Erectile Function Status Research Articles

(049) Prevalence of Erectile Dysfunction in Men with Stress Urinary Incontinence After Radical Prostatectomy

Abstract Introduction Stress urinary incontinence (SUI) and erectile dysfunction (ED) are significant complications that have a negative impact on patients' quality of life following radical prostatectomy (RP). Objective This study aimed to assess the prevalence of ED in men with SUI who underwent RP the first year after RP. Methods This study included men who underwent RP and followed up for 1 year post-surgery. Men who received androgen deprivation therapy (ADT) or radiation therapy before or after RP were excluded. We performed a descriptive assessment of demographics, comorbidities, erectile function (EF), laboratory, surgical pathology, and nerve-sparing status (NSS). Post-op SUI was described based on the number of pads used per day, categorized as 0 to 1 pad per day (continent or mild/social SUI), 2 pads per day (moderate SUI), and ≥ 3 pads per day (severe SUI) at 3, 6, and 12 months post-RP. ED was described based on IIEF score as normal EF normal (≥24), mild ED (18-23), moderate ED (11-17), and severe ED (≤10) at 3, 6, and 12 months post-RP. We reported the prevalence of ED among men with SUI during the first year after RP. We assessed if the severity of the SUI was a predictor of severe ED in a multivariable logistic regression model at 3, 6, and 12 months post-RP. Factors entered into the model included: patient age, number of comorbidities (≥ 3), NVB status (both resected), pre-RP EF, PDE5i exposure post-RP (yes), and severe SUI (≥ 3 pads per day). Results 9953 men were included in this study, with a median age of 62 (56, 67). The median number of comorbidities was 1 (0, 2). 10% had diabetes, 27% obstructive sleep apnea, and 19% reported 3 or more comorbidities. Preoperative median PSA was 5.7 ng/ml, with a median Gleason grade of 2 (2, 3).73% had Bilateral NSS, 20% unilateral, and 7% had both sides resected. The prevalence of severe ED was higher among men with severe SUI compared to men with 0 to 1 pad per day at 3, 6, and 12 months post-RP. At 3 months, men with 0 to 1 pad per day reported 31% no/mild ED and 59% severe ED, vs. men with severe SUI described 18% no/mild ED and 75% severe ED (p-value <0.001). At 6 months, for men with continence/mild SUI, 35% described no/mild Ed and 51% severe ED vs. men with severe SUI who had 20% no/mild ED and 70% severe ED (p-value <0.001). And at 12 months, men with 0 to 1 pad per day reported 42% no/mild ED and 46% severe ED, vs. men with severe SUI described 22% no/mild ED and 70% severe ED (p-value <0.001). In the multivariable regression model, severe SUI significantly predicted severe ED at 3, 6, and 12 months (Table1). Conclusions Men experiencing severe SUI have a high prevalence of severe erectile dysfunction. Severe SUI significantly predicted severe ED during the first year following RP. Disclosure No.

(039) Clinical Outcomes of Corporal Burnett “Snake” Maneuver Modification for Ischemic Priapism

Abstract Introduction The conventional approach for managing ischemic priapism (IP) involves a stepwise process that includes corporal aspiration and irrigation, intracavernosal sympathetic agent injection, shunt surgeries with or without snaking, and penile prosthesis implantation. It is crucial to determine the most appropriate surgical shunt procedure for patients who do not achieve detumescence with medical treatment, as complication rates are known to increase with ischemia time. Objective This study compared the effectiveness and clinical outcomes of distal penile shunt procedures with or without corporal Burnett "Snake" maneuver in patients presenting with IP. Methods We conducted a retrospective study involving patients who presented to our emergency department with IP and underwent surgical treatment at our institution between 2005 and 2021. The patients were divided into two groups: Group 1 (n = 26) underwent distal shunt + Burnett snake maneuver, and Group 2 (n = 56) underwent distal shunt-only. Clinical history, clinical parameters of IP, medical and surgical treatment details, and follow-up information, including IP recurrence, erectile function (EF), and complications, were determined through physician-patient interviews during preoperative assessment and postoperative visits. Successful priapism resolution was defined as pain relief, detumescence, and no further intervention required until discharge. Priapism recurrence was defined as a new presentation to the hospital with IP. EF was assessed before distal shunt surgeries and during post-op visits. EF was graded on a 4-point patient-reported scale: 1 = fully rigid, always capable of penetration, 2 = diminished erection, capable of penetration with phosphodiesterase-5 inhibitors, 3 = diminished erection, capable of penetration with intracavernosal/intraurethral injection or vacuum pump, 4 = insufficient erection despite non-surgical treatment methods. Results The patient's demographic characteristics are shown in Table 1. IP resolution was observed in 24 out of 26 patients (92.3%) in Group 1 and in 30 out of 56 patients (53.6%) in Group 2 (p < 0.001) with a single surgical intervention. IP recurrence was observed in 1 out of 24 patients (4.2%) in Group 1 and in 18 out of 30 patients (60%) in Group 2 among those successfully treated with a single surgical intervention (p < 0.001). When comparing the EF status between groups, 6 out of 14 patients (42.8%) in Group 1 compared to 13 out of 26 patients (50%) in Group 2 had functional preservation of EF (level 1 + level 2) after priapism surgery, among those successfully treated with a single surgical intervention which had EF data in their charts (p = 0.66). Conclusions Our study demonstrates that Burnett snake maneuver is more effective than distal shunt-only procedures in resolving acute IP. Furthermore, this technique shows greater success in preventing IP recurrences. Regarding EF recovery, Burnett snake maneuver is at least as successful as distal shunt-only procedures, even in cases with longer ischemia times. Disclosure No.

