Recovery Of Erectile Function Research Articles

MP80-20 FUNCTIONAL OUTCOMES OF LAPAROSCOPIC VS ROBOT-ASSISTED RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP80-20 FUNCTIONAL OUTCOMES OF LAPAROSCOPIC VS ROBOT-ASSISTED RADICAL PROSTATECTOMY Marco Paciotti, Luigi Nocera, Carlo Andrea Bravi, Cesare Saitta, Adele Piro, Luca Sarchi, Roberto Contieri, Mottaran Angelo, Maria Peraire Lores, Eleonora Balestrazzi, Federico Piramide, Ruben De Groote, Geert De Naeyer, Paolo Casale, Rozzano, Giovanni Lughezzani, Alexandre Mottrie, and Nicolò Maria Buffi Marco PaciottiMarco Paciotti More articles by this author , Luigi NoceraLuigi Nocera More articles by this author , Carlo Andrea BraviCarlo Andrea Bravi More articles by this author , Cesare SaittaCesare Saitta More articles by this author , Adele PiroAdele Piro More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Roberto ContieriRoberto Contieri More articles by this author , Mottaran AngeloMottaran Angelo More articles by this author , Maria Peraire LoresMaria Peraire Lores More articles by this author , Eleonora BalestrazziEleonora Balestrazzi More articles by this author , Federico PiramideFederico Piramide More articles by this author , Ruben De GrooteRuben De Groote More articles by this author , Geert De NaeyerGeert De Naeyer More articles by this author , Paolo CasalePaolo Casale More articles by this author , Rozzano Rozzano More articles by this author , Giovanni LughezzaniGiovanni Lughezzani More articles by this author , Alexandre MottrieAlexandre Mottrie More articles by this author , and Nicolò Maria BuffiNicolò Maria Buffi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003357.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We entered the third decade of the robotic era in prostate cancer (PCa) surgery, and robotic platforms are increasingly spreading worldwide. Robotic surgery is usually believed to facilitate critical steps of the prostatectomy, increasing the precision of the surgical act and optimizing the probability of favorable outcomes. However, strong evidence supporting superiority of robotic vs laparoscopic prostatectomy (LRP) in terms of functional results are still missing. We performed a systematic review (SR) and meta-analysis (MA) to assess the functional outcomes of LRP vs robot-assisted radical prostatectomy (RARP). METHODS: We searched for all the studies comparing LRP and RARP in Medline, Embase, the Cochrane Central Register of Controlled Trials, and abstracts from the AUA and EAU meetings up to October 2022. Results were independently reviewed by two authors following the PRISMA guidelines. A SR+MA were performed. We followed a predefined PICOS approach: (P) patients affected by PCa (I) LRP (C) RARP (O) continence and potency recovery and (S) randomized controlled trials (RCTs). Continence was defined as using no pads or one safety pad per day. Potency was defined either as IIEF-5 score >17 or capability of intercourse. Effect measures for the outcomes were relative risk (RR) and 95% CI. Random-effect models were utilized to report RR. The RoB 2 was used to assess the risk of bias. RESULTS: Three RCTs were included in this SR. A total of 966 patients undergoing RARP for localized PCa were included in the three studies. The number of patients undergoing LRP vs RARP was 60 vs 60, and 586 vs 196, and 64 vs 64 in the #1, #2 and #3 RCT, respectively. Continence recovery and erectile function (EF) at 3 months were the most reported outcomes. Across the three studies, the pooled RR for 3 months continence was 1.15 (1.06-1.24), while the pooled RR for 3 months EF was 1.55 (1.23-1.95), both in favor of robotic surgery (Table 1). Therefore, we found a significant Risk of bias was assessed for all the three studies and determined as follows: “unclear risk of bias”. CONCLUSIONS: This MA found a higher EF and urinary continence recovery rate in patients who underwent RARP vs LRP for localized PCa. Therefore, evidence from RCTs demonstrated that robotic surgery offers a significant advantage in terms of functional outcomes in these patients. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1161 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marco Paciotti More articles by this author Luigi Nocera More articles by this author Carlo Andrea Bravi More articles by this author Cesare Saitta More articles by this author Adele Piro More articles by this author Luca Sarchi More articles by this author Roberto Contieri More articles by this author Mottaran Angelo More articles by this author Maria Peraire Lores More articles by this author Eleonora Balestrazzi More articles by this author Federico Piramide More articles by this author Ruben De Groote More articles by this author Geert De Naeyer More articles by this author Paolo Casale More articles by this author Rozzano More articles by this author Giovanni Lughezzani More articles by this author Alexandre Mottrie More articles by this author Nicolò Maria Buffi More articles by this author Expand All Advertisement PDF downloadLoading ...

