Penile Rehabilitation Program Research Articles

(014) Expectations of Patients and Their Partners After Penile Rehabilitation Programs After Nerve-Sparing Prostatectomy: Are There Relevant Differences?

Abstract Introduction Several strategies are published for postoperative erectile function rehabilitation after nerve-sparing radical prostatectomy (nsRP). Expectations of the partners of the patients are rarely subject of most of these rehabilitation studies. Objective The aim of our study was to evaluate the expectations of patients and of the partners of patients undergoing nerve-sparing radical prostatectomy and penile rehabilitation programs and possible relevant differences between the expectations. Methods We performed a questionnaire sent to patients and their partners of all enrolled patients of 3 different penile rehabilitation studies after nsRP with a regular dose of different PDE5-inhibitors (sildenafil/vardenafil/tadalafil). 124 patients (mean age 69 years) had been enrolled in the rehabilitation studies and their partners (mean age 66 years) were included in this study. The survey consists of different questions, e.g. if the patients and their partners believe in the rehabilitation concept and what they expect with regards to the outcome. Results 89 patients and 78 partners of the 124 patients (72% / 63%) completed and returned the questionnaire. Before rehabilitation treatment 81 patients (91%) and 51 partners (65%) believed in the concept of rehabilitation, 55 patients (62%) but only 32 partners (41%) expected partly to fully rehabilitation of erectile function caused by the initiated penile rehabilitation program. After the end of the study treatment, 2 years after nsRP, 64% of patients and 45% of their partners are satisfied by the recovery of erectile function. Conclusions Despite the fact that 91% of patients within penile rehabilitation programs believe in the concepts of rehabilitation only 62% of the patients and only 41% of their partners expect partly to fully recovery of erectile function after nsRP. Satisfaction rate with erectile function recovery was reported by 64% of patients and 45% of their partners 2 years after nsRP. Disclosure No.

(012) Incidence of Peyronie’s Disease After Radical Prostatectomy Among Patients Undergoing Penile Rehabilitation Regimen

Abstract Introduction Radical prostatectomy remains one of the gold standard treatments for localized prostate cancer, the most prevalent solid organ cancer in men. Surgical management of prostate cancer has been theorized to increase the risk of developing Peyronie’s Disease (PD). In 2010, Drs. Tal and Mulhall’s team characterized the incidence of PD in a cohort of 1011 men after radical prostatectomy to be 13.7% at 2 years and 15.9% at 3 years of follow-up. These numbers, significantly higher than estimates in the general population, which range from 0.5 to 7.1% (Sharma et al., Sex Med Rev 2020;8:314–23), suggest radical prostatectomy is a risk factor for developing PD. Objective Our aim was to evaluate the incidence of PD among post-prostatectomy patients who undergo a formal multi-modal penile rehabilitation program that includes mechanical and pharmacologic interventions to promote penile smooth muscle activation after surgery. Methods In this retrospective, descriptive study we reviewed the charts of 581 patients who were diagnosed with prostate cancer, treated with robot-assisted laparoscopic radical prostatectomy (RALP), and were engaged in a penile rehabilitation program from January 2016 through January 2019. At our institution, patients scheduled for prostatectomy are referred preoperatively to an academic Men’s Health clinic to start a multi-modal program and follow up regularly for evaluation of sexual health. The program includes daily tadalafil, L-citrulline, and VED use (Table 1). Patients refractory to these therapies had the option to increase tadalafil dosing or undergo further treatment with intracavernosal injections at ~3 months post-op. We excluded patients who had PD pre-operatively or who did not have post-operative follow-up with the providers at this institution. The primary outcome of interest was the incidence of PD among this cohort. Secondary outcome included time to development or diagnosis of PD. Results 581 patients with prostate cancer treated with RALP engaged in penile rehabilitation and were included in this analysis. The median age of men was 62.6 y with additional demographics listed in Table 2. The incidence of PD in this cohort was 2.9% (17 patients) with a median follow-up of 21.4 mo (IQR 2.8 – 55.8 mo). The diagnosis of PD was made at a median of 28.7 mo (IQR 20 – 36 mo) after prostatectomy. The 17 patients with PD had a median follow-up of 38.9 mo (IQR 23.2 – 55.8 mo). Conclusions In this cohort of prostate cancer patients treated with RALP and undergoing a consistent, multi-modal penile rehabilitation program, the incidence of PD was 2.9%, and median time to diagnosis was 28.7 months. This is the first study to assess PD incidence in men who engage in mechanical and pharmacologic penile rehabilitation at time of RALP. Furthermore, diagnosis of PD was made more than two years after surgery; this warrants further evaluation on whether penile rehabilitation prevents PD. This retrospective analysis is a hypothesis-generating study that should inspire further research on the role of regular mechanical stimulation or daily PDE-5 inhibitors in delaying or preventing PD after pelvic surgery. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Scientific.

