Postoperative Erectile Function Research Articles

Posterior Urethroplasty Complexity and Prognosis Can be Described by a Novel Method: Posterior Urethral Stenosis Score

To develop a standardized PU-score (posterior urethral stenosis score), with the goal of using this scoring system as a preliminary predictor of surgical complexity and prognosis of posterior urethral stenosis. We retrospectively reviewed records of all patients who underwent posterior urethral surgery at our institution from 2013 to 2015. The PU-score is based on 5 components, namely etiology (1 or 2 points), location (1-3 points), length (1-3 points), urethral fistula (1 or 2 points), and posterior urethral false passage (1 point). We calculated the score of all patients and analyzed its association with surgical complexity, stenosis recurrence, intraoperative blood loss, erectile dysfunction, and urinary incontinence. There were 144 patients who underwent low complexity urethral surgery (direct vision internal urethrotomy, anastomosis with or without crural separation) with a mean score of 5.1 points, whereas 143 underwent high complexity urethroplasty (anastomosis with inferior pubectomy or urethrorectal fistula repair, perineal or scrotum skin flap urethroplasty, bladder flap urethroplasty) with a mean score of 6.9 points. The increase of PU-score was predictive of higher surgical complexity (P = .000), higher recurrence (P = .002), more intraoperative blood loss (P = .000), and decrease of preoperative (P = .037) or postoperative erectile function (P = .047). However, no association was observed between PU-score and urinary incontinence (P = .213). The PU-score is a novel and meaningful scoring system that describes the essential factors in determining the complexity and prognosis for posterior urethral stenosis.

A Retrospective Study of Erectile Function and Use of Erectile Aids in Prostate Cancer Patients After Radical Prostatectomy in Denmark.

IntroductionRadical prostatectomy (RP) offers a good long-term cancer control for clinically localized prostate cancer. However, complications such as erectile dysfunction and substantial decreases quality of life of the afflicted men and their sexual partners. Identification of pre-, per-, and postoperative factors that correlate with poor postoperative erectile status must be considered an important step to improving penile rehabilitation.AimTo describe postoperative erectile function after RP in a Danish cohort.MethodsThe medical records of 1,127 patients undergoing RP from March 2003 through September 2014 were reviewed retrospectively with a 12-month follow-up after surgery. In all, 704 patients fulfilling the inclusion criteria were included in the final analysis. Recovery was defined as self-reported erection sufficient for intercourse (ESI) with or without usage of erectile aids.Main Outcome MeasuresSubjective reporting of erectile function and usage erectile aids 12 months after RP.ResultsESI with or without erectile aids was reported by 226 men (32.1%), among whom 109 (48.2%) required erectile aids. Erectile dysfunction (ED) was reported by 478 men (67.9%) and by 121 (25.3%) despite use of erectile aids. Of men with ED, 155 (22%) stated not being interested in penile rehabilitation, 26 (3.7%) stated not having resumed their sex life 12 months after RP, and 241 (34.2%) had ED and were unsatisfied with the condition. We found that 134 of 445 men (30.1%) who underwent non–nerve-sparing RP had ESI 12 months after RP. Age older than 60.5 years, a high body mass index, comorbidity, and a high American Society of Anesthesiologists score were negative predictors of erectile function 12 months after RP.ConclusionTwelve months after RP, 32.1% of men had ESI; half these men required the use of erectile aids. Age older than 60.5 years, a high body mass index, comorbidity, and a high American Society of Anesthesiologists score were negative predictors for ED 12 months after RP.Haahr MK, Azawi NH, Andersen LG, et al. A Retrospective Study of Erectile Function and Use of Erectile Aids in Prostate Cancer Patients After Radical Prostatectomy in Denmark. Sex Med 2017;5:e156–e162.

Cryotherapy for low risk prostate cancer, oncological and functional medium term outcomes: A three center prospective study