MP79-07 EFFECT OF NEAR-INFRARED LASER TREATMENT ON IMPROVING ERECTILE FUNCTION IN RATS WITH DIABETES MELLITUS

You have accessJournal of UrologyCME1 Apr 2023MP79-07 EFFECT OF NEAR-INFRARED LASER TREATMENT ON IMPROVING ERECTILE FUNCTION IN RATS WITH DIABETES MELLITUS Lin Yang, Guoxiong Liu, Dali Jiang, Guiting Lin, Hengtong Fan, Zejun Ren, Bing Yang, Liyue Mu, Tom F Lue, and Dalin He Lin YangLin Yang More articles by this author , Guoxiong LiuGuoxiong Liu More articles by this author , Dali JiangDali Jiang More articles by this author , Guiting LinGuiting Lin More articles by this author , Hengtong FanHengtong Fan More articles by this author , Zejun RenZejun Ren More articles by this author , Bing YangBing Yang More articles by this author , Liyue MuLiyue Mu More articles by this author , Tom F LueTom F Lue More articles by this author , and Dalin HeDalin He More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003356.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Diabetes mellitus induced erectile dysfunction (DMED) is difficult to treat. The oxidative stress (OS) created by DM is a major cause of injuries to the corpus cavernosum (CC), thereby resulting in ED. Near-infrared (NIR) laser has already been shown to be effective in treating multiple brain disorders due to its anti-OS effect. In this study we want to investigate whether an NIR laser improves the erectile function of DMED rats through its anti-OS effect. METHODS: Knowing its advantage of reasonable deep tissue penetration and good photo activation on mitochondria, a NIR laser with wavelength of 808nm was used in the experiment. Since the internal and external CC was covered by different tissue layers, the laser penetration rates of the internal and external CC were measured separately. Different radiant exposure settings were applied: in the initial experiment, 40 male SD rats were randomly assigned to five groups, normal controls (NC), and STZ-induced DM rats that 10 weeks later received various radiant exposures (J/cm2) from the NIR laser (DM0J, DM1J, DM2J, and DM4J) in the subsequent 2 weeks. Erectile function was then assessed 1 week after NIR treatment. It was found the initial radiant-exposure setting was not optimal according to the Arndt–Schulz rule. We followed with a second experiment using a different radiant exposure setting. Forty male rats were randomly divided into five groups (NC, DM0J, DM4J, DM8J, and DM16J), and the NIR laser was again applied according the new setting and erectile function was assessed as in the first experiment. Histologic, biochemical analyses and proteomic were then conducted. RESULTS: Recovery of erectile function of varying degrees was observed in the NIR treatment groups, and radiant exposure of 4 J/cm2 achieved optimal results. The NIR4J group showed improvement in mitochondrial function and in morphology in DM rats, and it was found that OS levels were significantly reduced by NIR exposure. The tissue structure of the CC was also improved by NIR exposure. The proteomics analysis confirming multiple biologic processes had been changed by DM and NIR. CONCLUSIONS: NIR laser activated mitochondria, improved OS, repaired the damage to penile CC tissue structures caused by DM, and improved erectile function in DM rats. These results thus raise the possibility that human patients with DMED may respond to NIR therapy in a manner that parallels the responses we observed in animal study. Source of Funding: Key R&D Plan of Shaanxi Province (2022SF-531) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1143 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lin Yang More articles by this author Guoxiong Liu More articles by this author Dali Jiang More articles by this author Guiting Lin More articles by this author Hengtong Fan More articles by this author Zejun Ren More articles by this author Bing Yang More articles by this author Liyue Mu More articles by this author Tom F Lue More articles by this author Dalin He More articles by this author Expand All Advertisement PDF downloadLoading ...

Effect of near-infrared laser treatment on improving erectile function in rats with diabetes mellitus.