Potential primary prevention of Peyronie's disease post prostatectomy?-retrospective analysis of peri-operative multi-modal penile rehabilitation.

The surgical management of prostate cancer through radical prostatectomy has the potential to impact patients' sexual function, including erectile dysfunction and Peyronie's disease (PD). Historical data suggests the incidence of PD in post-prostatectomy patients is higher than in the general population at 15.9%. Our study objective was to measure the rate of the development of PD among patients that receive penile rehabilitation (PR) regimen prior to and immediately after radical prostatectomy. In this study, we retrospectively reviewed the charts of 581 patients who were diagnosed with prostate cancer, treated with radical prostatectomy, and engaged in a PR program. Patients with the diagnosis of PD prior to prostatectomy were excluded from this study. The PR program consists of daily tadalafil, L-citrulline, and weekly vacuum erectile device with the option of intracavernosal injections if patients fail to respond to the regular regimen. We found the incidence of PD to be 2.9%, suggesting that PR regimens programs may be associated with a reduced incidence of PD in post-prostatectomy patients. Ten (out of 17) patients were diagnosed with PD after 2 years of follow up. The return of erections was not statistically different among patients who developed PD and the rest of the patients. Prospective, multi-institutional trials will be required to elucidate whether PR can prevent the development of PD in this patient population.

The effectiveness of medical penile rehabilitation after radical prostatectomy

Background. Among the drug methods of penile rehabilitation in patients after nerve-sparing prostatectomy, the use of phosphodiesterase-5 (PDE-5) inhibitors is proposed as the first line of therapy, which have shown high efficiency, ease of use, good tolerability and safety, improving the quality of life of patients.Aim. To evaluate the effectiveness of drug-induced penile rehabilitation after nerve-sparing prostatectomy in the restoration of erectile function (EF) with an analysis of the factors influencing it.Materials and methods. The study included 108 patients with localized prostate cancer who underwent nerve-sparing prostatectomy. All patients were randomized into two groups. In Group 1 patients did not receive drug therapy for the prevention and treatment of erectile dysfunction. In Group 2 patients in the postoperative period received daily PDE-5 inhibitors (tadalafil) at a minimum dosage of 5 mg for 12 months as a drug therapy. Initially and at the annual stage of the study, the state of EF, erectile rigidity, night penile test, and quality of life were assessed. An analysis was also made of the factors affecting the preservation of EF one year after nerve-sparing radical prostatectomy.Results. The best reliable results in terms of maintaining EF at the annual stage of the study were obtained in the group whose patients received postoperative drug therapy with PDE-5 inhibitors. It was possible to identify the most significant factors influencing the state of EF in the postoperative period after radical prostatectomy: the type of operation – bilateral nerve sparing, taking PDE-5 inhibitors, the patient’s age, the presence/absence of diabetes mellitus, the state of EF (International Index of Erectile Function-5 value) before the operation.Conclusion. Daily intake of PDE-5 inhibitors at a low dose of 5 mg is indicated for patients after nerve-sparing prostatectomy as an effective means of penile rehabilitation in order to preserve EF, as it provides better results compared to no drug therapy. Patients who meet criteria such as young age, no diabetes, high preoperative International Index of Erectile Function-5 levels may benefit most from nerve-sparing surgical techniques and early postoperative participation in a penile rehabilitation program for erectile dysfunction.

