Normal Preoperative Erectile Function Research Articles

(023) FIRST-IN-HUMAN IMPLANTABLE NEUROSTIMULATOR FOR ERECTILE FUNCTION REHABILITATION POST-PROSTATECTOMY: EARLY RESULTS

Abstract Introduction Radical prostatectomy (RP) remains a leading cause of erectile dysfunction (ED), primarily due to the inevitable damage to the cavernous nerves. Despite technical improvements in nerve-sparing surgery, post-prostatectomy rates of erectile dysfunction remain unacceptably high. Low-intensity electrostimulation (LIES) has been demonstrated to enhance peripheral nerve regeneration. Indeed, it has been shown that LIES improves erectile function and prevents corpora cavernosal remodeling in animal models of cavernous nerve injury. Recently, an implantable neurostimulator (CaverSTIM) has been developed to deliver electrostimulation to the cavernosal nerves following radical prostatectomy. This is a first-in-human study to evaluate CaverSTIM long-term safety, tolerability, and effectiveness. Objective The primary objective of this study is to assess the safety and tolerability of the CaverSTIM device by monitoring the occurrence of adverse events following implantation and to assess the tolerability of cavernous nerve electrostimulation in the post-operative setting. The secondary objectives are to evaluate the effectiveness of LIES in treating and/or rehabilitating erectile function post-prostatectomy. Methods Participants with normal pre-operative erectile function undergoing nerve-sparing RP were recruited for this prospective study. CaverSTIM was implanted during robotic-assisted laparoscopic prostatectomy (RALP) and the participants were followed for 6 months. The electrodes were placed bilaterally over the cavernous nerves and the implantable pulse generator was implanted subcutaneously in the lower abdomen. Seven days after implantation, participants were instructed to initiate daily LIES for 1 hour for rehabilitation and after 21 days, normal-intensity stimulation for 15 minutes to induce an increase in cavernosal blood inflow. The erectile function of all participants was assessed before surgery (baseline) and at 44, 90 and 180 days after surgery, using the IIEF-15, EHS and EPIC-26 questionaires and direct measurements of spontaneous nocturnal erections with RigiScan. Results In this in-progress study, six patients have been successfully implanted with CaverSTIM. No serious adverse event has been observed and the device is well tolerated. Functional data has been collected from 3 patients until now. A rapid and complete recovery of erectile function was observed in all 3 patients (IIEF-15 erectile funtion (EF) score □SD: 30.0□0.0; 27.7□2.1; 26.5□3.5; 28.0□1.4, at baseline and 44, 90 and 180 days post-surgery, respectively, n = 3), strongly contrasting with published literature showing substantial decreases in the IIEF-15 EF post-prostatectomy. Notably, nocturnal erections also recovered rapidly, with maximum decrease of approximately 30% from baseline at day 90 post-surgery, and complete recovery at 180 days (Rigidity Activity Unit as a percentage of the baseline value □SD: 80.0%; 70.1%; 98.4%, at 14, 90 and 180 days post-surgery respectively, n = 3). These findings contrast sharply with reported significant decreases in nocturnal erection post-prostatectomy, with approximately 90% decrease 28 days after surgery and still 70% diminished after 196 days (McCullough et al, J Sex Med, 2008, Feb;5(2):476-84). Conclusions CaverSTIM implantation following RP appears safe and well tolerated. Early results indicate LIES shows promise in the maintenance and restoration of erectile function in post-prostatectomy patients. Disclosure Yes, this is sponsored by industry/sponsor: Comphya. Clarification: Industry initiated, executed and funded study.

MP59-11 ORGASMIC FUNCTION WORSENING COULD LEAD TO ERECTILE FUNCTION DECREASE AFTER HoLEP RESULTS FROM A PROSPECTIVE TRIAL (Expho)

You have accessJournal of UrologyCME1 Apr 2023MP59-11 ORGASMIC FUNCTION WORSENING COULD LEAD TO ERECTILE FUNCTION DECREASE AFTER HoLEP RESULTS FROM A PROSPECTIVE TRIAL (Expho) Paolo Capogrosso, Andrea Salonia, Giuseppe Fallara, Edoardo Pozzi, Eugenio Ventimiglia, Schifano Nicolò, Federico Belladelli, Alessandro Bertini, Luca Boeri, Francesco Lanzaro, Luigi Candela, Federico Dehò, and Francesco Montorsi Paolo CapogrossoPaolo Capogrosso More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Eugenio VentimigliaEugenio Ventimiglia More articles by this author , Schifano NicolòSchifano Nicolò More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Alessandro BertiniAlessandro Bertini More articles by this author , Luca BoeriLuca Boeri More articles by this author , Francesco LanzaroFrancesco Lanzaro More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Federico DehòFederico Dehò More articles by this author , and Francesco MontorsiFrancesco Montorsi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003312.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Holmium laser enucleation enucleation of the prostate (HoLEP) has been associated with a low risk of erectile dysfunction (ED). We investigated factors associated with risk of erectile function (EF) worsening after surgery for men with normal pre-operative EF. METHODS: The ExpHo trial (NCT03583034) is a prospective study collecting data of consecutive patients treated with HoLEP by one highly-experienced surgeon (>1500 cases), at a single centre. All patients completed the International Index of Erectile Function (IIEF) at baseline and those with normal IIEF-EF (>26) were considered for this analysis. Patients have been re-assessed at 1 week, and at 1, 3, 6 and 12 months throughout the follow-up (FU). Kaplan Meier analysis investigated the risk of EF decrease over time. Cox-regression model tested predictors of post-operative EF worsening. RESULTS: Of 242 patients, 66 reported normal IIEF-EF before surgery. Baseline median (IQR) age was 65(60-70) years and prostate volume (PV) was 75(58-100) mL. Median pre-operative IIEF-orgasmic function (OF) was 10(7-10). Median follow-up was 6(1-12) months. At Kaplan-Meier analysis, estimated rates of EF impairment depicted an increase over time, with 12%(95%CI: 6,25) and 19%(95%CI: 11,33) of patients with normal pre-operative EF reporting a post-operative worsening at 3 and 6 months, respectively. Median IIEF-EF score decrease was 4 (2-11). At cox regression analysis, baseline factors (i.e., age, BMI, Charlson Comorbidiy Index, PV, IPSS) and intraoperative factors (i.e., total energy used, capsule perforation) were not associated with EF decrease over time (all p>0.6). Conversely, patients experiencing a post-operative decrease of IIEF-OF were at higher risk of reporting IIEF-EF worsening (IIEF-OF: HR 0.81; 95%CI: 0.59, 0.94; p=0.009) (Figure 1). CONCLUSIONS: Sexually active patients with normal pre-operative sexual function may experience a non-negligible EF worsening after HoLEP, which appears associated with post-operative OF decrease, thus suggesting that the impairment of antegrade ejaculation could play a major influence in post-HoLEP sexual function. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e811 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Paolo Capogrosso More articles by this author Andrea Salonia More articles by this author Giuseppe Fallara More articles by this author Edoardo Pozzi More articles by this author Eugenio Ventimiglia More articles by this author Schifano Nicolò More articles by this author Federico Belladelli More articles by this author Alessandro Bertini More articles by this author Luca Boeri More articles by this author Francesco Lanzaro More articles by this author Luigi Candela More articles by this author Federico Dehò More articles by this author Francesco Montorsi More articles by this author Expand All Advertisement PDF downloadLoading ...

