyProstate Cancer: Localized (VI)1 Apr 20131344 WHICH ABLATIVE STRATEGY IN LOCALIZED PROSTATE CANCER IS BEST FOR ERECTILE FUNCTION PRESERVATION? Stefano Legramanti, Alberto Gritti, Massimo Valerio, Louise Dickinson, Neil Mccartan, Hashim Ahmed, and Mark Emberton Stefano LegramantiStefano Legramanti London, United Kingdom More articles by this author , Alberto GrittiAlberto Gritti London, United Kingdom More articles by this author , Massimo ValerioMassimo Valerio London, United Kingdom More articles by this author , Louise DickinsonLouise Dickinson London, United Kingdom More articles by this author , Neil MccartanNeil Mccartan London, United Kingdom More articles by this author , Hashim AhmedHashim Ahmed London, United Kingdom More articles by this author , and Mark EmbertonMark Emberton London, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.03.055AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Current whole-gland therapy can lead to significant genitourinary side effects in men with localised prostate cancer. New ablative modalities have been shown to reduce such side-effects, but the degree to which erectile function, in particular, is impacted on by differing ablative strategies (whole-gland (WG) vs. hemiablation (HA) vs. focal therapy (FT)) has been poorly reported. We aimed to determine the functional changes in erectile function by comparing WG to organ-sparing high intensity focused ultrasound (HIFU). METHODS A registry-based analysis of patients who underwent HIFU identified only those men having at least one complete IIEF-15 questionnaire at baseline and follow-up. Changes in total IIEF-15 scores were compared between WG and the tissue-preserving groups, and then between the HA and FT groups. Variation in ability to have penetrative intercourse was also evaluated (positive outcome defined as score ≥2 on IIEF-15 question 2). RESULTS The HIFU registry incorporates data for 1405 men. After applying exclusion criteria, 169 were included in the final analysis: 84 WG and 85 tissue preserving (51 FT; 34 HA). WG ablation affected erectile function to a greater extent (IIEF-15= -10.3 ± 19.0) than the tissue-preserving strategies (IIEF-15= -2.5 ± 15.3; p=0.004). In addition, there was a trend (though not statistically significant) to better erectile function preservation after FT (IIEF-15= -0.6 ± 15.7) when compared to HA (IIEF-15= -5.4 ± 14.4; p=0.153). The proportions able to have erections sufficient for penetration showed a trend in favour of FT. The retrospective nature and important differences in baseline scores indicate possible selection biases. CONCLUSIONS The extent of tissue preservation when treating prostatic disease seems to have a significant impact on postoperative erectile function. According to these results, organ-sparing strategies were better than WG ablation. There is an urgent need for prospective comparative effectiveness in this area. Whole gland Tissue-preserving Hemi-ablation Focal Number of patients 84 85 51 34 Age 64±8.2 66±7.4 64±6.5 68±7.6 Median months follow up 24 (6 - 72) 12 (3 - 48) 12 (3 - 48) 12 (3 - 36) Average IIEF baseline 44±24.1 41±24.0 50±20.9 34±23.9 IIEF difference -10.3±19.0 -2.5±15.3 -5.4±14.4 -0.6±15.7 Q2 ≥ 2 baseline 62% 64% 79% 53% Q2 ≥ 2 post treatment 51% 61% 70% 55% © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e549 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stefano Legramanti London, United Kingdom More articles by this author Alberto Gritti London, United Kingdom More articles by this author Massimo Valerio London, United Kingdom More articles by this author Louise Dickinson London, United Kingdom More articles by this author Neil Mccartan London, United Kingdom More articles by this author Hashim Ahmed London, United Kingdom More articles by this author Mark Emberton London, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...