Analyze the oncologic and functional outcomes in patients affected by low risk prostate cancer underwent prostate cryotherapy. Materiasl and methods: It's a prospective tricentric study of 434 patients treated with prostate cryoablation for low risk prostate cancer. By low risk we refer to the D'Amico's risk classification. Two cycles of freezing/thawing are run for each patient following the technique described by Onik. For the 434 patients, the median age was 66 years with a standard deviation of ± 6.68, the average PSA was 6.17 ng/d/L, the median 5.55 with a standard deviation of ± 2.13, the mean prostate volume was 35.59 cc, the median 34.00 cc, with a standard deviation of ± 7.89. Biochemical failure occurred in 67 patients (15.4%). Pre-operative erectile function in men was distributed as follows: severe in 95 patients (19.2%), moderate in 95 (19.2%), medium-moderate in 180 (36.4%), mild in 92 (18.6%), with no dysfunction in 32 (6.5%) patients. Post-operative erectile function, measured 1 month after cryotherapy, was distributed as follows: severe in 321 (65%) patients, moderate in 69 (14%), medium-moderate in 79 (16%), mild in 23 (4.7%), and no dysfunction in only 2 patients (0.4%). Post-operative erectile function after 3 months was distributed as follows: severe in 233 (47.2%) patients, moderate in 66 (13.4%), medium-moderate in 122 (24.7%), mild in 65 (13.2%), and no dysfunction in 8 patients (1.6%). Urinary incontinence was present in 21 patients (4.8%) after 3 months while it dropped to 13 patients (2.9%) after 6 months. Cryotherapy in the treatment of prostate cancer remains a viable alternative. The availability of new cryoprobes and the use of new diagnostic means such as fusion magnetic resonance will make this more precise and more effective method.

Neurovascular bundle size measured on 3.0-T magnetic resonance imaging is associated with the recovery of erectile function after robot-assisted radical prostatectomy

Background and objectiveErectile dysfunction is one of the complications occurring after radical prostatectomy (RP), and recovery of erectile function is quantitatively related to the preservation of the neurovascular bundles (NVB).We evaluated the significance of NVB area on functional outcomes after RP. Materials and methodsPreoperative magnetic resonance imaging was performed on 141 patients who underwent bilateral, nerve-sparing, robot-assisted RP for clinically localized prostate cancer (clinically T2N0M0 on magnetic resonance imaging) and were evaluated at least 12 months after surgery. NVB area was measured as a region of interest that coincided with the outline of the maximum area of the posterolateral region of the prostate on T2-weighted axial imaging. Factors associated with functional outcomes were evaluated using logistic regression analysis. ResultsOf 141 patients, 36 patients (25.5%) had no preoperative potency (group 1), 66 patients (46.8%) recovered potency (group 2), and 39 patients (27.7%) did not recover potency (group 3). Although the mean age of the entire cohort was 65.4 years, the mean age of group 1 was greater than groups 2 and 3 (P = 0.001). The NVB area of group 2 was larger than those of groups 1 and 3 (P = 0.001). Potency evaluations involved 105 patients (74.5%; groups 2 and 3), and patients with pre-existing erectile dysfunction were excluded. The median time to potency recovery was 3.0 months after surgery. The multivariable analysis revealed that the NVB area was the only significant factor predictive of potency recovery. ConclusionsThe NVB area in the posterolateral region of the prostate is an independent factor for predicting potency recovery. The degree of postoperative erectile function can be predicted based on the preoperative NVB area.

PD15-08 ASSOCIATION BETWEEN EARLY URINARY CONTINENCE AND ERECTILE FUNCTION RECOVERY AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY: DEVELOPMENT OF A NOVEL POSTOPERATIVE RISK SCORE TO OPTIMIZE PATIENT COUNSELING AND FOLLOW-UP