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

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

PD63-12 EXCISION AND PRIMARY ANASTOMOSIS RECONSTRUCTION FOR TRAUMATIC STRICTURES OF THE PENILE URETHRA

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II1 Apr 2017PD63-12 EXCISION AND PRIMARY ANASTOMOSIS RECONSTRUCTION FOR TRAUMATIC STRICTURES OF THE PENILE URETHRA Boyd Viers, Billy Cordon, Travis Pagliara, Jeremy Scott, Noel Armenakas, and Allen Morey Boyd ViersBoyd Viers More articles by this author , Billy CordonBilly Cordon More articles by this author , Travis PagliaraTravis Pagliara More articles by this author , Jeremy ScottJeremy Scott More articles by this author , Noel ArmenakasNoel Armenakas More articles by this author , and Allen MoreyAllen Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2936AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Anastomotic urethroplasty has long been recognized as a reliable method of reconstruction for focal, severe bulbar urethral strictures. The role of excision and primary anastomosis (EPA) is less well defined for penile urethral strictures due to concerns for potential compromise of sexual function. We report a multi-institutional experience with functional outcomes among men undergoing EPA of pendulous urethral strictures. METHODS A retrospective review was conducted of over 2000 urethroplasty patients from two tertiary referral centers from 1995-2016. We identified 13 men treated with EPA for isolated penile urethral strictures, with radiographically confirmed location between the penoscrotal junction and urethral meatus. Clinical characteristics and outcomes are described. Validated questionnaires were utilized to evaluate overall improvement (PGI-I), urinary bother (I-PSS), sexual function (IIEF-5), as well as symptoms related to penile curvature (PDQ). RESULTS Among the 13 men who underwent EPA for penile urethral strictures, strictures were focal (median length 1cm, IQR 1-1.4) and median follow-up was 31 months (IQR 5-110). Only 1/12 (8%) men experienced a treatment failure requiring further instrumentation. None reported new onset penile curvature or curvature related bother (PDQ) following treatment. The majority of men had stricture etiology reported as trauma (10/13, 77%), of which 4 had a history of urethral disruption secondary to penile fracture and 6 iatrogenic trauma. Median patient age was 51 years (IQR 30-60); and 8/12 (67%) had normal preoperative erectile function. After stricture treatment, 75% of men reported a significant global improvement in condition (PGI-I). Sexually active men reported normal erectile function (median IIEF 21 (IQR 19-25), and the majority had only mild urinary bother (median IPSS 4 (IQR 2-14)). The single treatment failure had a history of hypospadias with multiple prior procedures who now requires intermittent catheterization. CONCLUSIONS Among selected patients with focal traumatic strictures involving the penile urethra, EPA appears to be highly effective with negligible impairment of erectile function. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1259 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Boyd Viers More articles by this author Billy Cordon More articles by this author Travis Pagliara More articles by this author Jeremy Scott More articles by this author Noel Armenakas More articles by this author Allen Morey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Incidence of De Novo Erectile Dysfunction after Urethroplasty: A Prospective Observational Study.

PurposeDe novo erectile dysfunction (ED) is a known complication after urethroplasty. Incidence and natural history of de novo ED after urethroplasty is underreported. We assessed the incidence of de novo ED after urethroplasty.Materials and MethodsConsecutive consenting urethroplasty (n=48) patients aged 21 to 50 years from February 2014 to July 2016 with normal preoperative erectile function as determined by an International Index of Erectile Function-5 (IIEF-5) score ≥22 were included and interviewed at 3, 6, and 12 months.ResultsIn patients with anterior stricture (n=40), substitution urethroplasty (SU) was performed in 22 patients (55.0%) and end-to-end anastomotic urethroplasty (EEAU) in 18 patients (45.0%). Their mean IIEF-5 score was 24.15±0.8 preoperatively, 20.10±4.2 at 3 months (p<0.001), 22.70±2.3 at 6 months (p=0.0012), and 23.70±1.7 at 12 months (p=0.03), showing a recovery of erectile function with time. All 8 patients with pelvic fracture urethral injury (PFUI) underwent progressive perineal urethroplasty. Their mean IIEF score was 24.0±1.2 preoperatively, 18.8±5.4 at 3 months (p=0.002), 20.9±3.5 at 6 months (p=0.37), and 22.0±1.5 at 12 months (p=0.427). The incidence of ED was similar at 1 year postoperatively between patients with anterior stricture and PFUI and between patients who underwent EEAU or SU for anterior stricture.ConclusionsIncidence of ED at 1 year after PFUI is similar to that after surgery for anterior stricture in patients with normal preoperative erectile function. Among the cases of anterior stricture, recovery was better with SU at 3 months and was similar between SU and EEAU at 1 year.