Erectile response profiles of men using PDE5 inhibitors combined with intracavernosal injections as part of a penile rehabilitation program after radical prostatectomy.

Phosphodiesterase type 5 (PDE5) inhibitor labeling states that these agents should not be used in conjunction with other erectogenic medications for fear of priapism occurring. We explored the risk of priapism and prolonged erections in men in our post-radical prostatectomy (RP) penile injection program who were using regular PDE5 inhibitor and intracavernosal injections (ICIs) as part of their rehabilitation program. The study cohort included men on penile injection therapy who (1) were taking tadalafil 5mg daily or taking sildenafil 25mg on noninjection days, (2) had an RP, (3) were using their respective PDE5 inhibitor regularly at the time of penile injection training, and (4) complied with the program instructions regarding penile injection use. Demographics, comorbidity details, PDE5 inhibitor dose and utilization, and injection dose and utilization data were collected. All patients underwent in-office injection training and used trimix (papaverine/phentolamine/prostaglandin E1) as the intracavernosal medication. Priapism was defined as a patient self-reported penetration hardness erection ≥4hours in duration, while prolonged erection was defined as a penetration hardness erection lasting ≥2hours. A total of 112 tadalafil users and 364 sildenafil users were compared. Mean age and duration post-RP were 62 ± 14years and 5.2 ± 12months, respectively, and there was no difference between tadalafil and sildenafil groups. The mean trimix dose was tadalafil 24 ± 24units and sildenafil 31 ± 37units (P< .05). Priapism occurred in 2 (1.7%) of 112 tadalafil users and 5 (1.4%) of 364 sildenafil users (P= .47). Excluding those men experiencing priapism on any occasion, those with any reported penetration hardness erection lasting ≥2hours were 7 (6.3%) of 112 tadalafil users and 12 (3.3%) of 364 sildenafil users (P< .01). A total of 53% of these prolonged erections occurred within the first 6 injections at home (no difference between tadalafil and sildenafil groups). We emphasize the need for continued monitoring and education on proper injection techniques to minimize the risk of adverse events in ICI and PDE5 inhibitor combination therapy. This study has a relatively large patient population with a considerable follow-up time. Additionally, the rigorous training, education, and monitoring of the participants, as well as the use of formal definitions for priapism and prolonged erections, enhances the accuracy and reliability of the results. However, there are some limitations, such as social desirability, confounding factors, and recall bias. There is no significant difference in the incidence of priapism in an ICI program in which men combine ICI with tadalafil or sildenafil. However, tadalafil patients had a higher rate of prolonged erections, which was found to occur mostly early during the titration phase.

Penile rehabilitation effectiveness after prostate cancer treatment: A systematic review of randomized controlled trials.

Prostate cancer treatment can significantly impact erectile function, and penile rehabilitation has been proposed to improve the impacts. However, the effectiveness of penile rehabilitations after treatment of prostate cancer is scarce. The aim of this systematic review was to evaluate the effectiveness of different interventions of penile rehabilitation program after prostate cancer treatment. We conducted a comprehensive search of electronic databases, PubMed and Google Scholar, to identify randomized controlled trials that evaluated interventions for penile rehabilitation after prostate cancer treatment. Studies that met our inclusion criteria were systematically reviewed, and data were synthesized and analyzed. We identified 11 randomized controlled trials that evaluated different interventions for penile rehabilitation after prostate cancer treatment. The interventions included the use of phosphodiesterase type 5 inhibitors, intracavernous injections, vacuum erection devices, and penile rehabilitation programs. The data suggest that these phosphodiesterase inhibitors, intracavernous injections, vacuum erection devices, and penile rehabilitation programs are promising in improving erectile function after prostate cancer treatment. However, the optimal timing and duration of these interventions remain unclear, and there is a need for further research to determine their long-term effectiveness and safety. Healthcare providers should consider individualized approaches to penile rehabilitation, taking into account patient characteristics and preferences.