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II1 Apr 2017PD15-08 ASSOCIATION BETWEEN EARLY URINARY CONTINENCE AND ERECTILE FUNCTION RECOVERY AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY: DEVELOPMENT OF A NOVEL POSTOPERATIVE RISK SCORE TO OPTIMIZE PATIENT COUNSELING AND FOLLOW-UP Giorgio Gandaglia, Nazareno Suardi, Andrea Gallina, Paolo Dell'Oglio, Nicola Fossati, Vito Cucchiara, Marco Moschini, Marco Bandini, Emanuele Zaffuto, Andrea Salonia, Franco Gaboardi, Rocco Damiano, Vincenzo Mirone, Francesco Montorsi, and Alberto Briganti Giorgio GandagliaGiorgio Gandaglia More articles by this author , Nazareno SuardiNazareno Suardi More articles by this author , Andrea GallinaAndrea Gallina More articles by this author , Paolo Dell'OglioPaolo Dell'Oglio More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Vito CucchiaraVito Cucchiara More articles by this author , Marco MoschiniMarco Moschini More articles by this author , Marco BandiniMarco Bandini More articles by this author , Emanuele ZaffutoEmanuele Zaffuto More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Franco GaboardiFranco Gaboardi More articles by this author , Rocco DamianoRocco Damiano More articles by this author , Vincenzo MironeVincenzo Mirone More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3290AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The identification of patients less likely to recover erectile function (EF) after surgery is crucial for counseling and for the early administration of proerectile treatments. We aimed at developing a model to predict EF recovery in prostate cancer (PCa) patients treated with robot-assisted radical prostatectomy (RARP). METHODS We included 833 PCa patients treated with RARP between 2006 and 2016. Postoperative UC recovery was defined as being pad-free over a 24-hour period. Early continence was defined as UC within 60 days from surgery. Postoperative EF was defined as an Erectile Function-Erectile Function (IIEF-EF) domain score ≥22. Kaplan-Meier and Cox regression analyses assessed the impact of early UC on EF recovery. Covariates were age, preoperative IIEF-EF, Charlson comorbidity index (CCI), nerve-sparing, adjuvant radiotherapy (aRT), and early UC recovery. Predictors of EF were used to develop a novel risk score based on the cumulative number of risk factors. Kaplan-Meier analyses assessed the impact of the risk score on EF rates. A decision-curve analysis (DCA) assessed the net benefit associated with the use of our model. RESULTS Median preoperative IIEF-EF was 25. Overall, 746 (90%) patients were treated with nerve-sparing surgery and 54 (6.3%) patients received aRT. Median follow-up was 36 months. The proportion of patients who experienced early UC recovery was 337 (40.5%). At 3-year follow-up, the UC and EF recovery rates were 85.9% and 45.8%. The 3-year EF rates were higher in patients who were continent within 2 months compared to those incontinent at this time point (53.8 vs. 40.4%; P<0.001). In multivariable analyses, age<65 years, a preoperative IIEF-EF ≥22, the receipt of nerve-sparing surgery, no aRT, and early UC recovery were associated with an increased probability of EF recovery (all P≤0.01). Based on these factors, a risk score predicting EF was calculated. When patients were stratified according to the risk score (≤2 vs. 3 vs. ≥4), the 3-year were 10.9 vs. 32.0 vs. 60.6%, respectively (P<0.001). At the DCA, clinical risk prediction improved for men with a probability of EF recovery between 15 and 60%. CONCLUSIONS Early UC recovery is associated with the probability of subsequent EF recovery. A risk score based on pre- and postoperative characteristics to predict EF recovery should be used for patient counseling in the early postoperative setting and for the identification of candidates for more aggressive proerectile therapies. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e285 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Giorgio Gandaglia More articles by this author Nazareno Suardi More articles by this author Andrea Gallina More articles by this author Paolo Dell'Oglio More articles by this author Nicola Fossati More articles by this author Vito Cucchiara More articles by this author Marco Moschini More articles by this author Marco Bandini More articles by this author Emanuele Zaffuto More articles by this author Andrea Salonia More articles by this author Franco Gaboardi More articles by this author Rocco Damiano More articles by this author Vincenzo Mirone More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

279 - Comparative assessment of postoperative erectile function and quality of life in male one-stage onlay vs. inlay buccal mucosal graft urethroplasty

279 - Comparative assessment of postoperative erectile function and quality of life in male one-stage onlay vs. inlay buccal mucosal graft urethroplasty

Tips and Tricks to Improve Neurovascular Bundles Preservation During Robot-Assisted Radical Prostatectomy

Objective: We demonstrate various tips and tricks, including latest innovations to improve neurovascular bundles preservation and their outcomes during robot-assisted radical prostatectomy (RARP). Materials and Methods: We have demonstrated our technique of nerve sparing (NS)—athermal, early retrograde release, minimization of tension with identification of landmark artery .We have shown the role of our subjective NS regression model in predicting time to recovery of postoperative erectile function after RARP. We have also shown application of a new innovative technology of near infrared fluorescence (NIRF) using indocyanine green (ICG) in identifying landmark prostatic artery and improving quality of NS. We have also shown the application of an innovative dehydrated human amnion chorion membrane allograft (dHACM) in improving postoperative functional outcomes after RARP. Results: The mean time taken for recovery of postoperative potency was significantly lesser in NS grades 4 and 5 vs grade 0 in subjective NS system. The NIRF with ICG could identify the landmark artery in 17/20 (85%) patients during NS RARP. Fifty-eight patients who were preoperatively potent (Sexual Health Inventory for Men score >19) and continent (no pads) underwent full NS RARP, and dHACM was used. The mean time to continence in dHACM graft group was 1.21 months vs 1.83 months in the nongraft group (p = 0.033). The mean time to potency in dHACM graft group was 1.34 months vs 3.39 months in nongraft group (p = 0.007). Conclusions: The surgeon's experience and volume are the key determinants in NS RARP. The key principles of NS include athermal, minimal traction, and bilateral complete preservation (wherever feasible). The use of these innovations can hasten early return of potency in patients after RARP. No competing financial interests exist. Runtime of video: 6 mins 55 secs