The Impact of Using Donor Sperm After ICSI Failure in Severe Oligozoospermia on Male Mental Health and Erectile Function.

To analyze the mental health and erectile function status of men using sperm donor during pregnancy after ICSI failure in severe oligoasthenospermia and to provide reference for clinical implementation of more targeted psychological intervention and nursing for this group. A total of 410 sterile men who received assisted pregnancy treatment in our hospital from December 2020 to December 2022 and met the inclusion and exclusion criteria were collected as the study subjects. Among them, 68 patients with severe oligoasthenospermia who used donor assisted pregnancy after ICSI failure were used as the study group. Sixty-eight patients with severe oligoasthenospermia who continued to receive ICSI assisted pregnancy were matched by propensity score 1:1 as control group. General data questionnaire, self-rating Anxiety Scale (SAS), self-rating Depression Scale (SDS), Chinese version of perceived Stress Scale (CPSS) and International Erectile Function Index Rating Scale (IIEF-5) were used to conduct a cross-sectional investigation to compare the mental health and erectile function status of the two groups. There were statistical differences in age and occupational status between the two groups before PSM (P < 0.05), but there was no statistical significance in social demographic data between the two groups after matching (P > 0.05). The incidence of anxiety, depression, stress and erectile dysfunction (ED) in the study group was higher than that in the control group, and there were statistical differences between the two groups (P < 0.05). The use of donor sperm to assist pregnancy has a great impact on the mental health and erectile function of infertile men. Medical personnel should pay attention to the mental health and erectile function of these men, and formulate targeted measures to help these patients actively cope with infertility, so as to improve the life and marriage quality of this group and improve their mental health status.

Reduced Libido Is a Major Factor in Decreased Erectile Function among Men with Mild COVID-19

During the Corona Virus Disease-2019 (COVID-19) pandemic, among men infected with SARS-CoV-2, little attention has been given to reduced libido and its associations with decreased erectile function, even though there may be physical and psychological factors that contribute to the two. So the purpose of the study is to determine the correlation between decreased erectile function and reduced libido in SARS-CoV-2 infected people during the COVID-19 pandemic and to describe the associated clinical, psychic, and lifestyle parameters. We recruited 321 eligible men with SARS-CoV-2 infection in the urology clinic of our hospital. We used the International Index of Erectile Function-5 (IIEF-5), the Patient Health Questionnaire-9 (PHQ-9), 7-item Generalized Anxiety Disorder (GAD-7) module, and Pittsburgh Sleep Quality Index to independently evaluate the subjects, collect relevant data, and analyze the data. In this study, we show that both libido and erectile function were decreased after SARS-CoV-2 infection (p&lt;0.0001), and reduced libido was strongly correlated with decreased erectile function (p&lt;0.0001; odds ratio (OR) = 11.33). In addition, anxiety (OR = 2.41, CI = 1.13–5.23), (p&lt;0.05), symptomatic infection (OR = 3.293, CI = 1.11–11.48), (p&lt;0.05), and body mass index (OR = 0.88, CI = 0.83–0.92), (p&lt;0.05) were also associated with decreased erectile function. So, we think that during the COVID-19 pandemic, for erectile dysfunction patients who decreased erectile function after SARS-CoV-2 infection, we should not only pay attention to patients’ erectile function status but also to patients’ reduced libido status.

Erectile function after different techniques of bulbar urethroplasty: does urethral transection make a difference?