Exploratory Decision-Tree Modeling of Data from the Randomized REACTT Trial of Tadalafil Versus Placebo to Predict Recovery of Erectile Function After Bilateral Nerve-Sparing Radical Prostatectomy

BackgroundUnderstanding predictors for the recovery of erectile function (EF) after nerve-sparing radical prostatectomy (nsRP) might help clinicians and patients in preoperative counseling and expectation management of EF rehabilitation strategies. ObjectiveTo describe the effect of potential predictors on EF recovery after nsRP by post hoc decision-tree modeling of data from A Study of Tadalafil After Radical Prostatectomy (REACTT). Design, setting, and participantsRandomized double-blind double-dummy placebo-controlled trial in 423 men aged <68 yr with adenocarcinoma of the prostate (Gleason ≤7, normal preoperative EF) who underwent nsRP at 50 centers from nine European countries and Canada. InterventionPostsurgery 1:1:1 randomization to 9-mo double-blind treatment with tadalafil 5mg once a day (OaD), tadalafil 20mg on demand, or placebo, followed by a 6-wk drug-free-washout, and a 3-mo open-label tadalafil OaD treatment. Outcome measurements and statistical analysisThree decision-tree models, using the International Index of Erectile Function-Erectile Function (IIEF-EF) domain score at the end of double-blind treatment, washout, and open-label treatment as response variable. Each model evaluated the association between potential predictors: presurgery IIEF domain and IIEF single-item scores, surgical approach, nerve-sparing score (NSS), and postsurgery randomized treatment group. Results and limitationsThe first decision-tree model (n=422, intention-to-treat population) identified high presurgery sexual desire (IIEF item 12: ≥3.5 and <3.5) as the key predictor for IIEF-EF at the end of double-blind treatment (mean IIEF-EF: 14.9 and 11.1), followed by high confidence to get and maintain an erection (IIEF item 15: ≥3.5 and <3.5; IIEF-EF: 15.4 and 7.1). For patients meeting these criteria, additional non-IIEF–related predictors included robot-assisted laparoscopic surgery (yes or no; IIEF-EF: 19.3 and 12.6), quality of nerve sparing (NSS: <2.5 and ≥2.5; IIEF-EF: 14.3 and 10.5), and treatment with tadalafil OaD (yes and no; IIEF-EF: 17.6 and 14.3). Additional analyses after washout and open-label treatment identified high presurgery intercourse satisfaction as the key predictor. ConclusionsExploratory decision-tree analyses identified high presurgery sexual desire, confidence, and intercourse satisfaction as key predictors for EF recovery. Patients meeting these criteria might benefit the most from conserving surgery and early postsurgery EF rehabilitation. Strategies for improving EF after surgery should be discussed preoperatively with all patients; this information may support expectation management for functional recovery on an individual patient level. Patient summaryUnderstanding how patient characteristics and different treatment options affect the recovery of erectile function (EF) after radical surgery for prostate cancer might help physicians select the optimal treatment for their patients. This analysis of data from a clinical trial suggested that high presurgery sexual desire, sexual confidence, and intercourse satisfaction are key factors predicting EF recovery. Patients meeting these criteria might benefit the most from conserving surgery (robot-assisted surgery, perfect nerve sparing) and postsurgery medical rehabilitation of EF. Trial registrationClinicalTrials.gov, NCT01026818

Effects of tadalafil treatment after bilateral nerve-sparing radical prostatectomy: quality of life, psychosocial outcomes, and treatment satisfaction results from a randomized, placebo-controlled phase IV study

BackgroundThis multicenter, randomized, double-blind, double-dummy, placebo-controlled trial primarily evaluated the efficacy of tadalafil once-daily (OaD) or on-demand (“pro-re-nata”; PRN) treatment, started early post-nsRP. Secondary outcome-measures on quality-of-life (QoL) and treatment satisfaction are reported.MethodsPatients, aged <68 yrs, with adenocarcinoma of the prostate (Gleason ≤ 7, normal preoperative erectile function [EF]) were randomized post-nsRP 1:1:1 to 9-month treatment with tadalafil 5 mg OaD, tadalafil 20 mg PRN, or placebo, followed by 6-week drug-free washout and 3-month open-label tadalafil OaD treatment (OLT). The main outcome measures were Changes in Expanded Prostate Cancer Index Composite (EPIC-26), Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), and Self-Esteem and Relationship (SEAR) questionnaires (mixed-model-for-repeated-measures, including terms for treatment, visit, treatment-by-visit interaction, age-group, country, baseline-score). LS means with 95% confidence interval (CI) are reported.Results423 patients were randomized to 3 treatment-groups: tadalafil OaD (N = 139), PRN (N = 143), or placebo (N = 141). In each group, 57 (41.0%), 58 (40.6%), and 50 (35.5%) patients were aged 61-68 yrs. At the end of double-blind treatment (DBT), patients’ EPIC sexual domain-scores improved significantly with tadalafil OaD versus placebo (treatment effect [95% CI]: 9.6 [3.1,16.0]; p = 0.004); comparisons of PRN versus placebo at end of DBT, and comparisons of tadalafil OaD and PRN versus placebo after OLT were not significant. Only in older patients (61-68 yrs; age-by-treatment p ≤ 0.1), EPIC urinary incontinence domain-scores also improved significantly with tadalafil OaD versus placebo (overall treatment effect across all visits, 8.3 [0.4,16.1]; p = 0.040). Treatment satisfaction increased significantly in both tadalafil groups, EDITS total-scores increased significantly with OaD and PRN versus placebo during DBT (p = 0.005 and p = 0.041, respectively). At the end of OLT, improvement was significant for tadalafil OaD versus placebo only (p = 0.035). No significant differences were observed for SEAR.ConclusionsThese results suggest that chronic dosing of tadalafil improves QoL of patients post-nsRP. The improvement of urinary incontinence in elderly patients randomized to tadalafil OaD may contribute to this effect.Trial registrationwww.clinicaltrials.gov, NCT01026818.Electronic supplementary materialThe online version of this article (doi:10.1186/s12894-015-0022-9) contains supplementary material, which is available to authorized users.