2192 - MRI-based periprostatic-fascia thickness measurements as tool to virtually predict postoperative erectile function after robot-assisted radical prostatectomy

2192 - MRI-based periprostatic-fascia thickness measurements as tool to virtually predict postoperative erectile function after robot-assisted radical prostatectomy

Differences in Influence between Intravenous Methylprednisolone and Intramuscular Progesterone toward Erectile Function After Operation Transurethral Resection of the Prostate (TUR-P) in Patients Benign Prostate Hyperplasia (BPH)

Background: Erectile function is an important factor for all men in an active sexual condition, as well as to assess the quality of sex life with their partners. Transurethral Resection of the Prostate (TURP) is a gold standard action for Benign Prostate Hyperplasia (BPH). The researcher tried to study to investigate the effect of corticosteroid and progesterone on erectile function in BPH patients who have done TURP surgery by using Erection Hardness Score (EHS). The purpose of this study was to investigate the effect of intra venous methylprednisolone on post-operative erection function of TURP in BPH patients. To investigate the effect of intra-muscular progesterone on postoperative erectile function of TURP in BPH patients. To investigate the different effect between methylprednisolone and progesterone on post-operative erection function of TURP in BPH patients. Subjects and Method: Subjects of all BPH patients who performed TUR-P surgery in the urology sub-section of Dr. Moewardi Hospital, Surakarta. The sampling technique in this study was incidental sampling. This study was a clinical experimental study using Pre and Post-test design-Only Control Design. 3 groups were divided to get different treatment, the first group was given methylprednisolone, the second group was given progesterone and the third group was given TURP therapy protocol only. Results: After 1 month of TURP treatment in BPH patients, the result obtained for the EHS which on a scale of 2 and 3. EHS on scale 2 for the methylprednisolone group was 9 patients (69.2%), the progesterone group had 6 patients (46.2%), and the control group had 8 of patients (66.7%). Meanwhile, EHS on scale 3 for the methylprednisolone group was 4 patients (30.8%), there were 7 patients (53.8%) of the progesterone group, and the control group had 4 patients (33.3%). After 3 months of TURP treatment in BPH patients, EHS on scale 2 in the methylprednisolone group there were 2 patients (15.4%), the progesterone group there were 0 patients (0.0%), and the control group there were 6 patients (50.0%). The methylprednisolone group had 9 patients (69.2%) on EHS 3 scale, the progesterone group had 4 patients (30.8%), and there were 6 patients (50.0%) in the control group. While, EHS scale of 4 the total of the patients in the methylprednisolone group was 2 patients (15.4%), the progesterone group had 9 patients (69.2%), and the control group had 0 patients (0.0%). Conclusion: the methylprednisolone improved the erectile function in post-operative TURP patients. Progesterone improved erectile function in post-operative TURP patients. Therefore, it can be concluded that progesterone was better than methylprednisolone. Keywords: Erectile dysfunction, Methylprednisolone, Progesterone Correspondence: Monica Yolanda. Masters Program in Family Medicine, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: monica_mail83@yahoo.co.id. Indonesian Journal of Medicine (2017), 2(2): 116-124 https://doi.org/10.26911/theijmed.2017.02.02.06

258 The Comparison of Post-Operative Erectile Function After Radical Nephrectomy and Partial Nephrectomy

258 The Comparison of Post-Operative Erectile Function After Radical Nephrectomy and Partial Nephrectomy

P042 - Hydrodissection of neurovascular bundles during nerve sparing prostatectomy improves postoperative erectile function and urinary continence

P042 - Hydrodissection of neurovascular bundles during nerve sparing prostatectomy improves postoperative erectile function and urinary continence

Bicentric prospective evaluation of corporoplasty with porcine small intestinal submucosa (SIS) in patients with severe Peyronie's disease.

Advanced Peyronie's disease (PD) with severe penile deviation demands grafting procedures following plaque incision or partial plaque excision in order to avoid penile shortening and to improve quality of life of affected patients. Small intestinal submucosa (SIS) is an established xenograft. The objective of the present study was to validate external results in a bicentric prospective manner. Patient selection criteria, surgical technique and standards for pre- and postoperative care were defined. Consecutively, patients with severe penile deviation in stable disease and sufficient erectile function were included between 2007 and 2015. After plaque incision, grafting was performed using SIS in a standardized manner. The postoperative evaluation using a non-validated questionnaire included complications, correction of curvature, pre- and postoperative erectile function, change in penile length and general satisfaction with the procedure. Forty-three patients underwent surgery between 2007 and 2015. The mean degree of preoperative curvature was 73.8° (range 60-90°). No intraoperative or major postoperative complications were reported. After a mean follow-up of 33.0months (range 10-59), complete straightening of the penis was achieved in 74.4%. 88.4% of all patients were able to achieve satisfying sexual intercourse (67.4% unaided, 21.0% with assistance). The IIEF-5 score was improved in 69.8% (mean improvement 4.0 points). Overall 86.0% were satisfied with the surgical treatment. Corporoplasty with SIS in patients with PD and severe penile curvature is a safe approach and shows good long-term results. A thorough patient selection and a standardized pre-, intra- and postoperative procedure are decisive for a satisfying outcome.