PurposeWe aimed to compare the impact of urethral transection after different techniques of bulbar urethroplasty on erectile function outcome.Materials and methodsWe retrospectively reviewed the records for 245 patients who underwent different urethroplasty techniques for bulbar urethral stricture between February 2013 and January 2021. The comparison between the transecting and non-transecting cohorts included patients’ demographics, clinicopathological features of the urethral stricture, post-urethroplasty erectile function, and success of urethroplasty. Outcomes were erectile function status verified by IIEF5-15 score at preoperative, three months, and 12 months post-surgery. We defined Post-urethroplasty ED as a decrease of 5 points or more.ResultsThe urethroplasty success rate of the entire cohort was 86.9% after a mean follow-up of 45.59 ± 21 months. Out of 245 patients, 18 (7.3%) experienced 90-day complications. Transecting bulbar urethroplasty techniques were performed in 74 patients (30.2%), while non-transecting techniques were performed in 171 patients (69.8%). there were no differences between the cohorts regarding urethroplasty success (87.8% Vs. 86.5%, Mantel-Cox test p = 0.93) or postoperative complications (8.1% Vs. 7%, p = 0.73). Transient ED was evident in the transecting cohort as reported in 8.1% compared to 2.9% for the non-transecting (p = 0.07).Still, but de novo permanent ED was comparable (4.1% Vs. 2.9%, p = 0.65), for transecting and non-transecting, respectively.ConclusionsUnfortunately, some patients who undergo transecting techniques of bulbar urethroplasty experience transient erectile dysfunction that can improve within the first post- urethroplasty year; however, de novo permanent erectile dysfunction is uncommon after different techniques of bulbar urethroplasty and is not predisposed by urethral transection.

The Treatment Satisfaction in Patients and Their Partners Treated with Low-Intensity Extracorporeal Shock Wave Therapy and Sildenafil: A Prospective Non-Randomized Controlled Study.

Phosphodiesterase 5 inhibitors (PDE5Is) and other more invasive options merely provide symptomatic relief rather than a permanent improvement in erectile dysfunction (ED), whereas the long-term improvement in ED via low-intensity extracorporeal shockwave therapy (Li-ESWT) has been confirmed. So far, no comparative study of sildenafil versus Li-ESWT has been conducted with respect to treatment satisfaction. In this study, we aim to compare erectile function status and satisfaction rates in patients who received sildenafil or Li-ESWT for ED. Patients complaining of ED were considered candidates. Participants chose to enter one of two active treatment groups according to their treatment intention-either a 9-week Li-ESWT regimen or 100 mg on-demand sildenafil. The erectile function was evaluated using the erectile function domain of the International Index of Erectile Function questionnaires (IIEF-EF), while the treatment satisfaction was evaluated using the Erectile Dysfunction Inventory of Treatment Satisfaction questionnaires (EDITS). We enrolled 72 participants in the study (42 in the Li-ESWT group and 30 in the sildenafil group). Patients in both groups were young men. Four weeks after the last session, the IIEF-EF score for Li-ESWT and sildenafil was 16.3± 5.5 and 18.3± 6.5 (P >0.05), respectively. The total EDITS index of the patient version and the partner version were similar in the two groups. Among EDITS questions measuring overall satisfaction and efficacy duration, the score was higher in the Li-ESWT group. We found that Li-ESWT may have better satisfaction than on-demand sildenafil for young ED patients. However, further studies are needed to determine the factors influencing satisfaction.

Post Radical Prostatectomy Erectile Dysfunction. A Single Centre Experience.

This study aims to determine the effects of radical retropubic prostatectomy on post-operative erectile function. A total of 50 patients were included in this study, diagnosed with localized prostate cancer, and underwent nerve-sparing radical retropubic prostatectomy. All patients completed the International Index of Erectile Function (IIEF-5) questionnaire pre-operatively and on the third, sixth, and twelfth post-operative month and completed a self-reporting of their satisfaction with their sexual performance. Patients with a history of severe heart disease, were on erectile dysfunction medication, or had a score of 7 or less on the IIEF-5 questionnaire, were excluded from the study. Pre-operatively it was observed that the lower the IIEF-5 score, the higher the biopsy Gleason score. Post-operatively, 16 patients stated that erectile function had returned to the pre-operative IIEF-5 category. In contrast, only 13 of them stated they were happy with their sexual performance on the self-reporting scale. The rest reported dissatisfaction despite returning to their pre-operative erectile function status. IIEF-5 scores were also different when compared amongst the four age groups, with scores indicating that younger age is related to higher IIEF-5 scores. At the 3-month follow-up, no statistically significant difference was observed between age groups. Finally, patients younger than 64 reported significantly less deterioration in post-operative erectile function. Post-radical prostatectomy erectile dysfunction remains one of the most pressing issues in prostate cancer therapy. A higher Gleason score has a more significant impact on pre-operative ED, and at the same time, the best post-operative ED results are observed in younger patients. Finally, patients need extensive follow-up, therapy, and pre-and post-operative psychological support to have the best possible erectile function.