Diabetes mellitus-induced erectile dysfunction is difficult to treat. The oxidative stress created by diabetes mellitus is a major cause of injuries to the corpus cavernosum, thereby resulting in erectile dysfunction. Near-infrared laser has already been shown to be effective in treating multiple brain disorders because of its antioxidative stress effect. To investigate whether a near-infrared laser improves the erectile function of diabetes mellitus-induced erectile dysfunction rats through its antioxidative stress effect. Knowing its advantage of reasonable deep tissue penetration and good photoactivation on mitochondria, a near-infrared laser with wavelength of 808nm was used in the experiment. Since the internal and external corpus cavernosum were covered by different tissue layers, the laser penetration rates of the internal and external corpus cavernosum were measured separately. Different radiant exposure settings were applied: in the initial experiment, 40 male Sprague-Dawley rats were randomly assigned to five groups, normal controls, and streptozotocin-induced diabetes mellitus rats that 10weeks later received various radiant exposures (J/cm2 ) from the near-infrared laser (DM0J(DM+NIR 0 J/cm2 ), DM1J, DM2J, and DM4J) in the subsequent 2weeks. Erectile function was then assessed 1week after near-infrared treatment. It was found that the initial radiant exposure setting was not optimal according to the Arndt-Schulz rule. We performed a second experiment using a different radiant exposure setting. Forty male rats were randomly divided into five groups (normal controls, DM0J, DM4J, DM8J, and DM16J), and the near-infrared laser was again applied according to the new setting, and erectile function was assessed as in the first experiment. Histologic, biochemical, and proteomic analyses were then conducted. Recovery of erectile function of varying degrees was observed in the near-infrared treatment groups, and radiant exposure of 4 J/cm2 achieved optimal results. The DM4J group showed improvement in mitochondrial function and morphology in diabetes mellitus rats, and it was found that oxidative stress levels were significantly reduced by near-infrared exposure. The tissue structure of the corpus cavernosum was also improved by near-infrared exposure. The proteomics analysis confirming multiple biologic processes were changed by diabetes mellitus and near-infrared. Near-infrared laser activated mitochondria, improved oxidative stress, repaired the damage to penile corpus cavernosum tissue structures caused by diabetes mellitus, and improved erectile function in diabetes mellitus rats. These results thus raise the possibility that human patients with diabetes mellitus-induced erectile dysfunction may respond to near-infrared therapy in a manner that parallels the responses we observed in animal study.

Эффективность трехмерной системы визуализации при выполнении лапароскопической радикальной простатэктомии.

Introduction. The three-dimensional (3D) imaging during laparoscopic procedures can improve the quality of that surgeries. There is a shortage of publications about the potential benefits of 3D navigation in laparoscopic surgery with urological diseases. Radical prostatectomy (RPE) is known as the gold standard of treatment of localized prostate cancer (PC), and investigation of imaging technologies in laparoscopic surgery in PC patients is a hot topic. Aim. To compare the perioperative outcomes of laparoscopic RPE performed with 3D and two-dimensional (2D) imaging. Materials and methods. We performed retrospective analysis of perioperative outcomes in 146 patients who had undergone radical surgery with localized PC. All the patients were divided into 4 groups by the surgery features: 1) 2D imaging with the technique for neurovascular bundles preservation (TNVBP) (n=52); 2) 2D without TNVBP (n=46); 3) 3D with TNVBP (n=23); 4) 3D without TNVBP (n=25). We assessed operative time, intraoperative blood loss volume (IBLV), duration of the bladder drainage, positive surgical margin (PSM) detection rate, duration of the postoperative inpatient period, urinary continence recovery rate, erectile function recovery (EFR) rate. Results and discussion. In groups 1, 2, 3, 4 the operative time was 171,4±21,1, 168,3±23,2, 98,7±17,3, 92,2±22,2 min, and the IBLV was 294,2±62,1, 281,2±53,2, 144,2±31,7, 148,5±33,0 mL, respectively. PSM detection rate was 1,92±0,11%, 2,17±0,04% in groups 1, 2, while PSM had not been detected in groups 3, 4. In all the participants, duration of the bladder drainage was 5–7 days, and the full recovery of urinary continence was detected at both 6 and 12 months after the surgery. The postoperative inpatient period was 8–10 days in groups 1, 2, and 8–9 days in groups 3, 4. The EFR at 3 months after the surgery was detected in 38,4%, 28,3%, 34.8%, 28.0% of patients, while at 12 months it was detected in 59,6%, 41,3%, 82,6%, 56,0% of patients in groups 1, 2, 3, 4, respectively. Conclusion. We revealed the following features of perioperative period of laparoscopic RPE performed with 3D imaging compared to 2D: 1) the operative time was reduced by 42–45% (р<0,05); 2) the IBLV was reduced by 47–51% (р<0,05); 3) the PSM had not been detected; 4) there was the tendency to the shorter postoperative inpatient period; 5) the EFR rate was increased by 1,3–1,4 times (р<0,05), and the best EFR outcomes were obtained via 3D imaging together with TNVBP. Thus, our study demonstrates the advisability of usage of both 3D imaging and TNVBP during the laparoscopic RPE.