The effect of urethral transection on erectile function after anterior urethroplasty.

To prospectively assess the effect of urethral transection on erectile function after anterior urethroplasty. From February 2012 to December 2014, 104 patients were enrolled in a prospective study assessing erectile function (EF) after anterior urethroplasty. Participants completed the International Index of Erectile Function (IIEF) questionnaire preoperatively and 6months postoperatively. Outcome measures were the incidence of erectile dysfunction (ED) defined by ≥5-point change in EF and mean change in the EF domain. Factors examined were urethral transection, stricture location, patient age and other demographics. Fisher's exact test, Student's t test and linear regression were used to evaluate associations when appropriate. Seventeen patients were excluded because of poor EF, leaving 87 patients for analysis. Twenty-two patients (25.3%) had urethral transection during urethroplasty, while 65 underwent non-transecting techniques (74.7%). For the entire cohort, IIEF scores remain unchanged (20.16 versus 20.14; p=0.98). Eighteen patients (20.7%) developed ED, while 15 (17.2%) experienced an improvement in EF. Urethral transection was not associated with ED (p=0.22) or mean change in EF (-0.8 versus +0.2; p=0.71). Stricture location was not associated with ED, but patient age ≥50 was associated with a decrease in mean postoperative EF (-2.84 versus +1.85; p=0.04). On linear regression analysis patient age remained independently associated with adverse change in EF (p=0.05). Urethroplasty can result in a decline in erectile function in some patients but overall is associated with minimal change in erectile function. Urethral transection is not associated with adverse change in erectile dysfunction after urethroplasty however, advanced patient age is.

Does total joint arthroplasty impair erectile function?

IntroductionSexuality is an important factor in quality of life (QoL) and was reported to improve after total joint arthroplasty (TJA). However, one study group found evidence regarding a high rate of impaired erectile function of about 20% in male patients after TJA. As erectile dysfunction is a serious matter of concern and there are no data explaining this observation sufficiently, the purpose of this study was to revaluate the erectile function in patients after TJA.Material and methodsAll consecutive male patients scheduled for TJA were enrolled in this prospective study. Evaluation was performed pre- and 6 months postoperatively with the International Index of Erectile Function (IIEF-5) questionnaire. One hundred and fifty-nine patients fulfilled the inclusion criteria, and 51 patients wished not to take part in the study.ResultsFrom the 108 patients who were included prior to surgery, 101 (94%) were available at the 6-month follow-up. In those patients, the preoperative erectile function was normal in 38 (24.0 ±1.1), impaired in 45 (14.7 ±6.5) and with no function in 18 patients. No significant difference in the pre- (15.4 ±9.3) and postoperative (15.3±9.2) IIEF-5 score was observed (p = 0.59) in the total group. Similarly, subgroup analysis revealed no significant difference in patients with total hip arthroplasty (p = 0.58), total knee arthroplasty (p = 0.37) or > 70 years (p = 0.08).ConclusionsThe previously reported high rate of impaired erectile function after TJA of the lower extremity could not be confirmed. Total joint arthroplasty remains a safe procedure in terms of postoperative erectile function.

Long-term sexual outcomes after holmium laser enucleation of the prostate: which patients could benefit the most?

