Postoperative Erectile Dysfunction Research Articles

Survey on consenting practice and discussion of post-operative erectile dysfunction following rectal cancer surgery

Introduction: Sexual dysfunction is a recognized complication of rectal cancer surgery, due to the close proximity of the pelvic autonomic nerves to the normal plane of dissection. The consenting process should therefore always include the risk of sexual and urinary dysfunction arising after such surgery. This survey was undertaken to assess the consenting practice, and to evaluate the frequency of use of phosphodiesterase Type 5 (PDE5) inhibitors to treat erectile dysfunction (ED) following rectal cancer surgery. Methods: All listed Association of Coloproctology of Great Britain and Ireland (ACPGBI) members were invited to participate in the electronic survey, which comprised six questions. By 8 weeks, 119 responses had been received. Results: There were 112 respondents (94.1%) who routinely discussed the risk of ED during the process of gaining consent for rectal cancer surgery. There were 104 respondents (87.3%) who documented ED on their consent form. There were 24 respondents (20.2%) who indicated that there was no stated percentage risk for ED; and there were 69 (58.0%) and 26 (21.9%) respondents who quoted there was a 0–25% and 26–50% risk of ED during the consent process, respectively. None were quoting > 50% risk of ED. There were 68 respondents (57.1%) who routinely enquired about ED during follow-up. There were 30 respondents (25.2%) who stated that they had experience in prescribing PDE5 inhibitors for their patients who suffer from ED: We had 25 of them who felt that patients benefited from using PDE5 inhibitors. Conclusions: The majority of colorectal surgeons routinely discuss and document the risk of ED when consenting for rectal surgery; however, most surgeons have no experience in prescribing PDE5 inhibitors. This is an area that requires further study and education.

Outcomes of Early Endoscopic Realignment of Post-Traumatic Complete Posterior Urethral Rupture

Objective: To report the experience with patients treated by early endoscopic realignment of complete post-traumatic rupture urethra.Methods: The cross sectional study included 30 patients in Dhaka Medical College Hospital and different private hospitals in Dhaka, Bangladesh, between April 2010 and March 2014 with post traumatic complete posterior urethral disruption. Pre-operative retrograde urethrography (RGU), micturition cysto urethrography (MCU) and ultrasonography (USG) of abdomen were performed to identify and to evaluate the Urethral defect length, the bladder neck competence, the prostate position and extend of pelvic hematoma. In second week after trauma, antegrade and retro-grade urethroscopy were performed to identify both urethral ends and insert a catheter. Before removal of catheter, Patients were followed up by pericatheter urethrogram after 4 weeks completed postoperative period. If extravasation seen, catheter was again maintained for another 2 weeks. Follow up was done by abdominal ultrasound and uroflowmetry 3 monthly up to 6 months and 6 monthly thereafter. RGU and MCU were performed 8 weeks after removal of catheter. Urinary continence and post-operative erectile dysfunction were assessed by direct patient interview.Results: 30 patients in the age group 18-60 years (mean 36 years) were treated. Patients were followed up for 12 to 36 months. Complete healing of the urethra occurred in 10 patients. Passable urethral stricture developed in 12 patients. Complete urethral obstruction occurred in 8 patients.Conclusion: Early endoscopic realignment for complete posterior urethral rupture is a feasible technique with no or minimal intra-operative complications. The technique is successful as the definite line of therapy in reasonable number of patients and it is seems to be effective Intervention for the prevention of inevitable urethral stricture formation.J Dhaka Medical College, Vol. 24, No.2, October, 2015, Page 136-140

Erectile function post robotic radical prostatectomy: technical tips to improve outcomes?

Robotic surgery is becoming more and more commonplace. At the same time, so are complications, especially related to erectile function. The population being diagnosed with cancer is younger, with more aggressive cancers and higher expectations for good erectile function postoperatively. We conduct a retrospective analysis of literature over 20 years for Embase and Medline. Search terms used include (Robotic) AND (prostatectomy) AND (erectile function). There are a variety of multifactorial causes, resulting in worsening ED post-robotic radical prostatectomy; however, there are a number of treatments that can support this. There is much we can do to help prevent patients getting postoperative erectile dysfunction post-radical surgery. However, part of this is management of realistic patient expectations.

Lengthening strategies for Peyronie's disease.