(336) Penile Rehabilitation Programs after Nerve-sparing Prostatectomy: What are the Expectations of the Partners?

Abstract Introduction Several strategies are published for postoperative erectile function rehabilitation after nerve-sparing radical prostatectomy (nsRP). Expectations of the partners of the patients are rarely subject of most of these rehabilitation studies. Objective The aim of our study was to evaluate the expectations of the partners of patients undergoing nerve-sparing radical prostatectomy and penile rehabilitation programs. Methods We performed a questionnaire sent to the partners of all enrolled patients of 3 different penile rehabilitation studies after nsRP with a regular dose of different PDE5-inhibitors (sildenafil/vardenafil/tadalafil). 124 patients (mean age 69 years) had been enrolled in the rehabilitation studies and their partners (mean age 66 years) were included in this study. The survey consists of different questions, e.g. if the partners believe in the rehabilitation concept and what they expect with regards to the outcome. Results 78 partners of the 124 patients (63%) completed and returned the questionnaire. Before rehabilitation treatment 51 partners (65%) believed in the concept of rehabilitation, but only 32 partners (41%) expected partly to fully rehabilitation of erectile function of the partners caused by the initiated penile rehabilitation program. After the end of the study treatment, 2 years after nsRP, 45% of the partners are satisfied by the recovery of erectile function of their partners. Conclusions Only 41% of the partners of patients within penile rehabilitation programs expect partly to fully recovery of erectile function after nsRP. Satisfaction rate with erectile function recovery was reported by 45% of the partners 2 years after nsRP. Disclosure No

Erectile Dysfunction in Pelvic Cancer Survivors and Current Management Options

Pelvic malignancies, including prostate, rectal, and bladder cancers, are among the most frequent malignancies found in the male population. These issues are most effectively and commonly treated with radiotherapy and/or surgery. However, these treatments can cause collateral damage, resulting in significant impacts on quality of life, with erectile dysfunction being one of the most frequent postoperative complications. Currently, there are several treatment options for erectile dysfunction, including oral phosphodiesterase type 5 inhibitors, vacuum erection devices, intracorporeal injections, and penile prosthesis. The latter has shown to be an effective and safe technique, with results comparable to those obtained by patients without pelvic surgery or radiotherapy. The results of early penile rehabilitation programs are promising and they have been incorporated into a greater proportion of treatment plans more recently, with varying degrees of success. In this narrative review, we summarize the literature on erectile dysfunction after pelvic cancer treatments and its management.

Expectations of partners of our patients undergoing penile rehabilitation programs after nerve-sparing prostatectomy – What do they expect about sexual outcome?

Expectations of partners of our patients undergoing penile rehabilitation programs after nerve-sparing prostatectomy – What do they expect about sexual outcome?

Sexual function recovery following open and robotic radical prostatectomy: results of an academic penile rehabilitation program.

Sexual function recovery following open and robotic radical prostatectomy: results of an academic penile rehabilitation program.