Assess rate and predictors of erectile function (EF) outcomes at long-term follow-up (FU) after holmium laser enucleation of the prostate (HoLEP). Cross-sectional analyses were performed on 135 patients with a mean FU of 12 years post HoLEP. Patients completed both a baseline and a FU International Index of Erectile Function (IIEF)-EF domain and the International Prostatic Symptoms Score (IPSS). Postoperative EF outcomes, including rate and predictors of EF improvement considering minimal clinically important differences (MCIDs) criteria, were assessed. Logistic regression models tested the association between predictors and EF. At a mean (median) FU of 152.1 (163) months, patients showed a significant decrease in the IIEF-EF score P<0.01) and significant IPSS improvement (P<0.01). Overall, 50 (37%) patients worsened by at least one IIEF-EF category. Conversel, 23 (17%) patients reported an improvement in postoperative IIEF-EF score; 75 (55.6%) and 10 (7.4%) patients maintained and eventually improved their IIEF-EF category, respectively. Patients reporting a decrease in the postoperative IIEF-EF score were significantly older (P=0.03) and showed a significantly longer mean FU (P<0.01) than those reporting postoperative improvements of IIEF-EF. Nine (6.7%) patients showed significant EF improvement according to MCIDs criteria. Both higher IPSS scores (odds ratio (OR): 1.12; P=0.02) and lower IIEF-EF (OR: 0.88; P<0.01) at baseline, emerged as independent predictors of postoperative EF improvement. HoLEP was associated with a decrease in EF and a persistent amelioration of BPH-related urinary symptoms at long-term FU. Almost one third of patients worsened by at least one IIEF-EF category. However, a clinically meaningful EF improvement was observed in roughly 7% of the individuals. Patients with more severe preoperative urinary symptoms and ED benefited more from HoLEP in terms of EF.

Preoperative PDE5i use is a prognostic metric for poor postoperative erectile function in men undergoing radical prostatectomy: An addition to patient counseling

Objective: In patients scheduled for radical prostatectomies (RP), preoperative (pre-op) erectile function (EF) characterization may be complicated by social and medical factors. We investigated pre-op use of phosphodiesterase type 5 inhibitor (PDE5i) as a simple metric for predicting long-term postoperative EF. Materials and methods: Electronic medical records (EMRs) for consecutive men who underwent RP between January 2004 and March 2009 at our institution were retrospectively reviewed. Data extracted included demographics, pre-op PDE5i use, cancer treatment details, post-op EF and ED treatment. Predictor variable data were categorical pre-op PDE5i use (pre-op PDE5i use vs. pre-op PDE5i naïve). ANOVA and Chi squared test were used. Results: A total of 250 individuals out of 436 charts met inclusion criteria. Mean follow-up length was 4.2 years (range 2–7). Thirty-seven men (15%) used PDE5i preoperatively. There were no differences in mean age at RP, type of nerve-sparing surgery (NSS), or medical comorbidities between groups. No men with pre-op PDE5i use regained unassisted EF but 37% regained PDE5i-assisted EF after bilateral nerve sparing (BNS). No men with pre-op PDE5i use regained unassisted or PDE5i-assisted EF after unilateral (UNS) or non-nerve-sparing surgery (NNS). Conclusions: Pre-op PDE5i use predicts poor long-term EF outcomes after RP and should be included in pre-op patient counseling.

The impact of surgical treatments for lower urinary tract symptoms/benign prostatic hyperplasia on male erectile function

Lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) is common in adult men and can impair erectile function (EF). It was believed surgical treatments for this illness can improve EF due to the relief of LUTS while they were also reported harmed EF as heating or injury effect. Current network meta-analysis aimed to elucidate this discrepancy.Randomized controlled trials (RCTs) were identified. Direct comparisons were conducted by STATA and network meta-analysis was conducted by Generate Mixed Treatment Comparison. Random-effects models were used to calculate pooled standard mean difference and 95% confidence intervals and to incorporate variation between studies.Eighteen RCTs with 2433 participants were analyzed. Nine approaches were studied as transurethral resection of the prostate (TURP), plasmakinetic resection of the prostate (PKRP), plasmakinetic enucleation of the prostate (PKEP), Holmium laser enucleation of the prostate (HoLEP), Holmium laser resection of the prostate (HoLRP), photoselective vaporization of the prostate (PVP), Thulium laser, open prostatectomy (OP), and laparoscopic simple prostatectomy (LSP). In direct comparisons, all surgical treatments did not decrease postoperative International Index of Erectile Function (IIEF)-5 score except PVP. Moreover, patients who underwent HoLEP, PKEP, Thulium laser, and TURP had their postoperative EF significantly increased. Network analysis including direct and indirect comparisons ranked LSP at the highest position on the variation of postoperative IIEF-5 score, followed by PKRP, HoLEP, TURP, Thulium laser, PKEP, PVP, HoLRP, and OP. In subgroup analysis, only PVP was found lower postoperative EF in the short term and decreased baseline group, whereas TURP increased postoperative IIEF-5 score only for patients with normal baseline EF. However, HoLEP and PKEP showed pro-erectile effect even for patients with decreased baseline EF and short-term follow-up. Our novel data demonstrating surgical treatments for LUTS/BPH showed no negative impact on postoperative EF except PVP. Moreover, HoLEP and PKEP were found pro-erectile effect for all subgroups. New technologies, such as LSP, PKRP, and Thulium laser, were ranked at top positions in the network analysis, although they had no pro-erectile effect in direct comparison due to limited original studies or poor baseline EF. Therefore, further studies and longer follow-up are required to substantiate our findings.