Erectile and voiding function outcomes after buccal mucosa graft urethroplasty for long-segment bulbar urethral stricture: ventral versus dorsal onlay technique.

To compare the impact of dorsal versus ventral onlay buccal mucosa graft bulbar urethroplasty on postoperative erectile function status. We retrospectively reviewed the records for 232 patients who underwent dorsal and ventral onlay buccal mucosa graft bulbar urethroplasty from March 2012 to April 2021. Outcomes were urinary and erectile function status as assessed by IIEF5-15 score at preoperative, three months, and 12months post-urethroplasty. We compared the dorsal and ventral only techniques at the different follow-up visits using difference-in-differences analysis. 165 patients met our inclusion criteria; the overall success rate was 87.9% after a mean follow-up of 52.3 ± 18.5months. Of the patients, 17.6% experienced a 90-day complication. When comparing dorsal and ventral only techniques, there were no significant differences in terms of success rate (88.3% vs. 87.1%, Mantel-Cox test p = 0.68) or postoperative complications (15.5% Vs. 19.4%, p = 0.3). Likewise, there was no significant difference between both techniques regarding postoperative erectile function as assessed by IIEF5-15 score after three months (26.28 ± 2.53 Vs. 26.37 ± 2.41; p = 0.836) and twelve months (26.88 ± 2.45 Vs. 26.48 ± 1.98; p = 0.532). We detected a post-urethroplasty transient ED in (3.9% vs. 1.6%; p = 0.41), and permanent ED in (1.9% vs. 3.2%; p = 0.6) for dorsal and ventral onlay, respectively. Onlay Buccal mucosa graft urethroplasty is a highly effective surgery in treating long-segment bulbar urethral stricture. The dorsal and ventral only techniques were comparable regarding urinary and erectile function outcomes. Additionally, both techniques have no significant negative impact on post-urethroplasty erectile function status.

MP36-14 THE EFFECT OF RENAL TRANSPLANTATION ON ERECTILE FUNCTIONS IN PATIENTS WITH END-STAGE RENAL DISEASE

You have accessJournal of UrologyCME1 May 2022MP36-14 THE EFFECT OF RENAL TRANSPLANTATION ON ERECTILE FUNCTIONS IN PATIENTS WITH END-STAGE RENAL DISEASE Serdar Karadag Serdar KaradagSerdar Karadag More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002590.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Erectile dysfunction (ED) is defined as the inability to achieve and maintain an erection sufficient to allow satisfactory sexual performance. In end-stage renal disease (ESRD), ED is an important problem that impairs quality of life. The incidence of ED may increase up to 84%, especially in ESRD patients receiving hemodialysis. Our aim is to determine the effect of renal transplantation on erectile functions in ESRD patients and patient-related factors affecting this change. METHODS: Data of patients with ESRD who had a renal transplant at our center from January 2015 to August 2020 were reviewed retrospectively. All male patients who had a kidney transplant for any reason and whose data were not missing were included. The patients were screened for erectile functions before kidney transplantation and at the 1st, 3rd and 12th months after transplantation. The International Index of Erectile Function (IIEF-5) evaluation questionnaire was used as a measure of erectile functions. The total scores were calculated, with normal erectile function defined as a score of 22 to 25; cases of ED were classified as mild (12–21), moderate (8–11), or severe (5–7). RESULTS: The mean age of 55 patients included in the study was 39.7±10.9 years. Mild ED was detected in 21 patients (38.2%), moderate ED in 19 patients (34.5%), and severe ED in 10 patients (18.2%). Preoperative mean IEFF-5 score was calculated as 13.8±5.5, 14.3±5.7 at 1st month, 16.9±6.8 at 3rd months, and 18.4±6.9 at 12th months. In the evaluation of erectile function, no significant improvement was observed in erectile functions at post-transplant 1st month (p>0.05), while significant improvements were noted at postoperative 3rd and 12th months (p=0.03, p=0.02, respectively). When the change in IEFF-5 score was evaluated between 3rd and 12th months, there was a statistically significant difference (p=0.04). Age, diabetes, hypertension, coronary artery disease, transplantation time and preoperative IEFF-5 score were found to be significantly associated with postoperative IEFF-5 score changes at the 3rd and 12th months. (p<0.05). CONCLUSIONS: Our data show that kidney transplantation improves erectile function in ESRD patients. Age, diabetes, hypertension, coronary artery disease, transplantation time and pre-transplant erectile function status were found to be significantly associated with postoperative erectile function changes. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e602 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Serdar Karadag More articles by this author Expand All Advertisement PDF DownloadLoading ...