SC24 - Sexual function recovery following open and robotic radical prostatectomy: preliminary results of a single academic penile rehabilitation program

SC24 - Sexual function recovery following open and robotic radical prostatectomy: preliminary results of a single academic penile rehabilitation program

PD49-07 SEXUAL FUNCTION RECOVERY FOLLOWING OPEN AND ROBOTIC RADICAL PROSTATECTOMY: RESULTS OF AN ACADEMIC PENILE REHABILITATION PROGRAM

You have accessJournal of UrologyCME1 May 2022PD49-07 SEXUAL FUNCTION RECOVERY FOLLOWING OPEN AND ROBOTIC RADICAL PROSTATECTOMY: RESULTS OF AN ACADEMIC PENILE REHABILITATION PROGRAM Ugo Falagario, Michele Di Nauta, Andrea Checchia, Marco Recchia, Anna Ricapito, Nicola D'Altilia, Pasquale Annese, Gian Maria Busetto, Luigi Cormio, Giuseppe Carrieri, and Carlo Bettocchi Ugo FalagarioUgo Falagario More articles by this author , Michele Di NautaMichele Di Nauta More articles by this author , Andrea ChecchiaAndrea Checchia More articles by this author , Marco RecchiaMarco Recchia More articles by this author , Anna RicapitoAnna Ricapito More articles by this author , Nicola D'AltiliaNicola D'Altilia More articles by this author , Pasquale AnnesePasquale Annese More articles by this author , Gian Maria BusettoGian Maria Busetto More articles by this author , Luigi CormioLuigi Cormio More articles by this author , Giuseppe CarrieriGiuseppe Carrieri More articles by this author , and Carlo BettocchiCarlo Bettocchi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002620.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical prostatectomy (RP) is the gold standard treatment for clinically localized prostate cancer (PCa) in patients with a life expectancy 10 yr. Notwithstanding improvements in surgical techniques, erectile dysfunction (ED) is a common sequela of RP.The aim of the present study was to evaluate the effect of early penile rehabilitation in a dedicated Penile Rehabilitation Program on both assisted and unassisted erectile function (EF) in men who developed ED after open and robotic RP. METHODS: All patients undergoing open or robotic RP and early penile rehabilitation were included in the present study. All patients were treated and followed up at a single academic institution in a dedicated Penile Rehabilitation Program. Treatment included phosphodiesterase type 5 inhibitors (PDE5Is), intracavernous injections and vacuum erection devices (VEDs). EF recovery was defined as IIEF>20. Both assisted and unassisted EF was evaluated. Data were prospectively collected and retrospectively reviewed. Kaplan Mayer curves were used to evaluate EF recovery. Ethical Committee approval has been obtained. RESULTS: a total of 397 patients were eligible. 168 (42.3%) underwent robotic RP. Unilateral and bilateral nerve sparing was performed in 38 (9.6%) and 116 (29.2%) patients respectively.A combination of PDE5I and intracavernous injections was the most frequently used first line treatment (233, 59%). VEDs were used in 52 patients in addition to PDE5I and intracavernous injections (39, 10%) or intracavernous injections (23, 6%). In patients with a preoperative IIEF>21, assisted and unassisted EF recovery rates were 78% and 36% respectively.In patients with a preoperative IIEF<16, assisted and unassisted EF recovery rates were 46% and 18% respectively. Sub analysis showed a moderate benefit of penile rehabilitation also in patients with a preoperative IIEF<16 undergoing bilateral nerve sparing RP.Intensive penile rehabilitation with PDE5I, intracavernous injections and VEDs led to the best patient perceived results. CONCLUSIONS: Intensive penile rehabilitation programs improves EF recovery in patients undergoing radical prostatectomy. Preservation of Neurovascular bundles should be attempted also in patients with preoperative ED. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e832 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ugo Falagario More articles by this author Michele Di Nauta More articles by this author Andrea Checchia More articles by this author Marco Recchia More articles by this author Anna Ricapito More articles by this author Nicola D'Altilia More articles by this author Pasquale Annese More articles by this author Gian Maria Busetto More articles by this author Luigi Cormio More articles by this author Giuseppe Carrieri More articles by this author Carlo Bettocchi More articles by this author Expand All Advertisement PDF DownloadLoading ...

A0544 - Sexual function recovery following open and robotic radical prostatectomy: Results of an academic penile rehabilitation program

A0544 - Sexual function recovery following open and robotic radical prostatectomy: Results of an academic penile rehabilitation program

Update on the Penuma® an FDA-cleared penile implant for aesthetic enhancement of the flaccid penis.