MP42-07 IMPACT OF SURGICAL APPROACH ON ERECTILE FUNCTION RECOVERY FOLLOWING BILATERAL NERVE SPARING-RADICAL PROSTATECTOMY: RESULTS FROM A RANDOMIZED CONTROLLED TRIAL OF TADALAFIL VERSUS PLACEBO (REACTT)

You have accessJournal of UrologyProstate Cancer: Localized I1 Apr 2015MP42-07 IMPACT OF SURGICAL APPROACH ON ERECTILE FUNCTION RECOVERY FOLLOWING BILATERAL NERVE SPARING-RADICAL PROSTATECTOMY: RESULTS FROM A RANDOMIZED CONTROLLED TRIAL OF TADALAFIL VERSUS PLACEBO (REACTT) Martin Schostak, Markus Graefen, Christian Kriegel, Uwe Michl, Antonio Martin Morales, Peter J. Pommerville, Martina Manning, Hartwig Büttner, Carsten Henneges, and Jens-Uwe Stolzenburg Martin SchostakMartin Schostak More articles by this author , Markus GraefenMarkus Graefen More articles by this author , Christian KriegelChristian Kriegel More articles by this author , Uwe MichlUwe Michl More articles by this author , Antonio Martin MoralesAntonio Martin Morales More articles by this author , Peter J. PommervillePeter J. Pommerville More articles by this author , Martina ManningMartina Manning More articles by this author , Hartwig BüttnerHartwig Büttner More articles by this author , Carsten HennegesCarsten Henneges More articles by this author , and Jens-Uwe StolzenburgJens-Uwe Stolzenburg More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1592AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Erectile function (EF) after nerve-sparing radical prostatectomy (nsRP) may be impacted by the type of surgical approach. We report pre-specified and exploratory analyses on the effect of different surgical approaches on recovery of EF obtained from the multicenter, randomized, double-blind, REACTT trial of tadalafil once a day (OaD) or on demand (pro re nata, PRN) versus placebo. METHODS Patients ≤(pts)68yrs with normal preoperative EF who underwent nsRP for localized prostate cancer were randomized post-nsRP 1:1:1 to 9 month double-blind, double-dummy treatment (DBT) with tadalafil 5mg OaD, tadalafil 20mg PRN, or placebo, followed by 6-week drug-free washout and 3-month open-label OaD treatment. EF-recovery was defined as an International Index of Erectile Function (IIEF)-EF domain score ≥22, and normal orgasmic function was defined as IIEF Question 10 item score ≥4. Both parameters were analyzed after washout using logistic regression including terms for: treatment, country, visit, visit-by-treatment interaction, age group, nerve-sparing score, and surgical approach. Time to EF-recovery was analyzed post-hoc with a Cox proportional-hazards model including terms for: treatment, age-group, country, nerve-sparing score, surgical approach, and surgery-by-treatment interaction. RESULTS Of 422 pts enrolled at 50 centers, 189 had open surgery, 115 robot-assisted laparoscopy (lap), 88 conventional lap, and 30 surgeries classified as “other” (endoscopic extraperitoneal nsRP). The odds of achieving EF-recovery at the end of drug-free washout were approximately twice as high for the robot-assisted laparoscopy group compared with the open surgery group (odds ratio: 2.42; 95%CI 1.24, 4.72; p=0.029). Pts who underwent robot-assisted laparoscopy were significantly more likely to recover during DBT compared with pts who had open surgery (hazard ratio: 1.9; 95%CI 1.18, 3.18; p=0.009). A favorable effect of conventional laparoscopy compared with open surgery could not be observed. CONCLUSIONS Although the trial was not primarily designed for these analyses, the results may provide further insights into the impact of surgery on EF-recovery post-nsRP. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e510-e511 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Martin Schostak More articles by this author Markus Graefen More articles by this author Christian Kriegel More articles by this author Uwe Michl More articles by this author Antonio Martin Morales More articles by this author Peter J. Pommerville More articles by this author Martina Manning More articles by this author Hartwig Büttner More articles by this author Carsten Henneges More articles by this author Jens-Uwe Stolzenburg More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Is it worth continuing sexual rehabilitation after radical prostatectomy with intracavernous injection of alprostadil for more than 1 year?

IntroductionIntracavernous alprostadil injection (IAI) is a widely used treatment for sexual rehabilitation (SR) after radical prostatectomy (RP). It is unknown whether the continuation of IAI beyond 1 year continues to improve erectile function.AimsTo assess evolution of sexual function in patients using IAI who are nonresponsive to phosphodiesterase type 5 inhibitors (PDE5i) between 12 (M12) and 24 (M24) months after RP.MethodsWe retrospectively studied 75 men with a nerve-sparing laparoscopic RP, who had normal preoperative erectile function, and who regularly used IAI for SR for at least 24 months. At M12, no patients had responded to PDE5i.Main Outcome MeasuresAt 12 and 24 months, sexual function was assessed with the UCLA Prostate Cancer Index (UCLA-PCI), International Index of Erectile Function (IIEF)-15, and erection hardness score (EHS) with and without IAI. We also assessed the satisfaction rate with IAI, injection-related penile pain, and satisfaction of treatment. Statistical analysis was performed by using t-tests for paired data and Spearman's rho correlation coefficients to assess the relationships between scores at M12 and M24.ResultsImprovement of nocturnal erection was noted (UCLA-PCI, question 25); however, no significant difference was found for IIEF-erectile function with (19.60 ± 9.80 vs. 18.07 ± 10.44) and without IAI (4.63 ± 2.93 vs. 4.92 ± 4.15), UCLA-PCI-sexual bother (37.14 ± 21.45 vs. 37.54 ± 19.67), nor the EHS score with (2.97 ± 1.30 vs. 2.57 ± 1.30) and without IAI (0.67 ± 1.11 vs. 0.76 ± 0.10). The rate of satisfaction with treatment decreased over time (66.6% vs. 46.7%, P = 0.013). Improved response to IAI at M12 was not correlated to improvement in spontaneous erections at M24.ConclusionThe response to IAI remained stable after 2 years of treatment, and no significant improvement of spontaneous erections during intercourse attempts was found between M12 and M24. Patients should be informed of the limited effect of IAI on natural erections after 1 year. Yiou R, Bütow Z, Parisot J, Binhas M, Lingombet O, Augustin D, de la Taille A, and Audureau E. Is it worth continuing sexual rehabilitation after radical prostatectomy with intracavernous injection of alprostadil for more than 1 year? Sex Med 2015;3:42–48.