Long term erectile function results of radical perineal prostatectomy

IntroductionAlthough many patients are being treated by radical prostatectomy (RP), there is still insufficient information about the changes in long-term erectile function after RP. Our aim is to examine long term, up to 5 year erectile function status of patients after Radical Perineal Prostatectomy (RPP). Materials and methodsOne hundred and thirty-two patients, who underwent bilateral nerve-sparing Radical Perineal Prostatectomy (RPP) in between January 2012 and January 2017, with preoperative age≤70, prostate volume<80g, transrectal ultrasound (TRUS) guided biopsy Gleason score (GS)<7, prostate specific antigen (PSA) value<10ng/mL, and cT stage≤2 (N0, M0) were included into this study. Exclusion criteria were previous cardiovascular diseases, serious chronic renal and/or hepatic insufficiency, neurological diseases, uncontrolled diabetes mellitus, and severe lung diseases. Patients who received additional treatment (hormonal and/or radiotherapy) after RPP were also excluded from the study group. Erectile function was evaluated before surgery and at postoperative 3rd, 12th, and 60th months. Patients with an “International Index of Erectile Function (IIEF) – 5” score of ≥21 and patients whose IIEF-5 scores were between 16 and 20 but responded as “yes” to the “Sexual Encounter Profile (SEP) – 2” and “SEP-3” questions were accepted as having normal erectile function. ResultsOut of the 132 patients, 96 (72.7%) of the patients were found to be potent in the first postoperative year. A total of 118 patients were evaluated at the end of 5 years. Eighty seven (73.7%) patients had normal erectile function according to our criteria. DiscussionAccording to the results of our study, short term and long term erectile function outcomes of patients undergoing RPP were favorable and there was no statistically significant difference between short and long term results.

Relationship between COVID-19 and Male Sexual Dysfunction; A Prospective, Multicentric Study.

Sexual function is an excellent marker of psychological, systemic, and specifically vascular performance. Endothelial dysfunction is the main determinant of coronavirus disease 2019 (COVID-19) symptoms. Considering the adverse effects of the COVID-19 pandemic on psychological and sexual functions, we hypothesized potential differences and underlying factors if there is any erectile function and premature ejaculation status of male patients with COVID-19 by comparing both with the control group. Hospitalized male patients diagnosed with COVID-19 pneumonia were evaluated. Male patients who applied to the Urology outpatient clinic were the control group. All participants completed the International Index of Erectile Function Form-15 (IIEF-15) and gave information regarding their premature ejaculation (PE) status if present. COVID-19 patients were called by phone to fill in the IIEF-15. Their PE status was questioned on the 45th and 90th days after discharge. The following parameters were in the data records: Age, comorbidity, length of hospital stay, treatment, oxygen saturation, pulmonary involvement, white blood cell (WBC), C-reactive protein (CRP), ferritin, fibrinogen, D-dimer, and sedimentation values. The study had 253 participants, including 168 COVID-19 patients and 85 volunteers as the control group. The number of PE cases was less, whereas erectile dysfunction (ED) cases were more in the COVID-19 patient group in comparison to the control group in the pre-pandemic period (p = 0.00) (p = 0.00). In the post-pandemic period, PE developed in 13 more COVID-19 patients on the 45th and 90th days (p = 0.00). The IIEF-15 scores of COVID-19 patients decreased by 4-point in the short term and by 3-point in the long term (p = 0.002). Age and sedimentation were responsible for the difference in PE status. On the other hand, comorbidity, length of hospital stay, treatment type, WBC, D-dimer, ferritin, CRP levels, and pulmonary infiltration were responsible for the difference in ED. Based on our findings, we can say that we have enough evidence to suspect COVID-19 sequelae can affect male sexual health. After the pandemic, male patients with andrological problems should have enough time to feel more comfortable and their organic and psychogenic conditions should be optimized.