Loss of penile length is a common complaint of men with Peyronie’s disease (PD), both before and after corrective intervention, which has a significant negative effect on patient quality of life. We sought to identify and describe the methods by which penile length can be preserved or increased. We conducted an extensive, systematic literature review, based on a search of the PUBMED database for articles published between 1990 and 2015. Articles with the key words “Peyronie’s disease”, “penile length” and/or “penile lengthening” were reviewed if they contained subjective or objective penile length outcomes. Only English-language articles that were related to PD and penile size were included. We found no evidence in the literature that medical therapy alone increases penile length. Classic inflatable penile prosthesis (IPP) placement, plication procedures, and the Nesbit procedure appear likely to maintain or decrease penile length. Plaque incision (PI) and grafting appears likely to maintain or increase penile length, but is complicated by risk of post-operative erectile dysfunction (ED). There are several surgical procedures performed concomitantly with IPP placement that may be suitable treatment options for men with comorbid ED, and consistently increase penile length with otherwise good outcomes concerning sexual function. These include the subcoronal penile prosthesis (scIPP), Egydio circumferential technique, the sliding technique, the modified sliding technique (MoST), and the multiple slice technique (MuST). In addition, adjuvant therapies such as penile traction therapy (PTT), post-operative inflation protocols, suspensory ligament relaxation, lipectomy, and adjuvant medical therapy for glans engorgement appear to increase subjective and/or objective penile length for men at high risk of decreased penile length after PD surgery. Considering the psychological burden of length loss in men with PD, providers with adequate volume and expertise should attempt, if possible, to maintain or increase penile length for men undergoing surgical intervention. There are several evidence-based, safe, and effective ways to increase penile length for these men and multiple emerging adjuvant therapies that may help ensure adequate length.

PS-07-001 A new original surgical technique for Peyronie disease: albugineal graft-free lengthening z-plasty. Results with mean follow up over 12 months

We present an original lengthening albugineal Z-plasty for the treatment of penile curvature due to Peyronie Disease (PD) with the aim to reduce the post-operative Erectile Dysfunction (ED) due to Veno-Occlusive Dysfunction (VOD) as major functional complication of incision and grafting surgical procedures performed for PD. Surgical technique: circumcision and deglooving of the penis; dorsal neurovascular bundle isolation and setup plaque size and direction by saline hydraulic erection; Z-shape plaque incision and translocation of albugineal flaps using 4/0 Vycril suture; saline hydraulic erection to confirm absence of residual curvature. From May 2013 to September 2015, 15 patients affected by PD have been enrolled in a surgical experimental pilot study with local Aethical Comitee certification. Inclusion criteria comprise: age up to 18 years (yr), penile curvature due to PD in stable phase (=>3 months), no ED (IIEF-5>19; EHS>3), specific informed file subscription. History (IIEF-5 and PDQ Scale Q2 to Q6), physical examination (EHS), dynamic penile ecocolorDoppler ultrasound examination (longitudinal plaque size, curvature degree) have been reported for each patients as soon as operating time procedure, intraoperative complications, post-surgical complication. Each patients has been re-evaluated after surgery at 1, 3, 6 and 12 mo.

AB023. Penile rehabilitation with phosphodiesterase type 5 inhibitors in men after nerve-sparing radical prostatectomy

Post-radical prostatectomy (RP) erectile dysfunction (ED) remains a challenge for the urologist. Despite the improvements in surgical technique, ED occurs between 20% and 90% in patients treated with bilateral nerve-sparing RP. Patient factors, cancer selection, type of surgery, surgical techniques, and surgeon factors represent the key significant contributors to erectile function recovery. The aim of a penile rehabilitation program is to preserve the functional smooth-muscle content of the corpus cavernosum during the neuropraxia period. Phosphodiesterase type 5 (PDE5) inhibitors are commonly used in rehabilitation programs. In animal models, such an approach could promote erectile function recovery, improve smooth muscle-to-collagen penile ration, reduce penile apoptotic index, preserve penile endothelial function and promote neuroprotection during nerve damage. Despite the strong basic science support from animal studies, discordant results have been reached in humans. The previous randomized trials comparing chronic versus on-demand PDE-5 inhibitors use after RP may be affected by improper patients’ selection in that only men at low risk of postoperative ED were included. These patients would recover erectile function regardless of the type of PDE5 inhibitor administration because of their excellent baseline profile. Prospective, randomized trials have shown a significant benefit of daily PDE5-I administration as compared with placebo in terms of postoperative EF recovery. Patients with intermediate risk of ED after surgery are the best candidates for daily treatment with PDE5 inhibitor after bilateral nerve-sparing RP. The maximal effect of penile rehabilitation may be found in those men with a certain (but not high) degree of systemic and erectile impairment preoperatively. In conclusion, penile rehabilitation could achieve faster and better natural erectile function after RP and should be started as early as possible. Chronic use of PDE5-I may confer the maximal gain as compared to the on-demand administration schedule. Attention should be pained to the observation that rehabilitation protocols are beneficial even in men with spontaneous erections postoperatively because further improvement in such patients was reported.