The Penuma® implant is a medical-grade silicone implant surgically inserted subcutaneously to provide cosmetic improvement of the penile aesthetic. The principal author was invited to provide an update on the usage of the Penuma® implant for penile aesthetics. He collected as yet unpublished data, which is undergoing synchronous submission to Urologic meetings and peer-reviewed publications by a variety of authors for this communication. The objective of this article is to provide updated information regarding the Penuma® aesthetic penile implant. A new scrotal method of implantation named "concealed" is emerging. Through physician comparison of various factors prior to and after the scrotal method intervention, early findings suggest this approach seems to have less visible scar, is quicker and is followed by less seroma formation. As the device is now surgically implanted by surgeons other than its inventor, new developments have appeared authenticating the original published paper in 2018. Patients were contacted via phone and were asked five questions regarding satisfaction with the responses recorded. This new multicenter study shows findings of high patient and partner satisfaction coupled with acceptable adverse outcomes similar to the single-surgeon study. A new penile rehabilitation program has been developed with the aim for the penis appearance to be restored to its pre-operative state if the Penuma® is removed. 12 patients who underwent penile implant removal were followed for 6 months while participating in the penile rehabilitation program. The discipline worked in patients who desired removal for dissatisfaction and is currently under evaluation in patients who require device removal for medical reasons, e.g., infection or suture-related issues. Through new developments, the acceptance of Penuma® in the prosthetic community seems to be further solidified.

A Review of Factors Affecting Patient Satisfaction With Inflatable Penile Prosthesis.

A variety of factors that can influence patient satisfaction after inflatable penile prosthesis (IPP) surgery, including patient expectations before surgery, intraoperative complications, and perceived penile shortening and partner satisfaction after surgery. While patient satisfaction rates with IPP are high, there are several reported methods to further improve patient satisfaction with IPP. Identifying factors responsible for patient satisfaction after IPP surgery from preoperative counseling, intraoperative techniques, and postoperative care and identifying ways to improve overall patient satisfaction. A PubMed search was performed of all articles available on the database relating to penile prosthesis and patient satisfaction. The main outcome measure is patient satisfaction after IPP surgery. Patient satisfaction has been reported to be as high as 90%. Factors affecting postoperative satisfaction include preoperative counseling and expectations, patient comorbidities, partner satisfaction, and postoperative complications. One of the most common complaints is decreased penile length postoperatively. It is critical to accurately measure penile length before surgical intervention. Preoperative strategies to improve penile length with IPP include the use of penile traction therapy and vacuum erection device (VED). Several adjuvant procedures have been described and shown to safely increase penile length with concomitant IPP surgery, including ventral phalloplasty, suprapubic fat pad excision, and modified sliding technique-multiple slice technique. Postoperative penile rehabilitation program has been shown to improve penile length. The use of phosphodiesterase type 5 inhibitors in the postoperative period leads to increased glans engorgement and improved patient satisfaction. Patient satisfaction with IPP is influenced by many factors, which can be categorized into 3 distinct patient care stages: preoperative, intraoperative, and postoperative. There are several techniques described in each patient care stage to improve perceived penile length including preoperative counseling and correct penile length measuring, preoperative penile stretching, the use of adjuvant surgical procedures, and postoperative penile rehabilitation. Shah T, Wang R, A Review of Factors Affecting Patient Satisfaction With Inflatable Penile Prosthesis. Sex Med 2021;9:350-357.