MP48-10 TADALAFIL ONCE A DAY SIGNIFICANTLY REDUCES PENILE LENGTH-LOSS IN PATIENTS POST BILATERAL NERVE-SPARING RADICAL PROSTATECTOMY (NSRP) - RESULTS FROM A RANDOMIZED CONTROLLED TRIAL

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Medical and Non-surgical1 Apr 2014MP48-10 TADALAFIL ONCE A DAY SIGNIFICANTLY REDUCES PENILE LENGTH-LOSS IN PATIENTS POST BILATERAL NERVE-SPARING RADICAL PROSTATECTOMY (NSRP) - RESULTS FROM A RANDOMIZED CONTROLLED TRIAL Gerald Brock, Francesco Montorsi, Pierre Costa, Nimish Shah, Jose Maria Martinez Jabaloyas, Peter Hammerer, Giuseppe M. Ludovico, Carsten Henneges, Karim Hamidi, Andrea Rossi, Hartwig Büttner, and John Mulhall Gerald BrockGerald Brock More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Pierre CostaPierre Costa More articles by this author , Nimish ShahNimish Shah More articles by this author , Jose Maria Martinez JabaloyasJose Maria Martinez Jabaloyas More articles by this author , Peter HammererPeter Hammerer More articles by this author , Giuseppe M. LudovicoGiuseppe M. Ludovico More articles by this author , Carsten HennegesCarsten Henneges More articles by this author , Karim HamidiKarim Hamidi More articles by this author , Andrea RossiAndrea Rossi More articles by this author , Hartwig BüttnerHartwig Büttner More articles by this author , and John MulhallJohn Mulhall More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1484AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Secondary analyses on stretched penile length (SPL) data from a multicenter, randomized, double-blind, double-dummy, placebo (PLC) controlled clinical trial (NCT01026818) evaluating the efficacy of tadalafil (TAD) initiated post-nsRP are reported. Methods Patients (pts) ≤68yrs with normal preoperative erectile function (EF) who underwent nsRP for localized prostate cancer (Gleason ≤7, PSA <10ng/mL) were randomized post nsRP 1:1:1 to 9-month (mo) double-blind treatment (DBT) with TAD 5mg once a day (OaD), 20mg TAD on demand (pro re nata; PRN), or PLC, followed by 6-week drug-free washout (DFW)and 3mo open-label OaD treatment (OLT, all pts). Secondary outcome measures included change of SPL from baseline (nsRP) to end of 9mo DBT (eDBT)(LS mean change compared by prespecified ANCOVA, including terms for treatment, country, baseline, age, and Nerve Sparing Score [NSS]), responses to Sexual Encounter Profile Questions (SEP) 1 and 3 (mixed model for repeated measures including terms for treatment, country, visit, visit-treatment interaction, age) and the Standardized Morning Erection Question (SMEQ; Cochrane Mantel Haenszel test adjusted for age and country). Results 423 pts were randomized to OaD (N=139), PRN (N=143), and PLC (N=141); 114/122/155 completed 9mo DBT. Greater retained SPL was observed with OaD vs PLC at eDBT (Figure; LS mean [95%CI] difference OaD vs PLC, 4.1 [0.4, 7.8] mm, p=0.032). No significant LS mean difference (p >0.05) was observed for PRN vs PLC. No significant effect of NSS on SPL loss was observed (Figure). Penile tumescense (SEP 1) as the initial sign of EF recovery was improved significantly vs. PLC at eDBT and OLT for pts randomized to OaD only. The ability for sexual intercourse (SEP 3) also significantly improved for pts on OaD vs placebo only at eDBT. The distribution of SMEQ responses was different at eDBT (p=0.045), with 34.2% of pts on OaD, 50.0% on PRN and 56.5% on PLC reporting the absence of morning erections, At eDFW, SEP responses were not statistically significantly different between OaD and PLC. Conclusions These data suggest that the early initiation of treatment with TAD OaD protects from penile length-loss and may contribute to protection from structural cavernosal changes post nsRP. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e530-e531 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Gerald Brock More articles by this author Francesco Montorsi More articles by this author Pierre Costa More articles by this author Nimish Shah More articles by this author Jose Maria Martinez Jabaloyas More articles by this author Peter Hammerer More articles by this author Giuseppe M. Ludovico More articles by this author Carsten Henneges More articles by this author Karim Hamidi More articles by this author Andrea Rossi More articles by this author Hartwig Büttner More articles by this author John Mulhall More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP48-13 EFFECTS OF TADALAFIL TREATMENT POST BILATERAL NERVE-SPARING RADICAL PROSTATECTOMY (NSRP): QUALITY OF LIFE (QOL), PSYCHOSOCIAL OUTCOMES AND TREATMENT SATISFACTION

MP48-13 EFFECTS OF TADALAFIL TREATMENT POST BILATERAL NERVE-SPARING RADICAL PROSTATECTOMY (NSRP): QUALITY OF LIFE (QOL), PSYCHOSOCIAL OUTCOMES AND TREATMENT SATISFACTION

Effects of Tadalafil Treatment on Erectile Function Recovery Following Bilateral Nerve-sparing Radical Prostatectomy: A Randomised Placebo-controlled Study (REACTT)