Delaying Surgical Treatment of Penile Fracture Results in Poor Functional Outcomes: Results from a Large Retrospective Multicenter European Study

BackgroundPenile fracture is a rare clinical entity that represents a urologic emergency. It involves traumatic rupture of the tunica albuginea of the corpora cavernosa due to twisting or bending of the penile shaft during erection. ObjectiveTo determine the differences in preoperative diagnostic evaluation patterns and outcomes of penile fracture patients to investigate the impact of surgical delay on functional outcomes. Design, setting, and participantsA retrospective analysis was performed using data obtained from 137 patients presenting with penile fracture at seven different European academic medical centers between 1996 and 2013. Age, imaging modalities used, timing of surgical intervention, length of tunica albuginea defect, and surgical technique were recorded. Postoperative erectile function outcomes were assessed with the International Index of Erectile Function (IIEF-5), and the presence of postoperative penile curvature was noted. Outcome measurements and statistical analysisThe association between timing of surgical intervention and postoperative IIEF-5 results was evaluated with discriminant function analysis. Results and limitationsThe median age of the patients was 34.50 yr (interquartile range [IQR]: 28.0–46.5 yr). Of the 137 patients, 82 (59.85%) underwent penile Doppler ultrasound, and 5 patients (3.64%) were evaluated with magnetic resonance imaging. All patients were treated surgically, and the duration between emergency room admission and surgical intervention was 5.0h (IQR: 3.6–8.0h). The median length of tunica albuginea defect was 10mm (IQR: 8–20mm). Postoperative IIEF-5 scores were 21 (IQR: 12–23) and 23 (IQR: 15–24) at the first and third postoperative months, respectively. Discriminant function analysis revealed that if the surgical intervention was performed >8.23hours after emergency room admission, postoperative erectile function was significantly worse (p=0.0051 at first month and p=0.0057 at third month postoperatively). ConclusionsOur multicenter study showed that delaying surgical intervention results in significantly impaired erectile function. Surgical treatment must be planned as soon as possible to avoid postoperative erectile dysfunction. Patient summaryWe looked at sexual outcomes following the repair of penile fracture in a large European population. We found that outcomes worsened if surgical repair was delayed.

Low-intensity extracorporeal shockwave therapy in the treatment of postprostatectomy erectile dysfunction: a pilot study

Objective: The objective was to investigate the effect and feasibility of low-intensity extracorporeal shockwave therapy (LI-ESWT) as a treatment for erectile dysfunction (ED) after bilateral nerve-sparing radical prostatectomy (RP). Materials and methods: Patients who had undergone robot-assisted bilateral nerve-sparing RP more than a year before entering this pilot study, had no preoperative ED and were suffering from mild to severe postoperative ED were invited to participate. Six treatments were given over a 6 week period, using the Duolith® SD1 T-Top machine. The effect of the treatment was evaluated 1 month (t1) and 1 year (t2) after the final treatment. The main outcome measure was changes in the five-item International Index of Erectile Function (IIEF-5) scores. Results: Eighteen patients were included in the study. However, two patients breached the protocol and consequently 16 patients were included in the analysis at t1 and 15 patients were included in the analysis at t2. At baseline the median age was 62 years (range 51 to 70 years) and the median time since surgery was 24 months (range 12 to 54 months). The median preoperative IIEF-5 score was 25 (range 22 to 25) and the median baseline IIEF-5 score was 9.5 (range 5 to 20). The median change in IIEF-5 scores was +3.5 (range –1 to 8; p = 0.0049) and +1 (range –3 to 14; p = 0.046) at t1 and t2, respectively. No severe side-effects were reported. Conclusions: LI-ESWT may improve erectile function after bilateral nerve-sparing RP. Based on these results, further studies in patients with ED after nerve-sparing RP are justified.

Comparison of retropubic radical prostatectomy and standard laparoscopic radical prostatectomy: a meta–analysis

Objective To compare the outcomes of standard laparoscopic radical prostatectomy(SLRP) and retropubic radical prostatectomy (RRP) via meta–analysis. Methods A systematic literature search of articles from January 1992 to April 2015 was conducted via Pubmed, Web of Science, Cochrane Library, and EMBASE databases, and the references of the retrieved articles.Fixed– or random–effect models were used to summarize the estimates to evaluate operation time, blood loss, transfusion, catheterization time, hospital stay, surgical margin status, perioperative complications, postoperative erectile dysfunction, and postoperative urinary incontinence in these two approaches. Results A total of 17 articles were included in this study.Compared with RRP group, the operation time was longer in SLRP group (SMD=1.20, 95%CI 0.83, 1.58). On the contrary, the SLRP group held advantages in blood loss (SMD=–2.02, 95%CI –2.67, –1.37), transfusion (RR=0.22, 95%CI 0.16, 0.30), catheterization time (SMD=–1.44, 95%CI –2.34, –0.54), hospital stay (SMD=–0.97, 95%CI –1.29, –0.66)(P 0.05). Conclusions Compared with RRP, SLRP could be a more suitable approach to treat localized prostate cancer.Random clinical trials are needed in the future to better evaluate these two approaches. Key words: Standard laparoscopic radical prostatectomy; Retropubic radical prostatectomy; Meta–analysis; Clinical research