Experience with an innovative surgical approach: 321 cases modified extraperitoneal single-incision robot-assisted laparoscopic radical prostatectomy without dedicated PORT based on Da Vinci SI system.

To summarize surgical experiences with a new modified technique involving extraperitoneal single-incision robot-assisted laparoscopic radical prostatectomy based on Da Vinci SI system by reviewing case data, including follow ups, and to evaluate the safety and clinical efficacy of the surgical procedure. The case data from December 2020 to September 2022 of 321 patients undergoing modified single incision (without dedicated PORT) robotic-assisted laparoscopic radical prostatectomy via an extraperitoneal approach were reviewed. All procedures were performed by the same surgeon at our center. Perioperative data and postoperative urinary control, tumor control, and erectile function recovery were assessed. The immediate, 3-months, 6-months, 12-months, 18-months and 24-months complete urinary control rates were 34.3%, 56.6%, 79.7%, 85.7%, 89.6% and 90.7%, respectively; the 3-months, 6-months, 12-months, 18-months and 24-months biochemical recurrence rates were 3.4%, 5.2%, 9.1%, 21.7% and 30.2%, respectively; and for those with normal preoperative erectile function, the 3-months, 6-months, 12-months, 18-months and 24-months postoperative erectile function recovery rates were 52.2%, 60.0%, 70.7%, 72.2% and 73.9%, respectively. The new modified technique involving extraperitoneal single-incision robotic-assisted laparoscopic radical prostatectomy is safe and feasible. This technique has satisfactory surgical results, and this new method results in satisfactory urinary control, tumor control and recovery of erectile function. In addition, this new method is not limited to specific dedicated access devices, which facilitates its application.

Rats, Neuregulins and Radical Prostatectomy: A Conceptual Overview

In the contemporary era of early detection, with mostly curative initial treatment for prostate cancer (PC), mortality rates have significantly diminished. In addition, mean age at initial PC diagnosis has decreased. Despite technical advancements, the probability of erectile function (EF) recovery post radical prostatectomy (RP) has not significantly changed throughout the last decade. Due to virtually unavoidable intraoperative cavernous nerve (CN) lesions and operations with younger patients, post-RP erectile dysfunction (ED) has now begun affecting these younger patients. To address this pervasive limitation, a plethora of CN lesion animal model investigations have analyzed the use of systemic/local treatments for EF recovery post-RP. Most promisingly, neuregulins (NRGs) have demonstrated neurotrophic effects in both neurodegenerative disease and peripheral nerve injury models. Recently, glial growth factor 2 (GGF2) has demonstrated far superior, dose-dependent, neuroprotective/restorative effects in the CN injury rat model, as compared to previous therapeutic counterparts. Although potentially impactful, these initial findings remain limited and under-investigated. In an effort to aid clinicians, our paper reviews post-RP ED pathogenesis and currently available therapeutic tools. To stimulate further experimentation, a standardized preparation protocol and in-depth analysis of applications for the CN injury rat model is provided. Lastly, we report on NRGs, such as GGF2, and their potentially revolutionary clinical applications, in hopes of identifying relevant future research directions.

Long-term efficacy of penile rehabilitation with low-intensity extracorporeal shock wave therapy for sexual and erectile function recovery following robotic-assisted radical prostatectomy: a single-cohort pilot study.

The long-term efficacy of low-intensity extracorporeal shock wave therapy (LIESWT) for penile rehabilitation after robot-assisted radical prostatectomy (RARP) has not yet been reported. To assess the long-term efficacy of LIESWT for penile rehabilitation after RARP by evaluating the postoperative recovery of sexual and erectile functions following RARP. Patients who underwent RARP at our institution were categorized into 2 groups: those who received LIESWT and those who underwent penile rehabilitation with a phosphodiesterase type 5 inhibitor (PDE5i). The control group included patients who did not undergo penile rehabilitation. Potency and scores on the Expanded Prostate Cancer Index Composite for sexual function and 5-item International Index of Erectile Function (IIEF-5) were evaluated preoperatively and over 60months after RARP. The LIESWT group had significantly higher postoperative sexual function and total IIEF-5 scores and potency than the control group over the long term, and its results were not inferior to those of the PDE5i group. The LIESWT, PDE5i, and control groups comprised 16, 13, and 139 patients, respectively. As compared with the control group, the LIESWT group had significantly higher sexual function scores at 6, 12, and 60 months after surgery (P < .05) and total IIEF-5 scores at 24 and 60 months (P < .05). The LIESWT group also had a significantly higher potency rate than the control group at 60months (P < .05). For all time points after surgery, there were no significant differences between the LIESWT and PDE5i groups in terms of sexual function and total IIEF-5 scores and potency. LIESWT may be a new option for penile rehabilitation in patients with erectile dysfunction after RARP. This pilot study was performed at a single center and involved relatively few patients, which may have led to selection bias. Furthermore, the selection of this study for penile rehabilitation was not made randomly but by the patient's choice. Despite these limitations, our results provide evidence in support of LIESWT for penile rehabilitation after RARP because this is the first study to assess the long-term efficacy of LIESWT. LIESWT can improve sexual and erectile functions in patients with erectile dysfunction after RARP, and its efficacy can be maintained over a long period after surgery.