PD20-12 HYPERBARIC OXYGENATION THERAPY IN SEXUAL RECOVERY AFTER RADICAL PROSTATECTOMY

You have accessJournal of UrologySexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy I (PD20)1 Sep 2021PD20-12 HYPERBARIC OXYGENATION THERAPY IN SEXUAL RECOVERY AFTER RADICAL PROSTATECTOMY Ragif Veliev, Eugeniy Veliev, and Yegor Sokolov Ragif VelievRagif Veliev More articles by this author , Eugeniy VelievEugeniy Veliev More articles by this author , and Yegor SokolovYegor Sokolov More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002009.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Erectile function (EF) preservation remains an important goal in maintaining quality of life after radical prostatectomy (RP). A number of methods have been proposed to improve the recovery of EF after RP, however the current results cannot be considered optimal. The aim of this study is to evaluate the efficacy of hyperbaric oxygenation therapy (HOT) on sexual function rehabilitation in patients after nerve-sparing RP (nsRP) METHODS: The study comprised 76 patients with preserved EF prior to surgery, which were randomized into two groups. Group 1 (n=36) received HOT course (10 x 90 min sessions, 100% oxygen at 2.0 ATA) during first month after RP; group 2 (n=40) had no postoperative therapy. Patients in both groups received no additional therapy with the aim of sexual rehabilitation (PDE5 inhibitors, prostaglandins, etc.). Both groups did not differ in the age of patients at the time of RP, prostate volume, body mass index, clinical stage, grade group, IIEF score before surgery and the proportion of uni- and bilateral nsRP (p>0.05). EF status was assessed by IIEF-15 questionnaire. A comparative analysis of the dynamics of EF restoration in both groups was performed. RESULTS: One year after surgery, full EF recovery in the HOT group was observed in 28 versus 19 cases in the control group (76.5% vs 47.6%, p=0.001), primarily because of positive HOT effect on EF rehabilitation in unilateral nsRP cases (77.7% vs 40%, p=0.003). HOT after bilateral nsRP did not have a significant effect on the recovery of EF (75% vs 71,4%, p=0.3). Use of HOT had no influence on orgasmic function rehabilitation (82.4% vs 81%, p>0.05). No biochemical recurrences were observed in the HOT group. CONCLUSIONS: HOT may be considered as possible EF rehabilitation method in patients after unilateral nsRP. According to the early results, use of HOT in postoperative period doesn’t exceed the risk of biochemical recurrence. Further efficacy and safety assessment is needed as well as evaluation of an optimal scheme and terms of the treatment. Source of Funding: No source of funding © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e371-e372 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ragif Veliev More articles by this author Eugeniy Veliev More articles by this author Yegor Sokolov More articles by this author Expand All Advertisement Loading ...

MP27-04 BASELINE PREOPERATIVE ERECTILE FUNCTION AND CARDIOVASCULAR MORTALITY AFTER RADICAL PROSTATECTOMY

You have accessJournal of UrologySexual Function/Dysfunction: Evaluation I (MP27)1 Sep 2021MP27-04 BASELINE PREOPERATIVE ERECTILE FUNCTION AND CARDIOVASCULAR MORTALITY AFTER RADICAL PROSTATECTOMY Egor Sokolov, Evgeny Veliev, Ragif Veliev, Andrey Bogdanov, and Dmitry Goncharuk Egor SokolovEgor Sokolov More articles by this author , Evgeny VelievEvgeny Veliev More articles by this author , Ragif VelievRagif Veliev More articles by this author , Andrey BogdanovAndrey Bogdanov More articles by this author , and Dmitry GoncharukDmitry Goncharuk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002024.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A number of studies show an obvious connection between erectile dysfunction (ED) and the development of cardiovascular diseases (CVD), which occupy one of the leading places in the structure of mortality in cancer patients. In these circumstances, it is potentially promising to use the erectile function (EF) status before surgery as an indicator of the general health of patients and a predictor of overall survival (OS). The objective was to study the causes of death of patients with prostate cancer (PC) after radical prostatectomy (RP) and evaluate OS depending on the preoperative EF. METHODS: The study is based on a series of 2642 RP performed at one medical institution between January 2003 and December 2017 Total of 1203 patients met the inclusion criteria and were divided into two groups: 620 patients with preserved EF or mild preoperative erectile dysfunction (ED) according to the five-item International Index of Erectile Function (IIEF-5) score (group 1) and 583 patients with mild-to-moderate, moderate or severe preoperative ED (group 2). The Mann-Whitney U test and chi-square test were used for statistical analysis. Survival was assessed using the Kaplan-Meier method with a log-rank test. RESULTS: A total of 101 deaths were observed in the study cohort; the median time to death was 72 months. Cardiovascular diseases (CVD) were the cause of death in 43.6% of patients, PC - 30.7%, other oncological diseases - 19.8%, other causes - 5.9%. There were no significant differences between the groups in age, body mass index, or degree of comorbidity. Biochemical relapse was observed in 19.8% in the group with preserved EF and 20.7% in the group with a baseline IIEF score <17 (p = 0.76). In the group with higher EF before RP, there was a tendency to higher 10- and 15-year OS: 92.8% and 83.7% versus 89.7% and 82.5%, respectively (p=0.074). Significant differences between the groups were observed in the mortality from CVD: in the group with higher IIEF score, almost three times less patients died from CVD (12 and 32), and cardiovascular survival was 97.8% and 93.5% versus 96.7% and 91.6% after 10 and 15 years (p=0.0014). CONCLUSIONS: A lower baseline EF is associated with higher cardiovascular mortality in patients after RP. The preoperative IIEF-5 score could be used as one of the predictors of further cardiovascular events and OS of patients. This can be helpful in preoperative selection of patients as well as initial treatment planning. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e473-e473 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Egor Sokolov More articles by this author Evgeny Veliev More articles by this author Ragif Veliev More articles by this author Andrey Bogdanov More articles by this author Dmitry Goncharuk More articles by this author Expand All Advertisement Loading ...

