Good Erectile Function Research Articles

(169) Penile Fracture and Urethral Injury Repair

Abstract Introduction Penile fracture refers to the rupture of tunica albuginea of the penile corpora cavernosum which most often occur due to trauma during coitus or manual manipulation. This can be associated with either a partial or a complete urethral injury up to 39% of cases, usually those fractures crossing the septum. It is important to address both conditions to ensure sexual and voiding function is maintained. Objective The patient presented in this video is a 35-year-old gentleman who presented to the emergency department post-trauma related to sexual intercourse causing immediate detumescence and swelling. Methods This video describes the penile fracture repair performed using a midline ventral incision repair technique. Prior to surgery the patient is imaged, usually ultrasound, to allow location and marking of the suspected penile fracture. Due to the suspected urethral injury requiring a suprapubic catheter insertion at the presenting hospital, a flexible cystoscopy was performed initially. This showed the urethra was inaccessible at the level of the penile scrotal junction but within the penile urethra. A ventral midline incision along the penile raphe over the suspected fracture site is made. Dartos and Bucks Fascia were dissected to expose the tunica albuginea and allow identification of the fracture site. Further dissection was required to determine the lateral extents of the injury. Stay sutures can then be placed to allow easier closure of the injury. The tunica albuginea was then sutured with PDS sutures, care was taken to ensure these are buried sutures to ensure the patient is unable to palpate these. Subsequently, urethral injury was addressed by performing primary urethral anastomosis. A catheter was introduced through the urethra, a complete transection was seen and the ends were then dissected out to allow an end to end anastomosis to be performed. The anastomosis was checked for a leak with a table urethrogram using dilute betadine. Upon adequate closure of the urethra the ventral midline incision was closed. Results The procedure was successful and uneventful. He has a urethrogram 3 weeks post-op on which no evidence of a leak was shown. This patient went on to have good erectile function at 2 months post-operatively. However, he has a 30-degree ventral curvature which he finds bothersome. This is currently being treated conservatively with a vacuum device. Conclusions The BAUS consensus documents reports erectile dysfunction and penile curvature rates following surgery for penile fracture repair are reported to be 5% and 5% respectively. Conservative management results have a much higher rate of complication with 62% chance of erectile dysfunction and 35% chance of curvature. Disclosure No.

(132) Vertical Fracture of the Penis: A Rare Entity

Abstract Introduction Penile fracture is not an uncommon occurrence. It is a serious injury involving the rupture of the tunica albuginea in the erect state of the penis. While most cases are transverse fractures occurring during coitus, we present a rare case of a “vertical” penile fracture, the second reported in English literature. Objective To document a rare case of penile fracture i.e. a vertical penile fracture and its management. Methods A 33-year-old man presented to the emergency room of the hospital past midnight. He experienced sharp excruciating pain while attempting to penetrate vagina in a rear entry position. He gave a history of popping sound followed by detumescence, and increasing swelling of penis with discoloration and curvature. The pain continued though reduced in severity over time. The patient was evaluated under the guidance of consultant urologist (Author 2). Magnetic resonance imaging reported suspected vertical tear in tunica albugenia and also suspected urethral injury. Results Emergency surgery revealed a vertical long tunica albugenia tear along with corpora spongiosal tear and intact urethral mucosa. The tunica albugenia tear was primarily repaired. Good erectile function was reported by the patient, and normal sexual activity resumed after 6 weeks. Conclusions This case report emphasizes the need for clinicians to be aware of and consider this uncommon entity, “Vertical Tunica Albugenia tear” while managing penile fractures. The utilization of MRI imaging of the penis can provide valuable insights into the pattern and extent of the injury, aiding in appropriate management decision. Surgical intervention within 6–8 hours of the injury offers excellent result and preserves sexual function without complications. Disclosure No.

The role of socioeconomic status and oxidative balance score in erectile dysfunction: A cross-sectional study

BackgroundErectile dysfunction (ED) is a complex disorder of biopsychosocial etiology. Approximately 3%–77 % of adult men worldwide are more or less affected by ED. ObjectiveThis cross-sectional study investigated the association between ED and socioeconomic status (SES) based on a nationally representative adult male population. MethodsThe poverty income ratio (PIR), which refers to household income ratio to the established poverty line, was used to assess SES. Oxidative stress related to diet and lifestyle was reflected by oxidative balance score (OBS). Erectile function was evaluated using a questionnaire. Based on the results of the questionnaire, participants were divided into two groups of those without ED (always or almost always be able to erect and keep erection, usually be able to erect and keep erection) and with ED (sometimes be able to erect and keep erection, never be able to erect and keep erection). Multivariate logistic regression, multiple models, and restricted cubic spline (RCS) were used to analyze and describe the interaction between ED, OBS, and SES. ResultsCompared with men without ED, those with ED were more likely to be older in age (43.98 vs 37.74, P＜0.0001), and less educated (P < 0.001), and with a ratio of family income to poverty less than 3.5 (P = 0.02), higher BMI (30.11 vs 27.84, P＜0.0001), lower OBS (21.71 vs 23.17, P = 0.04), having habit of smoking (P = 0.04), with diabetes (P＜0.0001), and with hypertension (P = 0.003). Participants with higher PIR were more likely to report good erectile function than those with lower PIR through multivariate analysis (OR = 0.49, 95 % CI = 0.31–0.78, P = 0.005). The RCS model revealed a negative non-linear correlation of PIR with ED when PIR ≤3.89. It is interesting to note that PIR was＞3.89 showed a positive non-linear relationship with ED. ConclusionThe social determinants of health and intake of oxidants and antioxidants were considered as risk factors for ED and could be studied as a research focus in the future.