AB020. Penile rehabilitation with PDE5 inhibitors in men following radical prostatectomy

Post-radical prostatectomy (RP) erectile dysfunction (ED) remains a challenge for the urologist. Despite the improvements in surgical technique, ED occurs between 20% and 90% in patients treated with bilateral nerve-sparing RP. Patient factors, cancer selection, type of surgery, surgical techniques, and surgeon factors represent the key significant contributors to erectile function recovery. The aim of a penile rehabilitation program is to preserve the functional smooth-muscle content of the corpus cavernosum during the neuropraxia period. Phosphodiesterase type 5 (PDE5) inhibitors are commonly used in rehabilitation programs. In animal models, such an approach could promote erectile function recovery, improve smooth muscle-to-collagen penile ration, reduce penile apoptotic index, preserve penile endothelial function and promote neuroprotection during nerve damage. Despite the strong basic science support from animal studies, discordant results have been reached in humans. The previous randomized trials comparing chronic versus on-demand PDE-5 inhibitors use after RP may be affected by improper patient selection in that only men at low risk of postoperative ED were included. These patients would recover erectile function regardless of the type of PDE5 inhibitor administration because of their excellent baseline profile. Prospective, randomized trials have shown a significant benefit of daily PDE5-I administration as compared with placebo in terms of postoperative EF recovery. Patients with intermediate risk of ED after surgery are the best candidates for daily treatment with PDE5 inhibitor after bilateral nerve-sparing RP. The maximal effect of penile rehabilitation may be found in those men with a certain (but not high) degree of systemic and erectile impairment preoperatively. In conclusion, penile rehabilitation could achieve faster and better natural erectile function after RP and should be started as early as possible. Chronic use of PDE5-I may confer the maximal gain as compared to the on-demand administration schedule. Attention should be pained to the observation that rehabilitation protocols are beneficial even in men with spontaneous erections postoperatively because further improvement in such patients was reported.

Specifics of Prostate Cryoablation

Cryotherapy is a tissue ablation procedure performed by local application of very low temperatures. It is highly effective minimally invasive treatment for prostate cancer. Significant improvement of cryosurgery equipment, use of cryoneedles with smaller diameter, temperature sensors, and a catheter for heating of the urethral mucosa minimize the number of complications compared with other treatments for prostate cancer and enable high recurrence-free survival. Due to the high probability of postoperative erectile dysfunction, this method is increasingly used in patients who are not interested in preserving sexual function. Cryotherapy can be repeated in the case of tumor recurrence after surgical or radiation treatment of prostate cancer.