Effect of vesicourethral anastomosis technique on functional results in retropubic radical prostatectomy.

We aimed to compare the functional results of two different vesicourethral anastomosis (VUA) techniques used in open retropubic radical prostatectomy. A total of 476 patients including the first group with four-focus VUA at 12-, 3-, 6-, and 9-o'clock positions (n=288) and the second group with six-focus VUA at 12-, 2-, 4-, 6-, 8-, and 10-o'clock (n=188) were included in the study. Perioperative data, erectile function, and continence status over a 12-month period were compared. Demographic and perioperative data were similar between two groups. The number of patients with VUA stricture in the first group was significantly higher those in the second group (5.1% vs 3.2%, P=.017). The mean time to stricture development was also shorter in the first group (48.9 vs 74.3days, P=.002). The number of continent patients at the 6th and 12th months were higher in the second group (79.3% vs 62.8%, P<.001; 92.4% vs 81.3%, P=.032, respectively). There was no significant difference between two groups in terms of the number of potent patients (P=.194 for 6months and P=.351 for 12months). Better continence results can be provided with the six-focus VUA technique compared with the four-focus technique. The number of anastomotic sutures in VUA may affect functional results and can be a determinative factor for surgeons who focus on functional results as well as oncological results.

The effect of hyperbaric oxygenation on the sexual function recovery in patients after radical prostatectomy

Introduction. Necessity of the functional results’ improvement after radical prostatectomy (RP) stimulates research of additional rehabilitation methods of the patients. The aim of this research is study of the hyperbaric oxygenation (HBO) efficacy on erectile function (EF) rehabilitation in patients after RP with nerve-sparing surgery (NSS). Materials and methods. This study analyzed the data of 37 patients with normal EF prior to surgery. Randomization into two groups was performed: patients who received HBO course (17 patients) and control group (20 patients) who had no postoperative therapy. The HBO course included 10 90-minutes sessions. Unilateral NSS was performed in 24 cases (64,9%), bilateral NSS – in 13 cases (35,1%). EF status was assessed by IIEF-15 questionnaire, biochemical recurrence was registered in PSA &gt; 0,2 ng/ml after the surgery. Clinical practice and results. Full EF rehabilitation in HBO group in one year was registered in 13 cases (76,5%) versus 9 cases in control group (45%, p=0,03). HBO had statistically significant influence on EF rehabilitation only in unilateral NSS cases (p=0,037). Use of HBO had no influence of orgasmic function rehabilitation (82,4% versus 80% in control group, p&gt;0,05). No biochemical recurrence was registered in the HBO group. Conclusion. The HBO application in RP with unilateral NSS may be considered as perspective possible EF rehabilitation method. According to the early results use of HBO in postoperative period doesn’t exceed the risk of cancer recurrence. Further method efficacy and safety assessment is needed as well as evaluation of an optimal scheme and terms of the treatment.

Radiation-Induced Erectile Dysfunction in Prostate Cancer Patients: Up-to-Date View on Pathogenesis

The true causes of sexual disorders after radiation treatment of prostate cancer, among which the central role is occupied by erectile dysfunction, are still not fully clarified. The number of patients who undergo various radiation-exposure options as a radical therapy is steadily increasing, which makes the issue very relevant. This literature review provides up-to-date data on the most studied probable mechanisms of the erectile function status decline after radiation therapy for prostate cancer.

Early Results of Unilateral Prostatic Artery Embolization as a Focal Therapy in Patients with Prostate Cancer under Active Surveillance: Cancer Prostate Embolisation, a Pilot Study

PurposeTo evaluate the feasibility of prostatic artery embolization in patients with low-risk prostate cancer (PC) under active surveillance (AS). MethodsThis monocentric prospective pilot study, running from June 2018 to June 2019, included 10 patients with low-risk PC under AS, median age 72 years (range, 62–77 years), with a unilateral focal lesion visible on magnetic resonance (MR) imaging, with Prostate Imaging Reporting and Data System v2 score ≥3/5 confirmed by multiparametric MR imaging-targeted biopsy and Gleason score 6. The patients underwent unilateral prostatic artery embolization with 300–500 μm Embospheres in the affected prostatic lobe. The primary endpoint was technical feasibility (prostate and no off-target ischemia in the imaging). The secondary endpoints included safety, negative biopsies/MR imaging response/functional outcomes at 6 months, and oncologic efficacy at 1 year. ResultsEmbolization was successfully achieved in all patients; prostate ischemia was confirmed on multiparametric MR imaging, and no off-target ischemia was reported. No major complications were reported. Four patients (40%) presented with both negative targeted and systematic biopsies at 6 months. No lesions were seen on the MR imaging in 30% of patients. The mean International Prostate Symptom Score and International Index of Erectile Function score were 7 and 19 and 5 and 20 at baseline and 6 months, respectively, with no significant difference. Nine patients (90%) were still under AS at 1 year. One patient (10%) had PC progression outside the target lesion and was switched over to curative radiotherapy. ConclusionsProstatic artery embolization is feasible and appears safe for prostate cancer patients under AS, with no impact on erectile function or continence status. These results justify the pursuit of further studies.