(124) Investigating the Risk Factors of Penile Arterial Insufficiency and Veno-occlusive Dysfunction In Patients with Erectile Dysfunction

Abstract Introduction It was reported that a more generalized peripheral atherosclerotic process is associated with a severer penile arterial insufficiency (PAI), and this in turn was correlated well with decreased blood supply in more important arteries like the coronary and carotid arteries. Objective We investigated the risk factors for PAI which is a known cause of erectile dysfunction (ED Methods Patients who attended our urology clinic complaining of ED for more than 6 months, were prospectively enrolled in this study in one year period. Patient consent was taken and ethical committee approval. Complete medical history and thorough general and local examination including body mass index (BMI), Peyronie’s disease (PD) and penile size measurements (length and girth) were done for all of them. Laboratory tests included testosterone, lipid profile, and glycated haemoglobin (HbA1c). Penile duplex ultrasound study (PDU) was done for all patients after intra-cavernosal injection (ICI) with Alprostadil. peak systolic velocity (PSV) and end diastolic velocity (EDV) were measured after 15 minutes. Statistical analysis was done using SPSS. Results A total of 440 patients were enrolled in this analysis. The mean age was 48 (23-81), and the mean BMI was 30 (18-51). Older patients had lower PSV (r=-0.361, P=0.000) and higher EDV (r=0.174, P=0.001) and both correlations were highly statistically significant. Diabetics had lower PSV (r=-0.318, P=0.000) and higher EDV (r=0.139, P=0.008) which were also highly statistically significant. Hypertensive patients had lower PSV (r=-0.296, P=0.000) which was highly statistically significant. Smokers had lower PSV (r=-0.140, P=0.008) and higher EDV (r=0.178, P=0.001) which were highly statistically significant. Men with larger penises measured skin to tip, had lower EDV (r=-0.119, P=0.024) which was less significant. Interestingly there was neither significant correlation between BMI and PSV (0.16, p=0.745) nor significant correlation between testosterone and PSV (0.029, p=0.552). Also, there was no correlation between PSV and both dyslipidaemia and penile PD. Conclusions Our study highlights key risk factors - Increased age, tobacco consumption, DM and hypertension - are factors that have a statistically significant negative impact on penile haemodynamics. Of these, tobacco consumption, good diabetic control and hypertension are potentially modifiable and should form part of any treatment plan for erectile dysfunction. Other risk factors – increased BMI, low testosterone, PD and penile size – had no statistically significant impact on penile hemodynamics. This allows for targeted advice that can be given to patients who present with this very common problem. Ultimately, good vascular health goes hand in hand with good erectile function. Disclosure No

(406) The “Kiel Knots” Technique for the Treatment of Congenital and Acquired Penile Curvature

Abstract Introduction Penile curvature is not only a cosmetic issue, but can also cause severe organic and psychological problems in the affected patients. It can negatively affect the quality of the person’s sexual life or even ruin a relationship. There are many surgical techniques for correction ranging from the least invasive as plication to more invasive as incision or excision and grafting. Objective We propose a surgical technique for the correction of both congenital and acquired penile curvatures. Our technique is based on modifying and combining the 16-dot and the Essed-Schroeder plication techniques by burying the knots in shallow troughs of the incised tunica albuginea. We entitle this modification as the “Kiel Knots”. In this video, we demonstrate step-by-step the Kiel Knots technique for the correction of a case of dorsal acquired curvature with good erectile function via the subcoronal approach. Methods A circumcising incision is made and the penis is degloved. Buck’s fascia is then incised exposing the tunica albuginea opposite the curvature. Eight dots 5mm apart are marked bilaterally on the tunica albuginea with the point of maximum curvature in the center and a 5 mm superficial incision along the marks is made without cutting into the corpus cavernosum. Instead of plicating with one suture for 4 dots, our modification entails utilizing a separate suture for every two dots with the knot being buried in the shallow trough we created by the scalpel. Results Our average operative time is an hour. An average loss of penile length of 0.5-1cm has been reported in 30% of our patients. All our patients preserved their erectile function. 90% of our patients remained without recurrence of curvature after 2 years of surgery. None of our patients reported problems with their suture knots. Conclusions The Kiel Knots technique achieves penile straightening with minimal loss of length and no erectile dysfunction. We believe that our technique combines the best of Lue’s 16 dot together with the Essed-Schroeder plication techniques while avoiding the downsides of both approaches. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast.