MP29-13 CORPOROPLASTY WITH SMALL INTESTINE SUBMUCOSA IN PATIENTS WITH PEYRONIE'S DISEASE

You have accessJournal of UrologyTrauma/Reconstruction: Ureter, Bladder, External Genitalia and Urotrauma II1 Apr 2015MP29-13 CORPOROPLASTY WITH SMALL INTESTINE SUBMUCOSA IN PATIENTS WITH PEYRONIE'S DISEASE Ramon Virasoro, Oscar A. Storme, Kenneth J. Delay, Jeremy B. Tonkin, Jack M. Zuckerman, Kurt A. Mccammon, and Gerald H. Jordan Ramon VirasoroRamon Virasoro More articles by this author , Oscar A. StormeOscar A. Storme More articles by this author , Kenneth J. DelayKenneth J. Delay More articles by this author , Jeremy B. TonkinJeremy B. Tonkin More articles by this author , Jack M. ZuckermanJack M. Zuckerman More articles by this author , Kurt A. MccammonKurt A. Mccammon More articles by this author , and Gerald H. JordanGerald H. Jordan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.616AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Peyronie's disease (PD) is a disorganized collagen deposition of the tunica albuginea. Genetic predisposition, trauma and inflammation may play an important role. Prevalence ranges from 3% to 9%. PD has significant psychological burden and difficulty with intercourse. Surgical alternatives for PD include corporeal plication, plaque incision and grafting, and penile prosthesis implantation. No single surgical method has emerged as the most favorable for every patient. The use of Autograft and Xenografts, such as dermis or small intestine submucosa (SIS) has shown benefits. The objective of this study is to report our experience with SIS. METHODS Retrospective chart review of all adult men with PD that underwent corporoplasty with SIS between January 1, 1999 and August 1, 2014. Photographs of the penis in erection were used to measure curvature; all patients with Erectile Dysfunction (ED) had preoperative penile duplex ultrasound. Penile X-ray was obtained if calcified plaque was suspected. Data collection included: demographics, preoperative evaluation, outcomes, and intra- and post-operative complications. Success was considered curvature correction with residual curvature ≤15 degrees. Secondary outcome was postoperative ED. We analyzed categorical data with chi2, and continuous data with t-test; statistical analysis was carried out using Graph Pad software. RESULTS Fifty-two patients, mean age 54.99 years (SD: +/-8.35), were included. Diabetes mellitus (23.1%), dyslipidemia (51.9%), hypertension (27.9%), and penile trauma (30.76%) were observed. Time from onset to surgery was 10 to 240 months; mean 35.02 months (SD: +/- 37.96). Curvature was dorsal in all. Mean preoperative curvature degree was 68.7 (SD+/-: 20.97). After a mean follow up of 5.71 month (SD: +/- 4.89 month), curvature correction was achieved in 82.7% patients. Postoperative ED was registered in 16.6%. Complications were observed in 4 patients. There was no statistically significant difference between postoperative ED and Diabetes mellitus (p=0.53) or with ≥90 degrees of preoperative curvature (p=0.59) CONCLUSIONS Penile curvature correction with SIS is safe and efficacious for patients with PD. We found no association of postop ED with co-morbid diseases, or preop curvature degree. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e344 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ramon Virasoro More articles by this author Oscar A. Storme More articles by this author Kenneth J. Delay More articles by this author Jeremy B. Tonkin More articles by this author Jack M. Zuckerman More articles by this author Kurt A. Mccammon More articles by this author Gerald H. Jordan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP18-19 DELAY OF SURGICAL TREATMENT OF PENILE FRACTURE RESULTS IN POOR FUNCTIONAL OUTCOME: RESULTS FROM A LARGE RETROSPECTIVE MULTICENTER EUROPEAN STUDY.

You have accessJournal of UrologyTrauma/Reconstruction: Ureter, Bladder, External Genitalia and Urotrauma I1 Apr 2015MP18-19 DELAY OF SURGICAL TREATMENT OF PENILE FRACTURE RESULTS IN POOR FUNCTIONAL OUTCOME: RESULTS FROM A LARGE RETROSPECTIVE MULTICENTER EUROPEAN STUDY. Giorgio Bozzini, Maarten Albersen, Javier Romero Otero, Juan Ignacio Martinez-Salamanca, Markus Margreiter, Christian Gratzke, Eduardo Garcia Cruz, Alex Mueller, Ege Can Serefoglu, and Paolo Verze Giorgio BozziniGiorgio Bozzini More articles by this author , Maarten AlbersenMaarten Albersen More articles by this author , Javier Romero OteroJavier Romero Otero More articles by this author , Juan Ignacio Martinez-SalamancaJuan Ignacio Martinez-Salamanca More articles by this author , Markus MargreiterMarkus Margreiter More articles by this author , Christian GratzkeChristian Gratzke More articles by this author , Eduardo Garcia CruzEduardo Garcia Cruz More articles by this author , Alex MuellerAlex Mueller More articles by this author , Ege Can SerefogluEge Can Serefoglu More articles by this author , and Paolo VerzePaolo Verze More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1051AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Penile fracture is a rare clinical entity, which represents a urological emergency. It involves traumatic rupture of the tunica albuginea of the corpora cavernosa due to twisting or bending of the penile shaft during erection. To determine the differences in preoperative diagnostic evaluation patterns and outcomes of penile fracture patients in order to investigate the impact of delaying the surgery on functional outcomes. METHODS A retrospective analysis of the data obtained from 137 patients presenting with penile fracture from 7 different European academic medical centers between 1996 and 2013 was carried out. Age, imaging modalities used, timing of surgical intervention, length of tunica albuginea defect and surgical technique were recorded. Postoperative erectile function outcomes were assessed with IIEF-5 and presence of postoperative penile curvature was noted. The association between timing of surgical intervention and postoperative IIEF-5 results was evaluated with discriminant function analysis. RESULTS The mean age of the patients was 38.96±13.55 (range 18–87). Of the 137 patients, 82 (59.85%) underwent penile Doppler ultrasound and 5 patients (3.64%) were evaluated with MRI. All of the patients were treated surgically and the duration between ER admission and surgical intervention was 13.01±0.51 (range 1.5-240) hours. The mean length of tunica albuginea defect was 15.32 ± 8.30 mm (range 7–50). Postoperative penile curvature was observed in 5/137 (3.64%) patients. Postoperative IIEF-5 scores were 15.09±7.8 and 16.85±8.96 at 1st and 3rd postoperative months, respectively. Discriminant function analysis revealed that if the surgical intervention was performed later than 8.23 hours after ER admission, postoperative erectile function was significantly worsened (p=0.0051 and p=0.0057 at 1st and 3rd months, respectively). CONCLUSIONS Our multicentric study shows that delaying the surgical intervention for more than 8.23 hours after presentation to the ER results in significantly impaired erectile function. Therefore, surgical treatment must be planned as soon as possible in order to avoid postoperative erectile dysfunction. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e214 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giorgio Bozzini More articles by this author Maarten Albersen More articles by this author Javier Romero Otero More articles by this author Juan Ignacio Martinez-Salamanca More articles by this author Markus Margreiter More articles by this author Christian Gratzke More articles by this author Eduardo Garcia Cruz More articles by this author Alex Mueller More articles by this author Ege Can Serefoglu More articles by this author Paolo Verze More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD36-04 TNF-α INHIBITS NEURITE OUTGROWTH FROM THE MAJOR PELVIC GANGLION BY INDUCING M1/M2 MACROPHAGES EX VIVO.