Radiation-induced erectile dysfunction in patients with prostate cancer: current methods of radiotherapy

In recent years, significant changes have taken place in the treatment of prostate cancer. Modern radiation treatment technologies are beginning to take a leading position not only in localized and locally-advanced forms of the disease, but also in the case of oligometastatic process. This encourages a natural interest in various aspects of radiation therapy of prostate cancer, in particular its effects on erectile function status. Analysis of domestic literature shows the complete absence of publications on the technical possibilities of radiation therapy to preserve potency after treatment. The purpose of this work was to highlight this critical issue.

Baseline erectile function and overall survival after radical prostatectomy

Introduction. A number of studies show an obvious connection between erectile dysfunction (ED) and the development of cardiovascular diseases (CVD), which occupy one of the leading places in the structure of mortality in cancer patients. In these circumstances, it is potentially promising to use the erectile function (EF) status before surgery as an indicator of the general health of patients and a predictor of overall survival (OS). Purpose of the study. To study the causes of death of patients with prostate cancer (pca) after radical prostatectomy (RP) and evaluate OS depending on the preoperative EF. Materials and methods . The study is based on a series of 2642 Rp performed at one medical institution between January 2003 and December 2017. Total of 1203 patients met the inclusion criteria and were divided into two groups: 620 patients with preserved EF or mild preoperative erectile dysfunction (ED) according to the five-item International Index of Erectile Function (IIEF-5) score (group 1) and 583 patients with mild-to-moderate, moderate or severe preoperative ED (group 2). The Mann-Whitney U test and chi-square test were used for statistical analysis. Survival was assessed using the Kaplan-Meier method with a log-rank test. Results. A total of 101 deaths were observed in the study cohort; the median time to death was 72 months. Cardiovascular diseases (CVD) were the cause of death in 43.6% of patients, pc — 30.7%, other oncological diseases — 19.8%, other causes — 5.9%. There were no significant differences between the groups in age, body mass index, or degree of comorbidity. Biochemical relapse was observed in 19.8% in the group with preserved EF and 20.7% in the group with a baseline IIEF score &lt;17 (p = 0.76). In the group with higher EF before RP, there was a tendency to higher 10- and 15-year OS: 92.8% and 83.7% versus 89.7% and 82.5%, respectively (p = 0.074). Significant differences between the groups were observed in the mortality from cVD: in the group with higher IIEF score, almost three times less patients died from CVD (12 and 32), and cardiovascular survival was 97.8% and 93.5% versus 96.7% and 91.6% after 10 and 15 years (p = 0.0014). Conclusions. A lower baseline EF is associated with higher cardiovascular mortality in patients after Rp. The preoperative IIEF-5 score could be used as one of the predictors of further cardiovascular events and OS of patients. This can be helpful in preoperative selection of patients as well as initial treatment planning.

Risk of erectile dysfunction after modern radiotherapy for intact prostate cancer.

Erectile dysfunction (ED) is a prevalent side effect of prostate cancer treatment. We hypothesized that the previously reported rates of ED may have improved with the advent of modern technology. The purpose of this project was to evaluate modern external beam radiotherapy and brachytherapy techniques to determine the incidence of radiotherapy (RT) induced ED. A systematic review of the literature published between January 2002 and December 2018 was performed to obtain patient reported rates of ED after definitive external beam radiotherapy, ultrafractionated stereotactic radiotherapy, and brachytherapy (BT) to the prostate in men who were potent prior to RT. Univariate and multivariate analyses of radiation dose, treatment strategy, and length of follow-up were analyzed to ascertain their relationship with RT-induced ED. Of 890 articles reviewed, 24 met inclusion criteria, providing data from 2714 patients. Diminished erectile function status post RT was common and similar across all studies. The median increase in men reporting ED was 17%, 26%, 23%, and 23%, 3DCRT, IMRT, low dose rate BT, and SBRT, respectively, at 2-year median follow-up. ED is a common side effect of RT. Risk of post-RT ED is similar for both LDR brachytherapy and external beam RT with advanced prostate targeting and penile-bulb sparing techniques utilized in modern RT techniques.