Long-Term Outcomes of Using Hyaluronic Acid-Carboxymethylcellulose Adhesion Barrier Film on the Neurovascular Bundle.

We hypothesize that the use of hyaluronic acid-carboxymethylcellulose (HACM) adhesion barrier at the neurovascular bundle may hasten the return of erectile function after robot-assisted laparoscopic prostatectomy. A retrospective review identified 462 consecutive patients who underwent a nerve-sparing prostatectomy between 2009 and 2012. The first 246 patients were administered the barrier film, while the next 216 patients, the control group, did not receive HACM. Postoperative erectile function and oncologic outcomes were compared. Independent t-test and Kaplan-Meier analysis were conducted, p < 0.05 was considered significant. The two groups were well matched, without significant differences in age, weight, operative time, prostate size, preoperative prostate-specific antigen, sexual health inventory for men (SHIM), or AUA symptom scores. The mean SHIM was significantly higher for the experimental group at 6 months (6.39 vs 4.75, p = 0.008), 9 months (7.32 vs 5.44, p = 0.006), 1 year (8.52 vs 6.90, p = 0.049), and 18 months (10.01 vs 7.60, p = 0.018). This effect was not noted beyond 18 months. A subgroup analysis of patients with initial SHIM scores 22 or greater demonstrated a higher rate of return to the preoperative SHIM score for the barrier film group, 23% vs 12% (p = 0.046). There was no significant difference in biochemical recurrence between groups, with a median follow-up duration of 18 months. HACM application at the neurovascular bundle during prostatectomy may decrease the time to return of erectile function, with improved SHIM at 6 to 18 months after surgery. This effect is more pronounced in patients with better baseline erectile function. There is no significant effect on biochemical recurrence.

MP86-09 WATER JET DISSECTION OF THE CAVERNOUS NERVES: A COMPARATIVE STUDY TO BLUNT CAVERNOUS NERVE INJURY IN A RAT MODEL AND ITS IMPLICATION ON ERECTILE FUNCTION