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Basic Research II1 Apr 2015PD36-04 TNF-α INHIBITS NEURITE OUTGROWTH FROM THE MAJOR PELVIC GANGLION BY INDUCING M1/M2 MACROPHAGES EX VIVO. Hotaka Matsui, Johanna L. Hannan, Xiaopu Liu, Ahmet Hoke, and Trinity J. Bivalacqua Hotaka MatsuiHotaka Matsui More articles by this author , Johanna L. HannanJohanna L. Hannan More articles by this author , Xiaopu LiuXiaopu Liu More articles by this author , Ahmet HokeAhmet Hoke More articles by this author , and Trinity J. BivalacquaTrinity J. Bivalacqua More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2253AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Erectile dysfunction (ED) is a common sequela after radical prostatectomy (RP) despite nerve-sparing surgery. Recently, we identified that tumor necrosis factor-alpha (TNF-α) is increased in major pelvic ganglion (MPG) following bilateral cavernous nerve injury (BCNI). We hypothesize that TNF-α impairs regeneration of cavernous nerve (CN) by inducing macrophages. To test this hypothesis, we examined exogenous TNF-α's effect on neurite outgrowth from MPG and gene expressions of macrophage markers ex vivo. METHODS Whole MPGs were harvested from Male Sprague-Dawley rats (300g) and cultured in Matrigel with or without TNF-α (20ng/ml). We measured neurite lengths from MPGs in each field at 48 and 72 hours after culture. Cultured MPGs were collected after 72 hours to evaluate gene expressions of TNF-α, inducible nitric oxide synthase (iNOS: M1 macrophage marker), arginase-1 (Arg1: M2 macrophage marker) by qPCR. RESULTS Average neurite lengths of MPGs cultured with exogenous TNF-α at 48 and 72 hours were significantly shorter than the control (p<0.05). In the control group, histogram of neurite lengths showed a single peak at the mean length. In the TNF-α group, histogram had two peaks: one at the mean of the control and the other at much shorter length. To demonstrate this difference quantitatively, variances of the both groups were compared. The variance of the TNF-α group was significantly larger than the control group's at 72 hours (p<0.05). MPGs incubated with TNF-α had increased gene expressions of iNOS, Arg1 and TNF-α (p<0.01). CONCLUSIONS This study demonstrates that exogenous TNF-α treatment inhibits neurite outgrowth from MPG. However, outgrowths of some neurites were not inhibited by TNF-α. Furthermore, exogenous TNF-α can induce increased expression of iNOS, Arg1 and TNF-α, suggesting that TNF-α recruits M1/M2 macrophages via positive feedback. These results imply that TNF-α inhibition may be a future therapy to prevent post-operative ED after RP. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e765-e766 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hotaka Matsui More articles by this author Johanna L. Hannan More articles by this author Xiaopu Liu More articles by this author Ahmet Hoke More articles by this author Trinity J. Bivalacqua More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Medical Hypothesis: Loss of the Endocrine Function of the Prostate Is Important to the Pathophysiology of Postprostatectomy Erectile Dysfunction