Comparative analysis of early post-operative outcomes between retzius-sparing and anterior approach robotic radical prostatectomy for a single surgeon

Introduction: The aim of this study was to compare intraoperative and early post-operative outcomes between retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) versus standard approach for RARP (S-RARP). Patients and methods: All RARPs by a single surgeon were included and divided into two groups: (1) standard approach including combined anterior–posterior approach (S-RARP); (2) retzius-sparing posterior approach (RS-RARP). Allocation was based on prostate size and location of index lesion on MRI. Initial post-operative follow-up was at 6 weeks. Results: Overall, 169 RARPs were performed between March 2018 and October 2021: S-RARP = 99 versus RS-RARP = 70. There was no significant difference in pre-operative body mass index (BMI), prostate-specific antigen (PSA), International Society of Urological Pathology (ISUP) grade group and clinical T stage. Intraoperative differences were found in blood loss (300 versus 200 mL, p = 0.008), console time (180 versus 135 minutes, p &lt; 0.001) favouring RS-RARP, with no differences in nerve-spare or lymph node dissection. Post-operatively, no difference was found in ISUP grade, pathological T stage, positive surgical margins, number of lymph nodes sampled, readmissions or complications. Gland size in the RS group was smaller (38 versus 29 g, p = 0.001). Early (6 weeks) post-op follow-up showed a significant difference between groups for both pad-free continence (35% versus 53%, p = 0.011) and social continence (79% versus 89%, p = 0.024), but no difference for erectile function recovery (27% versus 50% of baseline) and post-op PSA levels &lt; 0.1 ng/mL (85% versus 93%). Conclusion: Even early in the learning curve, continence recovery, operative time and blood loss were significantly better for RS-RARP than S-RARP. Margin status and PSA levels are comparable to published literature for both groups. Standardised training in RS-RARP might help to improve the uptake of this novel technique. Level of evidence: 2.

Vitamin D3 improved erectile function recovery by regulating autophagy and apoptosis in a rat model of cavernous nerve injury.

Vitamin D3 is an important element in improving erectile function. However, the mechanisms of vitamin D3 remain unknown. Thus, we explored the effect of vitamin D3 on erectile function recovery after nerve injury in a rat model and investigated its possible molecular mechanisms. Eighteen male Sprague-Dawley rats were used in this study. The rats were randomly divided into three groups: the control, bilateral cavernous nerve crush (BCNC), and BCNC + vitamin D3 groups. BCNC model was established in rats by surgery. The intracavernosal pressure and the ratio of intracavernosal pressure to mean arterial pressure were utilized to evaluate erectile function. Masson trichrome staining, immunohistochemistry, terminal deoxynucleotidyl transferase-mediated dUTP nick end labelling and western blot analysis were performed on penile tissues to elucidate the molecular mechanism. The results indicated that vitamin D3 alleviated hypoxia and suppressed the fibrosis signalling pathway by upregulating the expression of eNOS (p = 0.001), nNOS (p = 0.018) and α-SMA (p = 0.025) and downregulating the expression of HIF-1α (p = 0.048) and TGF-β1 (p = 0.034) in BCNC rats. Vitamin D3 promoted erectile function restoration by enhancing the autophagy process through decreases in the p-mTOR/mTOR ratio (p = 0.02) and p62 (p = 0.001) expression and increases in Beclin1 expression (p = 0.001) and the LC3B/LC3A ratio (p = 0.041). Vitamin D3 application improved erectile function rehabilitation by suppressing the apoptotic process through decreases in the expression of Bax (p = 0.002) and caspase-3 (p = 0.046) and an increase in the expression of Bcl2 (p = 0.004). Therefore, We concluded that vitamin D3 improved the erectile function recovery in BCNC rats by alleviating hypoxia and fibrosis, enhancing autophagy and inhibiting apoptosis in the corpus cavernosum.