BackgroundThe potential rehabilitative and protective effect of phosphodiesterase type 5 inhibitors (PDE5-Is) on penile function after nerve-sparing radical prostatectomy (NSRP) remains unclear. ObjectiveThe primary objective was to compare the efficacy of tadalafil 5mg once daily and tadalafil 20mg on demand versus placebo taken over 9 mo in improving unassisted erectile function (EF) following NSRP, as measured by the proportion of patients achieving an International Index of Erectile Function-Erectile Function domain (IIEF-EF) score ≥22 after 6-wk drug-free washout (DFW). Secondary measures included IIEF-EF, Sexual Encounter Profile question 3 (SEP-3), and penile length. Design, setting, and participantsRandomised, double-blind, double-dummy, placebo-controlled trial in men ≤68 yr of age with adenocarcinoma of the prostate (Gleason ≤7) and normal preoperative EF who underwent NSRP at 50 centres from nine European countries and Canada. Interventions1:1:1 randomisation to 9 mo of treatment with tadalafil 5mg once daily, tadalafil 20mg on demand, or placebo followed by a 6-wk DFW and 3-mo open-label tadalafil once daily (all patients). Outcome measurements and statistical analysisLogistic regression, mixed-effects model for repeated measures, and analysis of covariance, adjusting for treatment, age, and country, were applied to IIEF-EF scores ≥22, SEP-3, and penile length. Results and limitationsFour hundred twenty-three patients were randomised to tadalafil once daily (n=139), on demand (n=143), and placebo (n=141). The mean age was 57.9 yr of age (standard deviation: 5.58 yr); 20.9%, 16.9%, and 19.1% of patients in the tadalafil once daily, on demand, and placebo groups, respectively, achieved IIEF EF scores ≥22 after DFW; odds ratios for tadalafil once daily and on demand versus placebo were 1.1 (95% confidence interval [CI], 0.6–2.1; p=0.675) and 0.9 (95% CI, 0.5–1.7; p=0.704). At the end of double-blind treatment (EDT), least squares (LS) mean IIEF-EF score improvement significantly exceeded the minimally clinically important difference (MCID: ΔIIEF-EF ≥4) in both tadalafil groups; for SEP-3 (MCID ≥ 23%), this was the case for tadalafil once daily only. Treatment effects versus placebo were significant for tadalafil once daily only (IIEF-EF: p=0.016; SEP-3: p=0.019). In all groups, IIEF-EF and SEP-3 decreased during DFW but continued to improve during open-label treatment. At month 9 (EDT), penile length loss was significantly reduced versus placebo in the tadalafil once daily group only (LS mean difference 4.1mm; 95% CI, 0.4–7.8; p=0.032). ConclusionsTadalafil once daily was most effective on drug-assisted EF in men with erectile dysfunction following NSRP, and data suggest a potential role for tadalafil once daily provided early after surgery in contributing to the recovery of EF after prostatectomy and possibly protecting from penile structural changes. Unassisted EF was not improved after cessation of active therapy for 9 mo. Trial registrationClinicalTrials.gov identifier NCT01026818.

Penile rehabilitation should not be the norm for patients post-radical prostatectomy.

Penile rehabilitation should not be the norm for patients post-radical prostatectomy.

2182 IMPACT OF THULIUM VAPOENUCLEATION OF THE PROSTATE (THUVEP) ON SEXUAL FUNCTION: A PROSPECTIVE SINGLE CENTER STUDY

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology (III)1 Apr 20132182 IMPACT OF THULIUM VAPOENUCLEATION OF THE PROSTATE (THUVEP) ON SEXUAL FUNCTION: A PROSPECTIVE SINGLE CENTER STUDY Christian Tiburtius, Sophie Knipper, Thorsten Bach, and Christopher Netsch Christian TiburtiusChristian Tiburtius Hamburg, Germany More articles by this author , Sophie KnipperSophie Knipper Hamburg, Germany More articles by this author , Thorsten BachThorsten Bach Hamburg, Germany More articles by this author , and Christopher NetschChristopher Netsch Hamburg, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2091AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate changes in sexual function after ThuVEP for the treatment of benign prostatic obstruction (BPO) in men at 12-month follow-up. METHODS A prospective analysis of seventy-two patients who underwent ThuVEP between January and July 2011. Preoperative evaluation included transrectal ultrasound gland volume measurement, maximum urinary flow rate (Qmax), international prostate symptom score (IPSS), quality of life (QoL), post-voiding residual urine (PVR), and the International Index of Erectile Function (IIEF-5). Patients were subdivided into two groups: group A: IIEF-5 > 19 and group B: IIEF-5 < 19. Intra-, peri-, and postoperative parameters were evaluated. All patients were reassessed at 12-month follow-up by Qmax, IPSS, QoL, PVR, and IIEF-5. Patient data were expressed as median (interquartile range). RESULTS Median patient age was 70 (65-73) years and the median prostate volume was 52.5 (39.75-72) ml, respectively. At 12-month follow-up, IPSS (20 vs. 4), QoL (4 vs. 1), Qmax (9.7 vs. 22.15 ml/s), and PVR (100 vs. 15 ml) improved significantly in comparison to preoperative assessment (p < 0.001) with no statistical differences between group A and B. A slight but no significant increase in the IIEF-EF domain score was reported at 12-month follow-up (19.5 vs. 20), which could also be shown in group A (25 vs. 26) and group B (6 vs. 8), respectively. CONCLUSIONS ThuVEP is an efficacious procedure for the treatment of BPO. ThuVEP did not impact erectile function in patients with normal preoperative erectile function (IIEF-EF > 19) and those with preoperative existing erectile dysfunction (IIEF-EF < 19). © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e894-e895 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Tiburtius Hamburg, Germany More articles by this author Sophie Knipper Hamburg, Germany More articles by this author Thorsten Bach Hamburg, Germany More articles by this author Christopher Netsch Hamburg, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Evaluation of the Effect of Photoselective Vaporization of the Prostate on Sexual Function in a Prospective Study: A Single Center Experience of 150 Patients.