Three decades after the first nerve-sparing radical prostatectomy, postoperative erectile dysfunction (ED) remains a challenging and common problem. Despite considerable advances and improvements in surgical techniques, full recovery of erectile function remains elusive even for young, potent men. This suggests, ipso facto, that factors other than surgical technique must be important to recovery of erectile function. This study aims to review evidence that the prostate is an endocrine gland with contributions to local and systemic concentrations of 5α-dihydrotestosterone (5α-DHT), a potent androgen shown to be critical to penile physiology. Literature review of human and animal studies related to endocrine role of prostate and postoperative recovery of erectile function. Effect of 5α-DHT on erectile function and recovery after surgical injury. We advance the following hypothesis: "Loss of endocrine function of the prostate, specifically reduced local 5α-DHT concentration plays a major role in the failure of full recovery of erectile function following anatomic nerve-sparing radical prostatectomy." We propose two separate, yet interrelated, mechanisms whereby the loss of 5α-DHT interferes with postoperative recovery of erectile function: (i) 5α-DHT contributes to cavernous nerve integrity and its ability to recover from surgical insult. (ii) 5α-DHT is important to the structural/functional integrity of penile tissues and erectile physiology. Kacker R, Morgentaler A, and Traish A. Medical hypothesis: Loss of the endocrine function of the prostate is important to the pathophysiology of postprostatectomy erectile dysfunction.

Three-year outcomes of recovery of erectile function after open radical prostatectomy with sural nerve grafting.

Optimal oncologic control of higher stage prostate cancers often requires sacrificing the neurovascular bundles (NVB) with subsequent postoperative erectile dysfunction (ED), which can be treated with interposition graft using sural nerve. To examine the long term outcome of sural nerve grafting (SNG) during radical retropubic prostatectomy (RRP) performed by a single surgeon. Sixty-six patients with clinically localized prostate cancer and preoperative International Index of Erectile Function (IIEF) score >20 who underwent RRP were included. NVB excision was performed if the risk of side-specific extra-capsular extension (ECE) was >25% on Ohori' nomogram. SNG was harvested by a plastic surgeon, contemporaneously as the urologic surgeon was performing RRP. IIEF questionnaire was used pre- and postoperatively and at follow-up. Postoperative IIEF score at three years of men undergoing RRP with SNG. Recovery of potency was defined as postoperative IIEF-EF domain score >22. There were 43 (65%) unilateral SNG and 23 (35%) bilateral SNG. Mean surgical time was 164 minutes (71 to 221 minutes).The mean preoperative IIEF score was 23.4+1.6. With a mean follow-up of 35 months, 19 (28.8%) patients had IIEF score >22. The IIEF-EF scores for those who had unilateral SNG and bilateral SNG were 12.9+4.9 and 14.8+5.3 respectively. History of diabetes (P=0.001) and age (P=0.007) negatively correlated with recovery of EF. 60% patients used PDE5i and showed a significantly higher EF recovery (43% vs. 17%, P=0.009). SNG can potentially improve EF recovery for potent men with higher stage prostate cancer undergoing RP. The contemporaneous, multidisciplinary approach provides a good quality graft and expedited the procedure without interrupting the work-flow.

Glans Preservation Contributes to Postoperative Restoration of Male Sexual Function: A Multicenter Clinical Study of Glans Preserving Surgery

We evaluated whether glans preserving surgery would be more helpful for patients to regain satisfactory sexual competency postoperatively than conventional partial amputation. From 2004 to 2012 at 4 centers a total of 135 men treated with glans preserving surgery and 36 treated with partial amputation were selected for evaluation from a total of 273 consecutive patients with penile cancer. Subjective evaluation for patient sexual performance was investigated using the IIEF-15. Objective evaluation was done using the audiovisual sexual stimulation test with the RigiScan® Plus. The degree of satisfaction with penile appearance, and patient confidence and partner acceptability for intercourse were evaluated by 5-point scales. Patients treated with glans preserving surgery had better performance in 4 IIEF-15 domains (erectile function, orgasmic function, intercourse satisfaction and overall satisfaction) and 1 RigiScan parameter (tip rigidity) (each p<0.01). They also had significantly higher appearance satisfaction (64.4% vs 13.9%) and intercourse confidence (55.6% vs 5.6%) than men who underwent partial amputation. Sexual partners in the glans preserving group also showed significantly higher appearance satisfaction (51.1% vs 5.6%) and intercourse acceptability (37.8% vs 16.7%) than in the partial amputation group. Glans preserving surgery effectively preserves the functional anatomy and cosmetic appearance of the glans penis. Glans preservation contributes to minimizing postoperative erectile dysfunction and negative psychological impediments, and promotes return to satisfactory sexual performance. Patients treated with glans preservation have more advantages in obtaining sexual acceptance from their partners than those who undergo amputation.

NNOS polymorphisms are associated with responsiveness to sildenafil in clinical and postoperative erectile dysfunction.