Radial wave therapy does not improve early recovery of erectile function after nerve-sparing radical prostatectomy: a prospective trial.

Low intensity shockwave therapy is an emerging treatment option for men with vasculogenic erectile dysfunction. Radial wave therapy (rWT), which differs from focused shockwave (fSWT) as it produces lower pressure waves with lower peak energy, is used to treat soft tissue and skin conditions and has some data to support its use in vasculogenic erectile dysfunction. There is limited data for the use of rWT for the treatment of erectile dysfunction after nerve-sparing (NS) radical prostatectomy. We report the first trial of rWT for penile rehabilitation after NS radical prostatectomy. We performed a prospective, non-randomized, open-label trial. Men with good pre-operative erectile function who underwent a NS radical prostatectomy at our institution from 2018-2020 were considered for inclusion. We compared post-operative erectile function outcomes between the rWT (6 weekly treatments initiated approximately 2 weeks post-operatively) plus standard of care (phosphodiesterase type 5 inhibitor) arm and the non-sham controlled standard of care arm. The primary end point for our study was the proportion of men who returned to "near normal" erectile function, defined as IIEF-5 score ≥17 and erectile hardness score (EHS) ≥3, by 3 months post-operatively between the intervention and control arm. We also compared mean IIEF-5 scores and median EHSs between the arms. One hundred and six patients were enrolled, of whom 73 patients had at least one reported survey response between 6 and 12 weeks post-operatively. Five (17%) and 11 (26%) patients recovered erectile function in the control and intervention arms, respectively, which was not a statistically significant difference (P=0.37). However, the intervention arm did have a significantly higher median EHS compared to the control arm (1 vs. 2, P=0.03). There were 4 adverse events related to pain during treatment and required only treatment intensity de-escalation. rWT is safe but did not substantially improve the recovery of early erectile function after NS radical prostatectomy.

Sapheno-Cavernous Shunt: A Vascular Approach In The Treatment Of Ischemic Priapism.

Priapism is an urologic emergency defined as an erection that persists for more than 4 hours and is unrelated or lasts beyond sexual stimulation. Ischemic priapism, caused by prolonged venous occlusion within the corporal bodies, works as a compartment syndrome that requires prompt resolution in order to preserve erectile function. We present two cases of ischemic priapism refractory to conventional treatment that were treated with the help of vascular surgeons. In both cases a sapheno-cavernous shunt was effective in achieving detumescence and erectile function recovery. Despite rarely described in literature, this can be a safe and effective technique in the treatment of ischemic priapism.

Synergistic Effect of Yemeni Sesame Oil and Squalene on Hyperlipidemia-induced Reproductive Damage in Male Rats

This study was purposed to explore the synergistic amelioration effect and optimal feeding time of sesame oil and squalene on hyperlipemia-induced sexual dysfunction rats. We established the hyperlipidemia-induced reproductive damage model, the three groups of test substances (sesame oil, a mixture of sesame oil and squalene, and sildenafil) were orally administrated to those hyperlipidemic rats on day 30 and day 60. The results showed that compared with the pure sesame oil, the mixture of sesame oil and squalene can synergistically decrease concentration levels of TG, TC, and LDL-C, significantly increasing the serum testosterone level and sperm count of the epididymal tail, which the 30 days’ effect was better than the day 60. Compared with the model control (MC) group, the Organ Coefficient of penile increased significantly in the sesame oil (SO), sesame oil+ Squalene (SOS), and Sildenafil (SN) group, and no pathological changes were found in the penile and testis in above three groups at the day 30 and the day 60. In conclusion, the present results demonstrated that sesame oil and squalene have a synergistic amelioration effect on lowering blood lipid and promoting the recovery of erectile and sexual function on hyperlipemia-induced reproductive damage rats at day 30. However, further studies should be carried out to deeply elucidate the molecular mechanisms of Sesame oil and squalene in lowering blood lipids and improving sexual function in vivo.