MP45-02 INVESTIGATING THE RISK FACTORS OF PENILE ARTERIAL INSUFFICIENCY AND VENO-OCCLUSIVE DYSFUNCTION IN PATIENTS WITH ERECTILE DYSFUNCTION

You have accessJournal of UrologyCME1 Apr 2023MP45-02 INVESTIGATING THE RISK FACTORS OF PENILE ARTERIAL INSUFFICIENCY AND VENO-OCCLUSIVE DYSFUNCTION IN PATIENTS WITH ERECTILE DYSFUNCTION Mohamad Habous, Ahmed Khattak, Mohammed Nassar, Saleh Binsaleh, and Gordon Muir Mohamad HabousMohamad Habous More articles by this author , Ahmed KhattakAhmed Khattak More articles by this author , Mohammed NassarMohammed Nassar More articles by this author , Saleh BinsalehSaleh Binsaleh More articles by this author , and Gordon MuirGordon Muir More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003291.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It was reported that a more generalized peripheral atherosclerotic process is associated with a severer penile arterial insufficiency(PAI), and this in turn was correlated well with decreased blood supply in more important arteries like the coronary and carotid arteries.Aim We investigated the risk factors for penile arterial insufficiency (PAI), which is a known cause of erectile dysfunction (ED). METHODS: Patients who attended our urology clinic complaining of ED for more than 6 months, were prospectively enrolled in this study in one year period. Patient consent was taken and ethical committee approval. Complete medical history and thorough general and local examination including body mass index (BMI), Peyronie’s disease (PD)and penile size measurements (length and girth) were done for all of them. Laboratory tests included testosterone, lipid profile, and glycated haemoglobin (HbA1c). Penile duplex ultrasound study (PDU) was done for all patients after intra-cavernosal injection (ICI) with Alprostadil. peak systolic velocity (PSV)and end diastolic velocity (EDV) were measured after 15 minutes. Statistical analysis was done using SPSS. RESULTS: A total of 440 patients were enrolled in this analysis. The mean age was 48(23-81), and the mean BMI was 30(18-51). Older patients had lower PSV (r=-0.361, p=0.000) and higher EDV (r=0.174, p=0.001) and both correlations were highly statistically significant. Diabetics had lower PSV (r=-0.318, p=0.000) and higher EDV (r=0.139, p=0.008) which were also highly statistically significant. Smokers had lower PSV (r=-0.140, p=0.008) and higher EDV (r=0.178, p=0.001) which were highly statistically significant. Men with longer penises measured skin to tip, had lower EDV (r=-0.119, p=0.024) which was also significant. Interestingly there was neither significant correlation between BMI and PSV (0.16, p=0.745) nor significant correlation between testosterone and PSV (0.029, p=0.552). Also, there was no correlation between PSV and either dyslipidaemia or Peyronie’s disease. CONCLUSIONS: Our study highlights key risk factors - Increased age, tobacco consumption, DM and hypertension - are factors that have a statistically significant negative impact on penile haemodynamics. Of these, tobacco consumption, good diabetic control and hypertension are potentially modifiable and should form part of any treatment plan for erectile dysfunction.Other risk factors – increased BMI, low testosterone, PD and penile size – had no statistically significant impact on penile hemodynamics. This allows for targeted advice that can be given to patients who present with this very common problem. Ultimately, good vascular health goes hand in hand with good erectile function. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e621 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamad Habous More articles by this author Ahmed Khattak More articles by this author Mohammed Nassar More articles by this author Saleh Binsaleh More articles by this author Gordon Muir More articles by this author Expand All Advertisement PDF downloadLoading ...

Effects of tadalafil on sexual behavior of male rats induced by chronic unpredictable mild stress.

Few studies have investigated psychogenic sexual dysfunction including psychogenic erectile dysfunction (pED); the effect of tadalafil on sexual behavior of male rats induced by chronic unpredictable mild stress (CUMS) remains unclear. The aim was to explore the influence of CUMS on sexual behavior of male rats and the effects of tadalafil on that. Adult male rats were divided into 3 groups, including the normal group without CUMS, the model group with 6weeks' CUMS, and the tadalafil group with treatment of tadalafil during CUMS. CUMS consists of water deprivation, food deprivation, stroboscopic lightning, white noise, cage tilting, weeding packing, and housing 2 unfamiliar rats. The apomorphine test and vaginal smear test were conducted with the aim to screen out male rats with good erectile function and make preparation for the sexual behavior test, respectively. At the end of the study period, the level of anhedonia and sexual function were evaluated by the sucrose preference test, sexual behavior test, and measurement of serum testosterone, dopamine, and 5-HT. Sucrose preference showed significant decrease in rats after CUMS. The intromission ratio and total intromission frequency decreased significantly, while the mount latency and ejaculation latency prolonged significantly in CUMS-induced rats when compared with normal rats. Meanwhile, the treatment of tadalafil reversed the level of anhedonia and sexual function in CUMS-induced rats. However, there were no statistical differences in the levels of serum testosterone, dopamine, and 5-HT among groups. The study constructed an animal model that can provide clinical insights into the mechanism of psychogenic sexual dysfunction and supports the application of tadalafil in pED therapy. We found that CUMS-induced rats exhibited anhedonia and poor sexual function that could be prevented by tadalafil administration. Future research needs to construct the standard of pED model and explore the mechanism of tadalafil on central nervous system. Tadalafil could prevent the changes of depression and poor sexual function in rats induced by CUMS, and the method of CUMS and the sexual behavior test should be used in the future for pED modeling.