Abstract Background and Purpose: Photoselective vaporization of the prostate (PVP) has emerged as a minimally invasive alternative to transurethral resection of the prostate for treatment of benign prostate hyperplasia (BPH) with lower urinary tract symptoms (LUTS). Very few prospective studies have addressed the effect of PVP on sexual function. We performed this prospective study to assess the short-term effect of PVP on erectile function in patients who present with LUTS secondary to BPH. Patients and Methods: There were 150 consecutive patients who presented with LUTS secondary to BPH who underwent PVP and who were enrolled prospectively in this study. Patients were categorized in two groups: Group A, International Index of Erectile Function (IIEF) ≥19; group B, IIEF <19. PVP was performed by using an 80 W GreenLight laser. Patients preoperative, perioperative, and follow-up data were recorded. Erectile function was assessed preoperatively and postoperatively at 1, 3, 6, and 12 months using IIEF-5. In follow-up, Ultrasonography of the kidneys, ureters, and bladder for residual prostate and postvoid residual urine, uroflowmetry, kidney function tests, and urine culture were performed at each visit. Cystoscopy was performed at 3 months. Data were analyzed statistically. Results: The two patient groups were comparable in their preoperative and perioperative data. Both groups showed improvement in International Prostate Symptom Score, maximum flow rate, quality of life, and decrease in postvoid residual urine at 1, 3, 6, and 12 months with no statistical significance. IIEF-5 scores in Group A, however, were 21.1, 19.2, 17.1, 16.2, and 16.1, respectively, at preoperative, postoperative month 1, 3, 6, and 12, respectively (P=0.02). IIEF-5 scores in Group B were 13.2, 12.1, 11.3, 11.2, and 10.9, respectively, at preoperative, postoperative month 1, 3, 6, and 12, respectively (P=0.45). Conclusions: In patients with normal preoperative erectile function, PVP resulted in significant decrease in EF up to follow-up of 1 year. In patients with preoperative ED, however, PVP did not significantly decrease EF.

Extended Nodal Dissection Reduces Sexual Function Recovery After Robot-Assisted Laparoscopic Prostatectomy

Considering the anatomic proximity of the internal iliac lymph nodes and the pelvic plexus, it may be expected that more extensive pelvic nodal dissection is associated with an increased risk of damage to the small pelvis neural and vascular structures. We evaluate whether nodal dissection is associated with functional outcome after robot-assisted radical prostatectomy (RARP). In a series of 798 RARP procedures, 325 (40.7%) patients underwent a lymph node dissection. Continence, sexual function, and lower urinary tract symptoms (LUTS) were assessed using the International Consultation of Incontinence Questionnaire short form (ICIQ)-SF), International Index of Erectile Function-15, and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ)-PR25 questionnaires before and at 6 months intervals after RARP. Preoperative ICIQ-SF, IIEF-15, and PR25-LUTS scores were similar for men with and without nodal dissection. Normal postoperative erectile function (IIEF-EF >24) at 6 months was reported by 1.7%, 9.1%, and 50.4% of men with no, unilateral, and bilateral nerve preservation and normal preoperative erectile function. All domains of the IIEF-15 score showed a negative correlation with the number of removed lymph nodes. In 70 of 325 (21%) cases with nodal dissection, more than 10 nodes were removed. Men with more than 10 nodes removed had lower IIEF-15 domain scores compared with men with 1 to 10 removed lymph nodes. The postoperative ICIQ-SF and PR25-LUTS scores were not associated with extent of nodal dissection. Nodal metastases were found in 5.9% and 15.7% of men with ≤ 10 nodes and >10 nodes removed (P=0.005). In a multivariate analysis, extent of fascia preservation (FP-score), preoperative IIEF-EF, and number of removed nodes were the strongest independent predictors of postoperative erectile function recovery. More extensive nodal dissection was associated with impaired postoperative sexual function recovery but not continence and voiding function after RARP, independent of preoperative function and nerve preservation.

Irbesartan promotes erection recovery after nerve‐sparing radical retropubic prostatectomy: a retrospective long‐term analysis

Study Type--Therapy (retrospective cohort) Level of Evidence 2b. What's known on the subject? and What does the study add? Erectile dysfunction following radical prostatectomy (RP) is among the most common and dreaded adverse effects of the surgery. Multiple studies confirm the potential benefit of various drug classes to accelerate the return of erectile function (EF) after RP. There is pre-clinical evidence supporting the use of angiotensin-receptor blockers (ARBs) for this purpose, although this has not been studied in humans. The present study shows that there may be a benefit in the recovery of EF post-RRP in patients taking a daily dose of irbesartan, an ARB, following RRP. In addition, the use of irbesartan may curb the loss of stretched penile length which occurs postoperatively. Further study in the form of prospective, randomized, placebo-controlled clinical trials are necessary to confirm these findings. • To evaluate retrospectively the potential benefit of administering irbesartan, an angiotensin-receptor blocker, to improve erectile function (EF) recovery after nerve-sparing radical retropubic prostatectomy (RRP). • Before surgery potent patients who underwent nerve-sparing RRP between April and December 2009 elected to start daily oral irbesartan 300 mg on postoperative day 1 (n= 17). A contemporaneously clinically matched cohort consisting of patients who declined irbesartan use served as the control group (n= 12). • Postoperative 'on demand' use of erectile aids (phosphodiesterase type 5 [PDE5] inhibitors and intracavernous injections) was adopted. • Potency was monitored by the administration of International Index of Erectile Function-5 (IIEF-5) questionnaires before surgery and at early (3 months) and long-term (12 and 24 months) postoperative intervals. • Stretched penile length (SPL) was measured both immediately and 3 months after surgery. • EF status was no different between groups at baseline (P > 0.05). • While the IIEF-5 scores at 24 months after surgery were statistically similar between the two groups (control = 15.2 ± 2.0, irbesartan = 14.1 ± 3.1, P = 0.77), at 12 months the IIEF-5 scores of the irbesartan group were significantly higher than those of the control group (14 ± 2.6 vs. 7.2 ± 1.6, P < 0.05). • The proportional loss of SPL after RRP was less in the irbesartan than in the control group at 3 months (-0.9 ± 1.5% vs -5.6 ± 1.5, P < 0.05). • Regular irbesartan use after nerve-sparing RRP in patients with normal preoperative erectile function could improve EF recovery after surgery and mitigate early loss of SPL.