322 Two-years Follow-up: Penile Rehabilitation Program with “Early” Low-dose Tadalafil after Nerve-sparing Radical Prostatectomy - Increased “Early” Nocturnal Penile Tumescence 8 Days After Nerve-sparing Radical Prostatectomy is Correlated with Further

322 Two-years Follow-up: Penile Rehabilitation Program with “Early” Low-dose Tadalafil after Nerve-sparing Radical Prostatectomy - Increased “Early” Nocturnal Penile Tumescence 8 Days After Nerve-sparing Radical Prostatectomy is Correlated with Further

New approaches to management of erectile dysfunction and lower urinary tract symptoms associated with benign prostatic hyperplasia

This paper addresses the background of phosphodiesterase-5 inhibitors use in erectile dysfunction and lower urinary tract symptoms, as well as a special position which is held by tadalafil as an only drug from its class suitable for daily intake. Tadalafil pharmacodynamics and hypotheses concerning its mechanism of action on prostatic tissue are discussed. Special attention is paid to drug»s efficacy and safety in elderly men, who often require therapy for benign prostatic hyperplasia with lower urinary tract symptoms. It is mentioned that tadalafil may be used in penile rehabilitation programs in men who underwent radical prostatectomy.

Acceptance and Commitment Therapy to Increase Adherence to Penile Injection Therapy-Based Rehabilitation After Radical Prostatectomy: Pilot Randomized Controlled Trial

IntroductionDespite the importance of using penile injections as part of a penile rehabilitation program, men have difficulty complying with these programs. AimTo test a novel psychological intervention based on Acceptance and Commitment Therapy for erectile dysfunction (ACT-ED) to help men utilize penile injections. MethodsThis pilot randomized controlled trial (RCT) recruited men who were beginning a standard care (SC) structured penile rehabilitation program following radical prostatectomy. The SC program instructed patients to use penile injections 2 to 3 times per week. Participants were randomized to SC+ACT-ED or SC+enhanced monitoring (EM). Over 4 months, patients in the SC+ACT-ED group received SC plus 4 ACT sessions and 3 ACT phone calls; those in the EM group received SC plus 7 phone calls from an experienced sexual medicine nurse practitioner. Participants were assessed at study entry and at 4 and 8 months. For this pilot study, the goal was to determine initial efficacy (ie, effect sizes, where d = 0.2 is small, d = 0.5 is medium, and d = 0.8 is large). Main Outcome MeasurePrimary outcomes were feasibility and use of penile injections. Secondary outcomes were ED treatment satisfaction (ie, Erectile Dysfunction Inventory of Treatment Satisfaction, or EDITS), sexual Self-Esteem and Relationship (SEAR) quality, sexual bother (SB), and prostate cancer treatment regret. ResultsThe 53 participants were randomized (ACT, n = 26; EM, n = 27). The study acceptance rate was 61%. At 4 months, the ACT-ED group utilized more penile injections per week (1.7) compared to the EM group (0.9) (d = 1.25; P = .001) and was more adherent to penile rehabilitation compared to the EM group (ACT, 44%; EM, 10%; relative risk [RR], 4.4; P = .02). These gains were maintained at 8 months for injections per week (ACT, 1.2; EM, 0.7; d = 1.08; P = .03) and approached significance for adherence (ACT, 18%; EM, 0%; P = .10). At 4 months, ACT-ED, compared to EM, reported moderate effects for greater satisfaction with ED treatment (d = 0.41; P = .22), greater sexual self-esteem (d = 0.54; P = .07) and sexual confidence (d = 0.48; P = .07), lower sexual bother (d = 0.43; P = .17), and lower prostate cancer treatment regret (d = 0.74; P = .02). At 8 months, moderate effects in favor of ACT-ED were maintained for greater sexual self-esteem (d = 0.40; P = .19) and less treatment regret (d = 0.47; P = .16). Clinical ImplicationsACT concepts may help men utilize penile injections and cope with the effects of ED. Strengths and LimitationsStrengths include use of an innovative intervention utilizing ACT concepts and pilot RCT. Limitations include the pilot nature of the study (eg, small samples size, lack of statistical power). ConclusionACT-ED is feasible and significantly increases the use of penile injections. ACT-ED also shows promise (moderate effects) for increasing satisfaction with penile injections and sexual self-esteem while decreasing sexual bother and prostate cancer treatment regret.Nelson CJ, Saracino RM, Napolitano S, et al. Acceptance and Commitment Therapy to Increase Adherence to Penile Injection Therapy-Based Rehabilitation After Radical Prostatectomy: Pilot Randomized Controlled Trial. J Sex Med 2019; 19:1398–1408.