Impact of age on the Quadrella index assessing oncological and functional results after prostate brachytherapy: A 6-year analysis.

As the oncological results of prostate brachytherapy (BT) are excellent for low-risk (LR) or favorable intermediate-risk (FIR) prostate cancer (PCa), evaluating the side effects has become a major issue, especially for young men. The objective of the study was to compare the oncologic and functional results of BT using Quadrella index for patients aged 60 or less compared with older patients. From June, 2007 to June, 2017, 222 patients, including 70 ≤ 60 years old and 152 > 60 years old, underwent BT for LR-FIR PCa, with good erectile function at baseline according to International Index of Erectile Function-5 (IIEF-5) > 16. Quadrella index was achieved under the following circumstances: 1) Absence of biological recurrence (Phoenix criteria); 2) Absence of erectile dysfunction (ED) (IIEF-5 > 16); 3) No urinary toxicity (international prostate score symptom) IPSS < 15 or IPSS > 15, and ΔIPSS < 5; 4) No rectal toxicity (RT) (Radiation Therapy Oncology Group, RTOG = 0). Patients were treated on demand with phosphodiesterase inhibitors (PDE5i) post-operatively. The Quadrella index was satisfied for about 40-80% of patients ≤ 60 years vs. 33-46% for older patients during 6-year follow-up (significant difference from the second year). At year 5, 100% of evaluable patients aged ≤ 60 and 91.8% > 60 (p = 0.29) reached Phoenix criteria. The criterion of ED (IIEF-5 < 16) largely explained the validity rate of Quadrella alone. There was no ED for 67.2-81.4% of patients ≤ 60 years compared with 40.0-56.1% for patients > 60 (significant difference since year 4 in favor of young men). After two years of follow-up, more than 90% of patients in both the groups showed neither urinary nor rectal toxicities. For young men displaying LR-FIR PCa, BT appears to be a first-class therapeutic option, as the oncological results were at least equivalent to those of older patients with good long-term tolerance.

Erectile Dysfunction in Man with Hyperprolactinemia, Obesity and Genetic Abnormality 46XYinv(9)(p11q13)

Background: A good erectile function and normal sexual arousal are indicators of male health. Impaired sexual function due to loss of libido and erectile dysfunction can interfere with quality of life and relationships with partners. Erectile dysfunction can be caused by vasculogenic, endocrinopathy, hormonal imbalance, neurogenic, trauma, iatrogenic and also due to psychological causes. This research to understand and overcome the problems related to sexual function in man with genetic abnormality.&#x0D; Case: A 32-year-old patient came for a sperm analysis examination because he was planning to get married soon. At first, there were no sexual problems complained of but the patient admitted that he was not too much interested in sexual matters since he was young. Nocturnal and morning erection happened rarely. Puberty at 15 years old and currently in a relationship with a woman and planning to get married. At this time libido was good. There was no history of mumps and orchitis. From the physical examination, it was found that the height was 180 cm, weight was 100 kg, and the arm span was 186 cm. waist circumference 104 cm. It means that he was obese. Other physical examinations were within normal limits. Examination of the genitalia showed testicle size of 4 cc right and 4 cc left and soft in consistency. Penis size 8 cm in stretched condition. Sperm analysis showed azoospermia. Cytogenetic examination showed 46XY inv(9)(p11q13) and no Klinefelter syndrome was found. Hormone examination results showed LH 11.92 mIU/ml, FSH 30.29 mIU/ml.He showed hyperprolactinemia 25.89 ng/ml, estradiol 16 pg/ml and total testosterone 2.33 ng/ml. HbA1c 5,9 %.&#x0D; Discussion: The patient was treated with cabergoline 0.25 mg 3 times a week and to overcome hormone imbalance ,we used letrozole 2.5 mg once a day for 2 months.After two months have passed, there is an increase in sexual arousal, morning erections occur at least 4 days a week, erections begin to improve. weight 94 kg, arm span 186 cm. waist circumference 99 cm. Other physical examinations were within normal limits. Examination of the genitalia showed testicle size of 5 cc right and 5 cc left and soft in consistency.Recent investigations showed LH 7.89 mIU/ml, FSH 14.53 mIU/ml, prolactin 15.00 ng/ml, estradiol 10 pg/ml and total testosterone 1.69 ng/ml. Until now, evaluation and treatment is still ongoing.&#x0D; Conclusion: Management of erectile dysfunction can not only be seen from one side but also requires a holistic and multidisciplinary approach. Risk factors that can cause erectile dysfunction problems must be assessed and controlled every single cause. The goal of erectile dysfunction management is not only for sexual satisfaction but also to improve fertility and quality of life.