Initial consecutive 125 cases of robotic assisted laparoscopic radical prostatectomy performed in Ireland’s first robotic radical prostatectomy centre

We examined the patient characteristics, operative proceedings and the outcomes of the initial series of 125 cases of robot-assisted laparoscopic radical prostatectomy (RALRP) in an independent hospital in Ireland, performed by two surgeons using the da Vinci(®) surgical system. The series data were gathered prospectively in a consecutive series. Focus was given to the outcome trifecta of oncological control, urinary continence and erectile function. We also report on complications reported using the Clavien-Dindo classification. Mean patient age was 58.86 years, with a range between 47 and 71 years. Positive surgical margin rates were 11.3% overall (n = 14); 7.8% (n = 8) in the pT2 group (n = 101) and 30% (n = 6) in the pT3/pT4 (n = 20) group. 93% (n = 125) of patients are continent at 6 months. Biochemical recurrence-free survival was 92.4%. 72% (n = 43) of patients under the age of 65 with normal preoperative erectile function are potent at 1 year post-operatively. No patient in this series required a blood transfusion. Some form of relatively minor complication occurred in 12.8% (n = 16) of cases; there was no mortality rate, and no complication was life-threatening or resulted in single-organ or multiple-organ failure. With a combination of high-level fellowship training of surgeons, a co-operative and combined approach to cases between surgeons, institutional support, and enthusiasm, encouragement and dedication from ancillary staff and colleagues, we have shown that a programme can be established with excellent levels of safety and efficacy.

What Is the Definition of a Satisfactory Erectile Function After Bilateral Nerve Sparing Radical Prostatectomy?

Different cut-offs of the erectile function (EF) domain of the International Index of Erectile Function (IIEF) have been used as definition of postoperative EF recovery. To test the correlation between patient satisfaction and IIEF-EF domain score cut-offs. The IIEF was used to evaluate EF and satisfaction before and after bilateral nerve sparing radical prostatectomy (BNSRP). The study included 165 consecutive patients treated with retropubic BNSRP at a single institution. All patients had normal preoperative EF (IIEF-EF ≥ 26) and reached an IIEF-EF ≥ 17 following surgery. Complete data included EF, intercourse (IS), and overall satisfaction (OS) assessed by the corresponding domains of the IIEF administered prior and after surgery. Patients were divided into three groups according to the highest IIEF-EF score reached postoperatively, namely 17-21 (group 1), 22-25 (group 2), and ≥ 26 (group 3). One-way analysis of variance was used to compare IIEF-OS and IIEF-IS domain scores at the time the EF end point was reached. The same analyses were repeated separately in those patients with a complete EF recovery after surgery (group 3). Mean preoperative IIEF-OS and IIEF-IS domain score was 8.4, 8.8, 8.7 and 11.6, 11.8, 11.9 in group 1, 2, 3, respectively (all P ≥ 0.3). After a mean follow-up of 26.7 months, mean postoperative IIEF-OS and IIEF-IS domain scores assessed at the time of EF recovery were comparable for patients reaching an IIEF-EF of 22-25 and for patients scoring postoperatively ≥ 26 (8.1, 8.1, and 10.6, 11.4; all P ≥ 0.3). However, mean IIEF-OS and IIEF-IS domain scores of these patients were significantly higher as compared to patients reaching an IIEF-EF domain score < 22 (6.3 and 8.4, respectively; all P ≤ 0.006). Similar results were achieved considering only those patients (group 3) who had complete EF recovery after surgery. We demonstrated that in preoperatively fully potent patients treated with BNSRP a lower satisfaction is expected when an IIEF-EF cut-off of 17 is used. Conversely, no difference was found using a cut-off of 22 or 26. Therefore, our results support that a cut-off of IIEF-EF ≥ 22 might represent a reliable score for defining EF recovery after BNSRP.

Sexual Rehabilitation and Penile Pain Associated with Intracavernous Alprostadil after Radical Prostatectomy

Intracavernous alprostadil injection (IAI) is widely used for sexual rehabilitation (SR) after radical prostatectomy (RP). However, the rate of spontaneous erection recovery with IAI remains unclear, and IAI causes pain that may hinder SR. To assess SR in IAI users after RP and to evaluate the course and impact on SR of postinjection penile pain. We prospectively studied 87 patients who underwent nerve-sparing laparoscopic RP, reported normal preoperative erectile function, and used IAI for 12 months. Patients started with 2.5 µg alprostadil and were advised to increase the dose gradually until erection hardness allowed vaginal penetration. At 6 and 12 months, the International Index of Erectile Function (IIEF-15) and Erection Hardness Score (EHS) were determined with and without IAI, and injection-related penile pain was assessed using a numeric rating scale. Correlations linking penile pain, IIEF-15, and EHS scores were evaluated. The mean alprostadil dose was 8.1 µg after 6 months and 9.9 µg after 12 months. With/without IAI, mean IIEF-15 scores for erectile and orgasmic function and mean EHS score were 14.6/4.6, 4.1/2.1, and 2.5/0.4, respectively, after 6 months; and 17.2/5.4, 4.9/2.6, and 2.7/0.9 after 12 months. Pain scores were 3.2±2.5/10 and 2.5±2.5/10 after 6 and 12 months, respectively. Pain intensity correlated with erectile function (r=-0.23), intercourse satisfaction (r=-0.23), and overall satisfaction (r=-0.24) after 6 months but not after 12 months. Follow-up was short and only patients who used IAI for 12 months were included. In patients who were willing and able to use IAI, erectile function improved after 1 year but remained below preoperative levels. The adverse impact of pain on SR was significant during the first 6 months and diminished over time. These data may help to counsel IAI users with painful erections.