Sildenafil potentiates the nitric oxide (NO) signaling pathway. Since neuronal NOS is very important in the penis, we assessed whether NOS1 polymorphisms are associated with altered responsiveness to sildenafil in erectile dysfunction (ED). Patients (n = 137) were divided as clinical ED or postoperative ED. They were subdivided as good responders or poor responders to sildenafil, and genotypes for rs41279104 and rs2682826 NOS1 polymorphisms were determined. We found that the rs41279104 CT genotype was associated with good responders in postoperative ED patients, while rs2682826 CT genotype was associated with good responders in postoperative ED, and the TT genotype associated with good responders in both groups. Finally, the CT haplotype was associated with good responders in postoperative ED. NOS1 polymorphisms are associated with responsiveness to sildenafil in ED. Original submitted 20 November 2013; Revision submitted 31 January 2014.

How to Optimize Patient Selection for Robot-Assisted Radical Prostatectomy: Functional Outcome Analyses from a Tertiary Referral Center

The role of surgical approach on functional outcomes recovery in prostate cancer (PCa) patients treated with bilateral nerve-sparing radical prostatectomy (BNSRP) is still debated. In this study, we examine the association between the surgical approach and functional outcomes after BNSRP. The study included 609 patients treated with robot-assisted radical prostatectomy (RARP) or open radical prostatectomy (ORP) between June 2008 and January 2011. Erectile function recovery was defined as an International Index of Erectile Function-Erectile Function domain (IIEF-EF) score ≥22. Urinary continence recovery was defined as being completely pad-free over a 24-hour period. Patients were stratified according to their probability of postoperative erectile dysfunction and urinary incontinence, according to previously published predictive models. Multivariable logistic regression tested the association between the surgical approach and functional outcomes recovery in the overall population after stratifying patients according to their risk of erectile dysfunction and urinary incontinence. Patients treated with RARP had higher 2-year erectile function (52.1% vs 67.8%; P<0.001) and urinary continence (72.0% vs 87.4%; P<0.001) recovery rates as compared to their ORP counterparts. After stratification according to the erectile dysfunction risk, RARP led to higher erectile function recovery rates in the low- and intermediate-risk erectile dysfunction groups (all P<0.001).This did not hold true, however, in patients at high risk of erectile dysfunction (P=0.5). Similarly, when patients were stratified according to their urinary incontinence risk, RARP was associated with a higher probability of urinary continence recovery in the very low, low, and intermediate risk groups only (all P<0.001). This did not hold true, however, in the group of men at high risk of postoperative urinary incontinence (P=0.8). RARP leads to higher urinary continence and erectile function recovery rates compared with ORP. Not all patients benefit from this approach to the same extent, however. Accurate preoperative patient selection would result in substantial savings for the health care system.

Prevention and management of post prostatectomy erectile dysfunction.

Sexual dysfunction is common in patients with prostate cancer (PC) following radical prostatectomy (RP). Review the available literature concerning prevention and management strategies for post-RP erectile function (EF) impairment in terms of preoperative patient characteristics, intra and postoperative factors that may influence EF recovery, and postoperative treatments for erectile dysfunction (ED). A literature search was performed using Google and PubMed database for English-language original and review articles, either published or e-published up to July 2013. The literature still demonstrates a great inconsistency in the definition of what is considered normal EF both before and after RP. Thus, using validated psychometric instruments with recognized cut-offs for normalcy and severity during the pre- and post-operative evaluation should be routinely considered. Therefore, a comprehensive discussion with the patient about the true prevalence of postoperative ED, the concept of spontaneous or pharmacologically-assisted erections, and the difference between “back to baseline” EF and “erections adequate enough to have successful intercourse” clearly emerge as key issues in the eventual understanding of post-RP ED prevention and promotion of satisfactory EF recovery. Patient factors (including age, baseline EF, comorbid conditions status), cancer selection (non- vs. uni- vs. bilateral nerve-sparing), type of surgery (i.e., intra vs. inter vs. extrafascial surgeries), surgical techniques (i.e., open, laparoscopic and robotically-assisted RP), and surgeon factors (i.e., surgical volume and surgical skill) represent the key significant contributors to EF recovery. A number of preclinical and clinical data show that rehabilitation and treatment in due time are undoubtedly better than leaving the erectile tissue to its unassisted postoperative fate. The role of postoperative ED treatment for those patients who received a non-nerve-sparing RP was also extensively discussed. Optimal outcomes are achieved mainly by the careful choice of the correct patient for the correct type of surgery. Despite a plethora of potential rehabilitative approaches, they should be only considered as “strategies”, since incontrovertible evidence of their effectiveness for improving natural EF recovery is limited. Conversely, numerous effective therapeutic options are available for treating post-RP ED.