Penile Autophotography Underestimates the Degree of Penile Curvature in Peyronie’s Disease

BackgroundPenile curvature is the most debilitating symptom of Peyronie’s disease (PD); the evaluation of the degree of angulation is essential for planning treatment strategy. However, the most used method of penile at-home autophotography (AHP) is associated with some potential pitfalls and discrepancies compared with different assessment methods. ObjectiveTo compare the degree of penile curvature quantified by AHP and in-office intracavernosal alprostadil injection (ICI) prior to therapy. Design, setting, and participantsData from 55 PD patients of a single tertiary referral center were analyzed. All patients provided standardized AHP of the erect phallus. Clinic-based assessment included ICI with curvature measurement and completion of the International Index of Erectile Function (IIEF-15). Outcome measurements and statistical analysisThe Wilcoxon and/or chi-square test was used to compare the degree of curvature obtained using AHP and ICI, and to evaluate whether erectile dysfunction was a predictor of a relevant difference of >10° in curvature assessment between AHP and ICI. Results and limitationsOur study showed a significant (p < 0.001) difference in the degree of penile curvature between AHP (48° [38°; 55°]) and ICI (50° [40°; 65°]). Patients suffering from erectile dysfunction tend to have a higher difference in the degree of penile curvature between AHP and ICI than patients with good erectile function (p < 0.001). Our study is not devoid of limitations. First, we did not use Peyronie's Disease Questionnaire, as suggested by the European Association of Urology guidelines. Second, we did not evaluate inter- and intraobserver variations in the measurements. ConclusionsAHP tends to underestimate the extent of penile curvature compared to ICI. Erectile dysfunction is an independent predictor of measurement differences of >10° between AHP and ICI. Patient summaryIt is necessary to evaluate the degree of penile curvature in Peyronie’s disease prior to therapy decision. The at-home self-photography underestimates the real degree of penile curvature compared with an erection by in-office penile drug injection. Especially men suffering from erectile dysfunction carry the risk of a high difference in the measured degree of penile curvature, with a potential impact on the further treatment.

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.

V07-04 SINGLE PORT TRANSVESICAL PARTIAL PROSTATECTOMY FOR LOCALIZED PROSTATE CANCER

You have accessJournal of UrologyCME1 May 2022V07-04 SINGLE PORT TRANSVESICAL PARTIAL PROSTATECTOMY FOR LOCALIZED PROSTATE CANCER Ethan Ferguson, Mahmoud Abou Zeinab, Alp Tuna Beksac, Aaron Kaviani, Christopher Weight, Eric Klein, and Jihad Kaouk Ethan FergusonEthan Ferguson More articles by this author , Mahmoud Abou ZeinabMahmoud Abou Zeinab More articles by this author , Alp Tuna BeksacAlp Tuna Beksac More articles by this author , Aaron KavianiAaron Kaviani More articles by this author , Christopher WeightChristopher Weight More articles by this author , Eric KleinEric Klein More articles by this author , and Jihad KaoukJihad Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002598.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cross-sectional imaging guided prostate biopsy has allowed for more accurate diagnosis of clinically localized prostate cancer. Appropriately counseled patients with low or intermediate risk localized disease may opt for focal or ablative therapies. Recently, partial prostatectomy has been shown to be safe and effective for anterior prostate tumors. The single port da Vinci surgical platform with a transvesical approach allows for anterograde dissection of the prostate gland with minimal disturbance to the space of retzius and has recently been adapted for simple and radical prostatectomy. In 2018, cadaver studies demonstrated that partial prostate gland excision was feasible using a single port transvesical approach. Here we present the case of a patient undergoing single port transvesical partial prostatectomy. METHODS: A patient with localized Gleason 3+4 prostate cancer in the left lateral peripheral zone diagnosed on MRI fusion prostate biopsy. The procedure was performed with intraoperative MRI fusion using the KOELISâ mobile fusion imaging platform. The following surgical steps were described: (1) anterograde bladder neck dissection, (2) endopelvic fascia incision, (3) unilateral vascular pedicle ligation, (4) partial DVC ligation, (5) lateral lobe excision, (6) Surgical margin assessment, (7) bladder neck reconstruction. RESULTS: The patient underwent an uncomplicated single port robotic partial prostatectomy with removal of the left lateral lobe and seminal vesical. Intraoperative frozen sections of medial and lateral margins were negative for malignancy. He was discharged after spending 3.8 hours in recovery and did not require narcotics at discharge. His foley catheter was removed on postop day 3 and he was fully continent within 7 days of foley removal. He had good erectile function preoperatively and was fully potent within seven days of surgery. 6 month follow up data shows a stable PSA of 0.88 and no lesions on prostate MRI. CONCLUSIONS: Single port transvesical partial prostatectomy is feasible and safe in carefully selected men with localized prostate cancer. Close attention to ongoing postoperative follow up is imperative to determine long-term oncologic outcomes. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e660 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ethan Ferguson More articles by this author Mahmoud Abou Zeinab More articles by this author Alp Tuna Beksac More articles by this author Aaron Kaviani More articles by this author Christopher Weight More articles by this author Eric Klein More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement PDF DownloadLoading ...