Surgical gestures as a method to quantify surgical performance and predict patient outcomes

How well a surgery is performed impacts a patient’s outcomes; however, objective quantification of performance remains an unsolved challenge. Deconstructing a procedure into discrete instrument-tissue “gestures” is a emerging way to understand surgery. To establish this paradigm in a procedure where performance is the most important factor for patient outcomes, we identify 34,323 individual gestures performed in 80 nerve-sparing robot-assisted radical prostatectomies from two international medical centers. Gestures are classified into nine distinct dissection gestures (e.g., hot cut) and four supporting gestures (e.g., retraction). Our primary outcome is to identify factors impacting a patient’s 1-year erectile function (EF) recovery after radical prostatectomy. We find that less use of hot cut and more use of peel/push are statistically associated with better chance of 1-year EF recovery. Our results also show interactions between surgeon experience and gesture types—similar gesture selection resulted in different EF recovery rates dependent on surgeon experience. To further validate this framework, two teams independently constructe distinct machine learning models using gesture sequences vs. traditional clinical features to predict 1-year EF. In both models, gesture sequences are able to better predict 1-year EF (Team 1: AUC 0.77, 95% CI 0.73–0.81; Team 2: AUC 0.68, 95% CI 0.66–0.70) than traditional clinical features (Team 1: AUC 0.69, 95% CI 0.65–0.73; Team 2: AUC 0.65, 95% CI 0.62–0.68). Our results suggest that gestures provide a granular method to objectively indicate surgical performance and outcomes. Application of this methodology to other surgeries may lead to discoveries on methods to improve surgery.

Combining effect of camellia oil and squalene on hyperlipidemia-induced reproductive damage in male rats.

Camellia oil (CO), a common edible oil in China, contains a variety of active ingredients. In this study, we explored the combining effect and optimal feeding time of CO and squalene on hyperlipemia-induced reproductive damage rats and probably provided supportive data for use of CO for health benefits. We established the hyperlipidaemia-induced reproductive damage model, and then the successfully modeled rats were randomly classified into four groups including a model control (MC) group, a camellia oil (CO) group, a camellia oil + squalene (COS) group, and a sildenafil (SN) group, which were feeding with different subjects during days 30 and 60. The normal (NC) group was fed under the same conditions. Our results showed that compared with the MC group, the CO, COS, and SN groups could significantly decline the serum TG, TC and LDL-C levels, increase the serum testosterone levels, the sperm counts in epididymidis and organ coefficients of penises, and no pathological change in penis and testis at days 30 and 60. Compared with the pure CO, the mixture of CO and squalene could significantly enhance the effect of decreasing the concentrations of TG, TC, and LDL-C and increasing the serum testosterone level and sperm count of epididymal tail, and the results of day 30 were better than those of day 60. CO and squalene have a combining effect on lowering blood lipid, improving the level of testosterone and the number of epididymal tail sperm, and promoting the recovery of erectile and sexual function on hyperlipidemia-induced reproductive damage rats on day 30.

New therapies for neurovascular bundles regeneration after radical prostatectomy: A narrative review on clinical studies

Prostate cancer is the most common cancer amongst men, and one of its treatments in the localized stage is radical prostatectomy (RP). This technique achieves a high success rate regarding oncological results, but one of its main drawbacks are sexual disorders, especially erectile dysfunction, ranging from 14-90% of the cases. Therefore, surgery advancements in the last decade have been focused on minimizing the impact on patient’s functioning. Now is time for a step forward in the recovery of functional outcomes after RP. Bioengineering solutions such as stem-cell therapy and tissue engineering hold great opportunities for the treatment of all tissues and organs dysfunctions, which may help in neuroprotection and neuro-regeneration. Specifically, the use of Dehydrated human amnion/chorion membrane (dHACM) allografts and chitosan membranes (ChiMe) aims at reconstructing damaged neurovascular plexuses of the urogenital system to support erectile function recovery. Some research is being done on this topic, and promising results are emerging.

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.

SC23 - Effect of a standardized rehabilitation program on erectile function recovery after robot-assisted radical prostatectomy

SC23 - Effect of a standardized rehabilitation program on erectile function recovery after robot-assisted radical prostatectomy

The Role of Post-Radical Prostatectomy Testosterone Therapy in Erectile Function Recovery

The relationship between androgens and prostate cancer (PC) continues to be a source of much controversy within the urologic community. It is well established that low endogenous testosterone levels correlate with increased prevalence of erectile dysfunction and that exogenous testosterone therapy (TT) significantly decreases this risk. Although TT is often used for these purposes in the general patient population, the application of TT to patients with a history of PC is dismissed due to questions regarding oncologic safety and recurrence risk. However, for patients presenting with symptomatic hypogonadism and no evidence of PC after definitive treatment, the benefits of TT on surgical recovery, erectile function (EF), and quality of life are significant. In this regard, the review seeks to present published data regarding the oncologic safety and therapeutic efficacy of TT use for improved EF recovery in patients with post-radical prostatectomy.