263 Penile Rehabilitation Program with “early” low-dose tadalafil after nerve-sparing radical prostatectomy - increased “early” nocturnal penile tumescence 8 days after nerve-sparing radical prostatectomy is correlated with further erectile function r

Cytotoxic factors in the corpora cavernosa released within the first 48 to 72 hours after surgery seem to play a major role for developing persistent erectile dysfunction. Several pathophysiologies are postulated for postoperative erectile function rehabilitation. In previous prospective studies nocturnal penile tumescense and rigidity (NPTR) in the acute phase during the first night after catheter removal was shown in 93% of the patients after nerve-sparing radical prostatectomy (nsRP) and the improvement of erectile function by using daily low dose PDE5-inhibitors. But the “optimal” time to initiate a rehabilitation program with PDE5-inhibitors is still unknown. 24 sexual active patients were operated by nerve-sparing retropubic radical prostatectomy. All patients completed an IIEF-5 questionnaire concerning erectile function preoperatively. To maintain and support recovery of spontaneous erectile function 12 patients received tadalafil 5mg/d at night starting at the 3rd night after surgery (group 1). A control of 12 patients received tadalafil 5mg/d at night beginning one day after catheter removal (group 2). 8 days after surgery the transurethral catheter was removed and an erectometer measurement of NPTR (Rigi-Scan®) was carried out on each patient at the following night. All patients completed an IIEF-5 questionnaire concerning erectile function at 3, 6, 12 and 18 months after surgery to evaluate further erectile function recovery.

Peyronie's graft surgery-tips and tricks from the masters in andrologic surgery.

BackgroundGrafting techniques in the surgical management of Peyronie’s disease (PD) are challenging, especially in inexperienced hands. In order to improve surgical outcomes the urologist should follow a standard surgical approach, preferably of an established and reliable grafting technique. The aim of this study is to provide tips and tricks for graft surgery for PD.MethodsThis report offers a step-by-step tutorial for grafting techniques in PD, especially for the Sealing technique and the partial plaque excision and grafting (PEG) procedure. Two senior surgeons (GH, LAL) describe their surgical technique in detail, and provide important aspects and tips one has to be aware of when performing a grafting technique in patients with PD. Special attention is also paid to preoperative considerations and adequate patient counseling. Moreover, postoperative penile rehabilitation programs are discussed.ResultsAdequate preoperative counseling of patients is crucial, and should include possible adverse effects and negative outcomes, such as persistent or recurrent curvature, diminished sensation at the glans penis, diminished erectile function, or penile shortening. The correct indication for a grafting technique is imperative. There are many surgical details during grafting techniques, which have to be considered in order to achieve the best result possible. These include the correct preparation of the neurovascular bundle, the following partial plaque excision without damaging the underlying erectile tissue, and the sufficient closure of the resulting tunica albuginea defect. Defect closure can be done by grafts like pericardial graft (PEG procedure) or the collagen fleece (Sealing technique). Postoperatively, the patient should refrain from sexual activities for at least 6 weeks, and follow a penile rehabilitation program with Phoshodiesterase-Type-5 inhibitors, manual stretch, penile massage, and penile traction therapy.ConclusionsThe present paper offers a step-by-step tutorial for grafting techniques in PD, especially for the Sealing technique and the PEG procedure, in order to help the reader to understand major steps during surgery and to avoid pitfalls. Careful patient selection, a reliable and established surgical technique and a postoperative rehabilitation program are main predictors for treatment success. In summary, the ultimate goal should be improved patient care, safety and satisfaction.