Consumption of a Healthy Plant-based Diet is Associated With a Decreased Risk of Erectile Dysfunction: A Cross-sectional Study of the National Health and Nutrition Examination Survey

ObjectiveTo investigate the association between the plant-based content of diet and erectile dysfunction in men from the National Health and Nutrition Examination Survey (NHANES). MethodsWe collected de-identified information from the NHANES database on demographics, comorbidities, diet, and erectile dysfunction (ED). Exclusion criteria were age <20 or >70 years, incomplete plant-based diet index information, history of prostate cancer, or other missing information. Using the food frequency questionnaire, an overall plant-based diet index (PDI) and healthful plant-based diet index (hPDI) were developed. A higher score on the PDI and hPDI is indicative of greater consumption of plant-based foods. ResultsA total of 2549 men were analyzed, of those 1085 (42.6%) have good erectile function and 1464 (57.4%) have some degree of ED [usually have erections 521 (20.4%), sometimes have erection 690 (27.1%), or never have erections 253 (9.9%)]. The median age and BMI were 54 [41-64] years and 28.8 [25.5-32.6] kg/m2, respectively. The median PDI and hPDI were 50 [46-54] and 50 [45-56], respectively. In multivariable adjusted logistic regression analysis, hPDI was negatively associated with ED (OR = 0.98, 95% CI: 0.96-0.99; P = .001). There was no association between PDI and ED. ConclusionIn a well characterized national database, we showed that a healthful plant-based diet is associated with less chance of having erectile dysfunction. Whether interventions with a plant-based diet will improve erectile function remains to be studied.

Health-Related Quality of Life following Cytoreductive Radical Prostatectomy in Patients with De-Novo Oligometastatic Prostate Cancer.

Simple SummaryRecent retrospective data indicate a survival benefit of surgical removal of the prostate in patients with oligometastatic prostate cancer as part of a multimodal therapeutic regime. However, the impact of radical prostatectomy (RP) on patient’s health-related quality of life (HRQOL) in this scenario has not been evaluated yet. In a contemporary and well-balanced cohort, we compared the self-assessed HRQOL of patients with oligometastatic prostate cancer with patients with locally confined prostate cancer two years postoperatively. In multivariate analysis, we found no significant difference in postoperative HRQOL and urinary continence recovery in patients with de-novo oligo-metastatic compared to patients with locally confined prostate cancer.(1) Background: local treatment of the primary tumor has become a valid therapeutic option in de-novo oligo-metastatic prostate cancer (PC). However, evidence regarding radical prostatectomy (RP) in this setting is still subpar, and the effect of cytoreductive RP on postoperative health-related quality of life (HRQOL) is still unclear. (2) Methods: for the current study, patients with de-novo oligo-metastatic PC (cM1-oligo), defined as ≤5 bone lesions in the preoperative staging, were included, and matched cohorts using the variables age, body-mass index (BMI), and pT-stage were generated. Patient-reported outcome measures (PROMS) were assessed pre- and postoperatively using the validated EORTC-QLQ-C30, IIEF-5, and ICIQ-SF questionnaires. The primary endpoint for univariate and multivariable analysis was good general HRQOL defined by previously validated cut-off values. (3) Results: in total, 1268 patients (n = 84 (7%) cM1-oligo) underwent RP between 2012 and 2020 at one tertiary care center. A matched cohort of 411 patients (n = 79 with oligo-metastatic bone disease (cM1-oligo) and n = 332 patients without clinical indication of metastatic disease (cM0)) was created. The median follow-up was 25mo. There was no significant difference in good general HRQOL rates between cM1-oligo-patients and cM0-patients before RP (45.6% vs. 55.2%, p = 0.186), and at time of follow-up (44% vs. 56%, p = 0.811). Global health status (GHS) worsened significantly in cM0-patients compared to baseline (−5, p = 0.001), whereas GHS did not change significantly in cM1-oligo-patients (+3.2, p = 0.381). In multivariate analysis stratified for good erectile function (IIEF5 > 18; OR 5.722, 95% CI 1.89–17.36, p = 0.002) and continence recovery (OR 1.671, 95% CI 1.03–2.70, p = 0.036), cM1-oligo was not an independent predictive feature for general HRQOL (OR 0.821, 95% CI 0.44–1.53, p = 0.536). (4) Conclusions: in this large contemporary retrospective analysis, we observed no significant difference in HRQOL in patients with the oligometastatic bone disease after cytoreductive radical prostatectomy, when compared to patients with localized disease at time of surgery.