Impact of Early Dorsal Venous Complex Ligation on Urinary Continence Recovery after Robot-assisted Radical Prostatectomy: Results from a Phase 3 Randomized Controlled Trial

BackgroundWhether early ligation of the dorsal venous complex (DVC) might improve recovery of urinary continence (UC) after robot-assisted radical prostatectomy (RARP) has never been investigated in a prospective randomized study. ObjectiveTo assess whether early DVC ligation might affect UC recovery after RARP. InterventionDVC ligation (early vs standard). Design, setting, and participantsA total of 312 patients with prostate cancer underwent primary RARP at a tertiary care institution. Outcome measurements and statistical analysisThe primary outcome was UC recovery at 1 and 4 mo after RARP. UC was defined as 0 pads/1 safety pad per day. All patients completed the International Prostate Symptom Score (IPSS) and International Consultation of Incontinence Questionnaire (ICIQ)-Short Form questionnaires. Secondary outcomes were early (≤4 mo) erectile function recovery, the positive surgical margin (PSM) rate, 30-d Clavien-Dindo complications, and biochemical recurrence rates. Quality of life was assessed using the EQ-5D-5L questionnaire. The association between treatment arm and UC recovery was also tested using multivariable regression models. Results and limitationsAfter surgery, 23 patients withdrew their consent and 29 were lost to follow-up, leaving 261 patients available for per-protocol analyses. Of these, 32 patients (24%) in the experimental group and 37 (29%) in the control group used no pad/one safety pad at 1 mo after RARP, whereas 96 (72%) in the control group versus 83 (65%) in the control group were continent at 4-mo follow-up (both p = 0.3). Median ICIQ and IPSS scores did not differ between the groups at both time points. The results were confirmed on multivariable regression analyses. PSMs were observed for 32 patients (25%) in the experimental group versus 30 (22%) in the control group (p = 0.6). The incidence of postoperative complications (17% experimental vs 13% control) and the 1-yr biochemical recurrence–free survival did not differ between the groups. ConclusionsIn this randomized clinical trial, we did not find evidence that early ligation of the DVC during RARP was associated with better UC recovery after surgery in comparison to the standard technique. Given its safety in terms of surgical margins and complications, this technique may be considered as an option for surgical dissection according to the physician’s preference. Patient summaryOur trial showed that for patients undergoing robot-assisted surgical removal of the prostate, the timing of a specific step to control bleeding from a network of veins draining the prostate did not affect recovery of urinary continence after surgery. The results indicate that earlier control of these veins may be considered as an option according to the surgeon’s preference.

Comparison of Three Approaches to Single-Port Robot-Assisted Radical Prostatectomy: Our Institution's Initial Experience.

Background: We aimed to compare three robot-assisted radical prostatectomy (RARP) approaches-Retzius sparing (RS), extraperitoneal (EP), and transperitoneal (TP)-performed at our institution using the da Vinci® single-port (SP) platform (Intuitive Surgical, Sunnyvale, CA). Materials and Methods: We retrospectively reviewed the records of 101 patients who underwent SP-RARP at our institution and stratified them into three cohorts based on the RARP approach: RS (n = 32), EP (n = 30), and TP (n = 39). Data regarding preoperative patient characteristics, perioperative characteristics, oncologic outcomes, and early functional outcomes were collected. The Fisher's exact test and chi-square tests were utilized for categorical variables, and the Kruskal-Wallis test was utilized for numerical variables. Wilcoxon rank-sum tests were utilized for pairwise comparisons. A two-tailed p < 0.05 was considered significant. Results: All three cohorts were largely similar in terms of preoperative patient characteristics. Operative time was significantly different between cohorts (p < 0.001), with the RS approach having a faster mean operating time than the TP approach (208 ± 40 minutes vs 248 ± 36 minutes, p < 0.001). Clinically significant margin rates did not differ significantly between cohorts (p = 0.861). Postoperative continence differed significantly between cohorts (p < 0.001); higher continence rates were observed in RS vs EP-94% (30/32) vs 52% (15/29), respectively, p < 0.001. Return of erectile function also differed significantly between cohorts (p = <0.001); higher erectile function recovery rates were observed in RS vs EP-88% (28/32) vs 41% (11/27), respectively, p < 0.001-and in RS vs TP-88% (28/32) vs 60% (22/37), respectively, p = 0.014. Median (IQR) follow-up time was 150 (88-377) days. Conclusions: RS SP-RARP is associated with improved early functional outcomes when compared with both EP and TP approaches. These benefits are achieved while maintaining equivalent oncologic outcomes. Further research is needed to optimize the patient selection paradigm for the SP-RARP approach.