You have accessJournal of UrologySexual Function/Dysfunction: Basic Research & Pathophysiology I1 Apr 2016MP86-09 WATER JET DISSECTION OF THE CAVERNOUS NERVES: A COMPARATIVE STUDY TO BLUNT CAVERNOUS NERVE INJURY IN A RAT MODEL AND ITS IMPLICATION ON ERECTILE FUNCTION Husain Alenezi, Ling X De Young, Gerald Brock, and Stephen E Pautler Husain AleneziHusain Alenezi More articles by this author , Ling X De YoungLing X De Young More articles by this author , Gerald BrockGerald Brock More articles by this author , and Stephen E PautlerStephen E Pautler More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2317AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Postoperative erectile dysfunction (ED) remains a commonly prevalent outcome after radical prostatectomy (RP) despite three decades of evolving surgical techniques and innovative prevention and treatment strategies. Water-jet technology is widely utilized for dissection in neurosurgical procedures due to its minimal effects on the function of nerves. Our objective is to study the impact of water-jet dissection (WJD) of the cavernous nerves (CNs) on postoperative erectile function (EF) and compare it to standard dissection in an established model of blunt surgical trauma of CNs in rats. METHODS Fifteen Sprague-Dawley male rats were randomly divided into two groups; group 1 (WJD) rats were subjected to WJD and barotrauma of bilateral CNs using a fluid pressure of 15 atm (n=8), while group 2 (BT) rats were subjected to standard dissection of the nerves and blunt trauma of bilateral CNs (n=7), in a survival surgery. After 4 weeks, postoperative erectile function was assessed by measuring the intracorporeal pressure (ICP) during 3 electrical stimulations of the CNs under anesthesia. Euthanasia was performed after harvesting the penile tissue for histopathological examination. The peak ICP was noted and the area under the curve (AUC) was calculated for each stimulation. Cross-sections from the penile tissue were prepared and stained with Masson trichrome dye. Digital copies of the slides at x100 and x200 magnifications were obtained and analyzed using image analysis software (Image J) to quantify the fibrosis ratio within each corpora cavernosum. RESULTS Both animal groups had a comparable preoperative weight with a mean of 609.6 ± 99.9 gm and 570.2 ± 72.8 gm in groups WJD and BT, respectively (p= 0.406). WJD rats demonstrated a significantly higher mean peak ICP of 65.7 ± 32.2 cm H2O in comparison to a mean peak ICP of 33.4 ± 23.5 cm H2O in BT (p <0.0001). WJD was also associated with more sustainable rise in the ICP in comparison to BT as the mean AUC was 3425.7 ± 1671 and 2163.2 ± 1551, respectively (p= 0.012). The ratio of fibrosis was comparable between the groups with a mean of 63.7% ± 11.5 vs. 64% ± 7 for x100 magnification (p=0.933), and 68% ± 11.3 vs. 64.6 % ± 8.5 for x200 magnification (p= 0.372) in WJD and BT, respectively. CONCLUSIONS In this study, WJD of the CNs was associated with a significantly better postoperative ICP than blunt trauma. Thus WJD had less of an effect on EF in this rat model of RP. Clinical studies are needed to investigate the effect of WJD on EF in humans post RP. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1109 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Husain Alenezi More articles by this author Ling X De Young More articles by this author Gerald Brock More articles by this author Stephen E Pautler More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP80-03 ORGASMIC FUNCTION AFTER RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy VII1 Apr 2016MP80-03 ORGASMIC FUNCTION AFTER RADICAL PROSTATECTOMY Kefu Du, Chong Zhang, Angela Presson, Jonathan Tward, William Brant, and Christopher Dechet Kefu DuKefu Du More articles by this author , Chong ZhangChong Zhang More articles by this author , Angela PressonAngela Presson More articles by this author , Jonathan TwardJonathan Tward More articles by this author , William BrantWilliam Brant More articles by this author , and Christopher DechetChristopher Dechet More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2035AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We examined post-prostatectomy orgasmic function (OF) and assessed for potential predictors. METHODS Between 2005 and 2013, 499 men received radical prostatectomy and completed Expanded Prostate Cancer Index Composite, American Urological Association symptom score, and Sexual Health Inventory for Men questionnaires prospectively at baseline and at regular postoperative intervals. We used mixed effects logistic regression models to evaluate average differences in follow-up measures and interactions with time and reported odds ratio (OR) and 95% confidence interval (CI), with statistical significance evaluated at 0.05. RESULTS Median follow up was 36 months (range 5 to 61 months). Postoperative OF was worsened, the same, or improved in 300 (60.1%), 152 (30.5%), and 47 (9.4%) men, respectively. Recovery of OF plateaued at 15 to 21 months. Patients ≤ 50 years old were more likely to achieve good OF (OR for age ≤ 50 years vs. age 51 to 60 years = 3.40; CI 1.56-7.41; p = 0.001), but comparisons among age groups older than 50 years were not significant. Robotic status did not affect OF, whereas bilateral nerve sparing significantly improved the likelihood of good OF compared to non-nerve sparing (OR = 5.00; CI 1.61-15.6; p = 0.04). The odds for patients with poor preoperative OF to achieve good postoperative OF was only 8.2% of that for men with good preoperative OF (p < 0.001). The effect of age, nerve sparing status, and preoperative OF persisted in subgroup analysis of 356 patients with > 21 months follow up (all p < 0.002). Good postoperative OF was positively associated with good erectile function (EF) (OR = 43.7; CI 25.2-75.9; p < 0.001) and sexual desire (OR = 5.1; CI 3.8-6.8; p < 0.001) but negatively associated with moderate to severe urinary incontinence (OR = 0.32; CI 0.19-0.54; p < 0.001) and lower urinary tract symptoms (OR = 0.63; CI 0.47-0.84; p = 0.002). Patients who were bothered by their EF were also likely to be bothered by their OF (OR = 189; CI 107-336; p < 0.001). However, use of erectile aids was not significantly related to OF (p = 0.06-0.58). In subgroup analysis of men with > 21 months follow up who had poor postoperative EF, the association of age ≤ 50 years (OR = 3.849; CI 1.136-13.044; p = 0.03) and bilateral nerve sparing (OR = 3.268; CI 1.355-7.882; p = 0.008) with good OF persisted, suggesting their independent effect on OF apart from that on EF. CONCLUSIONS Orgasmic function is negatively impacted by radical prostatectomy and takes 15 to 21 months to recover. Predictors of orgasmic function include age, nerve sparing status, preoperative orgasmic function, erectile function, sexual desire, and urinary control and function. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1043-e1044 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Kefu Du More articles by this author Chong Zhang More articles by this author Angela Presson More articles by this author Jonathan Tward More articles by this author William Brant More articles by this author Christopher Dechet More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...