A single-blinded, multicenter, randomized controlled trial to evaluate NeuroSAFE robotic-assisted radical prostatectomy (RARP) versus standard robotic-assisted radical prostatectomy (RARP) in men with localized prostate cancer: NeuroSAFE PROOF—Trial in progress.

TPS262 Background: Robot-assisted radical prostatectomy (RARP) offers cure for localised prostate cancer but is associated with considerable toxicity. Potency and urinary continence are improved when the neurovascular bundles (NVBs) are preserved during a nerve-sparing (NS) RARP. The NeuroSAFE (intra-operative frozen section examination of the neurovascular structure adjacent prostate margin) seeks to promote optimal NS to maximise the opportunity for functional recovery without jeopardising oncological safety. The NeuroSAFE technique in RP has never been evaluated against a standard of care in an randomised controlled trial. Methods: This is a pragmatic, multicentre, single-blinded randomised controlled trial (RCT) in which men are allocated in a 1:1 ratio to NeuroSAFE RARP or standard RARP. Men in the NeuroSAFE RARP arm will undergo RARP with NS guided by the NeuroSAFE technique. Men in the standard RARP arm will undergo RARP with NS guided by standard current practice (prostate cancer clinical characteristics, multi-parametric magnetic resonance imaging (mpMRI) recommendations and digital rectal examination (DRE)). Eligible men will have operable localised prostate cancer, will be opting for RARP as primary treatment and will have good baseline erectile function (EF) (as defined by an Internatinoal Index of Erectile Function (IIEF)-5 score &gt;21). The primary outcome is the proportion of men who achieve EF recovery at 12-months according to the IIEF. Oncological safety will be ensured by the independent DMC who will routinely review proportions of men with treatment failure (adjuvant therapy or biochemical recurrence (BCR)) in each arm. A sample size of 404 is estimated required. NeuroSAFE PROOF will continue to follow participant recovery for 5 years following treatment. Key secondary outcomes include patient-reported urinary continence recovery, sexual satisfaction, quality of life, and economic analyses. NeuroSAFE PROOF will be the first RCT of frozen section in radical prostatectomy (RP) in the world. Ethics and dissemination: Ethical approval was obtained from the National Research Ethics Committee North London (17/LO/1978). Results of this study will be disseminated through national and international papers, and to study participants. Clinical trial information: NCT03317990.

Association between masturbation and functional outcome in the postoperative course after nerve-sparing radical prostatectomy.

BackgroundPenile rehabilitation after nerve-sparing radical prostatectomy (nsRP) improves the functional outcome, i.e., erectile function and urinary continence. Masturbation as a concept of penile rehabilitation has been practically not investigated. The aim of this observational and explorative study was to evaluate the association between masturbation and the recovery of the functional outcome in patients after nsRP.MethodsPatients after nsRP (11/2013-3/2016) with preoperative International Erectile Function Score-Erectile Function (IIEF-EF) of ≥22 and/or Erection Hardness Score (EHS) of ≥3 without neo- or adjuvant therapy were included in this analysis. Patients were classified according to their masturbation behavior (yes: m; no: nm). Chi-square tests were used to test for association between masturbation and functional outcome. The main outcome measures were rates of erectile function, morning erections, and urinary continence 6, 12, 24, and 36 months after nsRP.ResultsA total of 250 preoperatively potent patients with median age of 63.8 years (1st, 3rd quartile: 59.1, 69.6) at nsRP were included. After 24 months, m-patients had a numerically higher rate of moderate to good erectile function compared to nm-patients (47.5% vs. 37.5%; P=0.193) and had morning erections more often than nm-patients (54.6% vs. 34.9%; P=0.011). Urinary continence rate 12 months after nsRP was higher compared to nm-patients (12 months: 83.1% vs. 70.2%; P=0.042).ConclusionsMasturbation might be a promising approach of both erectile function and urinary continence recovery, and patients could be encouraged to masturbate after nsRP. However, due to the study design, causality cannot be concluded. Thus, masturbation as a possible concept of penile rehabilitation warrants further investigation.

Current state of image-guided focal therapy for prostate cancer

To review the current evidence regarding protocols and outcomes of image-guided focal therapy (FT) for prostate cancer (PCa). A literature search of the latest published studies assessing primary FT for PCa was carried out in Medline and Cochrane library databases followed by a critical review. FT modalities, follow-up strategies, and oncological and toxicity outcomes were summarized and discussed in this review. Twenty-four studies with six different sources of energy met the inclusion criteria. A heterogeneity of patient selection, energy sources, treatment templates, and definitions of failure was found among the studies. While a third of patients may be found to have additional cancer burden over 3-5 years following FT, most patients will remain free of a radical procedure. The vast majority of patients maintain urinary continence and good erectile function after FT. Acute urinary retention is the most common complication, whilst severe complications remain rare. An increasing number of prospective studies with longer follow-up have been recently published. Acceptable cancer control and low treatment toxicity after FT have been consistently reported. Follow-up imaging and routine biopsy must be encouraged post-FT. While there is no reliable PSA threshold to predict failure after FT, reporting post-FT positive biopsies and retreatment rates appear to be standard when assessing treatment efficacy.

Female Orgasm and Overall Sexual Function and Habits: A Descriptive Study of a Cohort of U.S. Women

IntroductionFew studies have investigated women's experiences with orgasm and the factors that they cite as important for their orgasmic function and sexual behavior related to foreplay and sexual stimulation. AimTo investigate and describe overall sexual function in a cohort of North American women, with a special focus on orgasmic function, satisfaction, triggers, risk factors, and sexual behavior. MethodsA total of 303 women aged 18–75 years completed a 100-questionnaire survey, which included the Female Sexual Function Index (FSFI) questionnaire and questions on orgasmic function, duration of sexual activity, sexual behaviors and relationship, and the partner’s sexual function. Statistical analysis was performed using SPSS to illuminate factors affecting sexual function. OutcomesThe main outcome measures are FSFI score, satisfaction with sexual life, ability to reach orgasm, orgasm frequency, preferred sexual stimulation, and sexual habits. ResultsFSFI scores, which were calculated for the 230 women who reported having had a steady male sex partner in the preceding 6 months, showed that 41% of the 230 women were at risk for female sexual dysfunction (a cutoff less than 26.55) and 21% were dissatisfied with their overall sexual life. Almost 90% of the overall cohort reported good emotional contact with their partner, that their partner was willing to have sex, satisfaction with the partner’s penis size (wherever applicable), and good erectile function and ejaculatory control of their partner (wherever applicable). 81% of the overall cohort claimed to be sexually active. Around 70% (70–72) did reach orgasm frequently, but around 10% never did so. Vaginal intercourse was reported by 62% of the overall cohort as the best trigger of orgasm, followed by external stimulation from the partner (48%) or themselves (37%). External stimulation was reported to be the fastest trigger to orgasm. Clinical ImplicationsThe knowledge on how women reach orgasm and how it is related to the partners' willingness to have sex and other factors can be incorporated in the clinical work. Strengths & LimitationsThe use of a validated questionnaire and the relative large number of participants are strengths of the study. Limitations are the cross-sectional design, the lack of a sexual distress measure, and a possible selection bias. ConclusionMost women in the overall cohort were satisfied overall with their sexual life and partner-related factors, even though 41% (of those who cited a steady sex male partner) were at risk for female sexual dysfunction. Most women did reach orgasm through different kinds of stimulation. Correlation was good between preferred and performed sexual activities and positions.Shaeer O, Skakke D, Giraldi A, et al. Female Orgasm and Overall Sexual Function and Habits: A Descriptive Study of a Cohort of U.S. Women. J Sex Med 2020;17:1133–1143.

On the Relationship Between Erectile Function and Sexual Distress in Men with Prostate Cancer.

Erectile difficulties are common after prostate cancer (PCa) treatment and are associated with sexual distress. However, the relationship between erectile function and sexual distress has yet to be carefully examined. This study had three goals: (1) examine the relationship between erectile function and sexual distress; (2) determine groups of men based on erectile function and sexual distress; and (3) examine the psychosexual characteristics of these groups. A cross section of 233 sexually active men after PCa treatment (age M = 64.90 years, SD = 7.50) completed an online survey containing demographic, health, and sexuality and relationship questionnaires. The relationship between erectile function and sexual distress was curvilinear. Four groups of men were found: good erectile function and low sexual distress, poor erectile function and high sexual distress, but also good erectile function yet high sexual distress, and poor erectile function and low sexual distress. Regardless of erectile function, men with greater sexual distress were more depressed, reported additional sexual concerns, placed less value on sex, were less sexually satisfied, and used protective buffering communication more frequently. They were also less likely to be satisfied with their adaptation to sexual changes and less likely to have found a solution to those changes. The relationship between erectile function and sexual distress is complex, characterized by a wide array of responses to erectile function (high and low distress) and multiple correlates of sexual distress. These results broaden the concept of sexual recovery after PCa treatment, which may assist clinicians and researchers to better address sexual problems after PCa treatment.

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

Prior data suggest that men with good erectile function (EF) early after radical prostatectomy (RP) can worsen their EF over the first 6 months postoperatively. We aimed to determine the prevalence and predictors of worsening EF after RP. 1,655 men who (i) underwent RP (ii) completed IIEF EF domain (EFD) pre-RP and (iii) serially post-RP constituted the population. Functional erections (FE) were defined as EFD score ≥24. We analyzed factors predicting FE at 3 months post-RP as well as factors predicting a decrease in FE between 3-6 months, defined as a two point drop or more in EFD score. Multivariable logistic regression (MVA) models were used with the following predictors: patient age at RP, baseline and 3-month EFD scores, PDE5i use at 3m (always vs other), diabetes, hypertension, hyperlipidemia, sleep apnea, cigarette smoking status (never vs current vs former), and nerve-sparing status (NSS; none vs unilateral vs bilateral).