Sexual Health Inventory For Men Score Research Articles

Urinary and bowel quality of life after image-guided, intensity modulated radiation therapy to the prostate bed.

312 Background: Majority of patients with adverse pathological features on radical prostatectomy do not receive post-prostatectomy radiation due to concerns of negative impact on their quality of life (QOL). The purpose of this study is to evaluate QOL after post-prostatectomy intensity modulated radiation therapy (IMRT) in the “adjuvant”(ADJ) setting for positive surgical margins, extraprostatic extension, or seminal vesicle invasion with a PSA < 0.2 ng/mL and a “salvage”(SAL) setting for a PSA ≥ 0.2 ng/mL at the start of IMRT. Methods: Between 2004 and 2013, 130 patients underwent IMRT to the prostate bed. Sexual Health Inventory for Men (SHIM), International Prostate Symptom Score (IPSS), and Expanded Prostate cancer Index Composite-26 for bowel (EPIC-26-bowel) scores were recorded before radiation and at 3-month intervals after completion of treatment to assess sexual, urinary, and rectal QOL, respectively. A mixed model for repeated measurements was used to compare QOL scores over time among various subgroups. Results: ADJ and SAL radiation were delivered to 48 (37%), 82 (63%) respectively. Total radiotherapy doses were 64.8-68.4 Gy using 1.8-Gy daily in 56 (43%) patients and 70.2-72.0 Gy in 74 (57%) patients. Androgen deprivation therapy (ADT) was given to 4/48 (8%) ADJ patients and 9/82 (11%) SAL patients. Fiducials were placed in prostate bed for image guidance in 42 (32%) patients. Median follow up was 46 months. Total radiation dose did not significalntly affect QOL. SAL IMRT was associated with worse mean SHIM scores (3 points, p = 0.002) and ADJ IMRT was associated with lower mean IPSS scores (2 points, p = 0.03). Mean EPIC-26-bowel scores were lower without fiducial markers (16 points, p < 0.0001). Conclusions: SAL IMRT was associated with worse sexual QOL, possibly due to less frequent usage of phosphodiesterase-5 inhibitors. ADJ IMRT was associated with worse urinary QOL, possibly due to a shorter post-operative recovery period. Fiducial marker resulted in better rectal QOL due to greater rectal sparing. Urinary and rectal QOL with post-prostatectomy, image-guided IMRT compare favorably with previous QOL reports involving three-dimensional conformal radiation therapy.

Dorsal Onlay Urethroplasty for Membranous Urethral Strictures: Urinary and Erectile Functional Outcomes

We evaluated urinary and erectile functional outcomes after dorsal onlay urethroplasty for bulbomembranous urethral strictures. Our aim was to understand the functional implications of dissection of the posterior urethra. We report on men who underwent membranous urethral stricture repair by buccal mucosal graft dorsal onlay substitution urethroplasty. Continence and erectile function were assessed preoperatively and postoperatively. Tissue routinely excised from the intercrural space during dissection of the dorsal aspect of the membranous urethra was evaluated for scar, striated muscle and nerves. A total of 16 consecutive men with a mean age of 48.3 years (range 26 to72) who had strictures with a mean length of 56 mm (range 15 to 170) involving the membranous urethra were included in analysis. Of the 16 men 15 were continent preoperatively and remained continent postoperatively. Three of 10men (30%) with a preoperative SHIM (Sexual Health Inventory for Men) score of 17 to 25 had a decrease after urethroplasty. All 16 men had an improved maximum urinary flow rate with a mean improvement of 22 ml per second. I-PSS (International Prostate Symptom Score) improved from a median of 23 to 4 postoperatively with a median bother score improvement of 5 to 0. Histopathological assessment identified striated muscle and nerves in 6 (46%) and 9 (69%) of 13 specimens. Overall nerves and muscle comprised an average of less than 15% of the specimen. The dorsal onlay technique with a buccal mucosal graft for membranous urethral stricture repair does not compromise continence or erectile function in most patients. Dissection at the level of the membranous urethra should be limited because striated muscle and cavernous nerves are present.

Are urge incontinence and aging risk factors of erectile dysfunction in patients with male lower urinary tract symptoms?

Introduction: Several studies have indicated that erectile dysfunction (ED) patients also suffer from lower urinary tract symptoms (LUTS). We investigated a group of men with LUTS and assessed their sexual function with the aim of being able to predict ED risk factors and introduce ED treatments earlier for this patient group.Methods: International Prostate Symptom Score (IPSS), Overactive Bladder Symptoms Score (OABSS) and Sexual Health Inventory for Men (SHIM) score were obtained from 236 men with LUTS at their first out-patients visit. Clinical parameters such as body mass index, prostate volume, residual urine volume and prostate specific antigen were also evaluated. The relationship between the SHIM score and other clinical data was analyzed.Results: According to the SHIM score, ED in men with LUTS was severe 15%, moderate 19%, moderate to mild 28%, mild 17%, normal 7% and data was incomplete in 14%. Based on the results of a multivariate analysis, aging (p < 0.001) and OAB severity (p = 0.024) were significantly correlated to severe and moderate ED. Furthermore, among OAB symptoms score items, urge urinary incontinence was a risk factor for severe and moderate ED (p = 0.005).Conclusion: Aging and OAB (notably urinary urge incontinence) are risk factors for severe and moderate ED in men with LUTS.

Sexual, irritative, and voiding outcomes, following stereotactic body radiation therapy for prostate cancer.

BackgroundUrinary symptoms and sexual dysfunction are the two most common complaints following prostate radiotherapy. The impact of hypofractionated treatment on sexual function, irritative symptoms, and voiding symptoms has not been determined within the same patient population. Here we present our institutional data on sexual function, voiding function, irritative symptoms, and treatment response following SBRT.MethodsThis retrospective analysis includes 102 non-metastatic patients treated with SBRT at a single institution between May 2008 and September 2014. The course of radiotherapy consisted of 36.25 Gy (range 35–40) over five daily fractions. International Prostate Symptom Score (IPSS), Sexual Health Inventory for Men (SHIM), and PSA were recorded at baseline, 1, 3, 6, 9, 12, 18, 24, and 36 months after treatment.ResultsMedian patient age was 72 years old with a median follow-up of 4.3 years. Pretreatment IPSS-I score was 5.21, increasing to 6.97 (p < .001) after 1 month. The mean IPSS-I score returned close to baseline after 3 months to 5.86 and decreased to below baseline after 2 years to 5.09. At 3 months, 9 months, and 2 years, 47.5, 76.2, and 91.1 % of patients had reached IPSS-I resolution. The mean IPSS-O score prior to treatment was 5.31 and there was an increase in the score to 6.45 (p = 0.344) at 1 month. The score remained close to baseline and decreased to 4.00 at 2 years and significantly decreased to 3.74 (p = 0.035) at 3 years. 64.4, 82.1, and 96.0 % of patients had IPSS-O resolution by 3 months, 9 months, and 2 years. The mean SHIM score prior to treatment was 13.52 and continually decreased to below baseline a year after treatment to 10.56 (p < .001). SHIM score began to improve at 18 months, but was still significantly less than baseline at 12.12 (p = .01).ConclusionsWhile an increase in AUA/IPSS score initially occurred, all patients resume normal activities immediately following treatment and the AUA/IPSS symptoms improved from baseline. Irittative symptoms take longer to resolve when compared to obstructive voiding symptoms in patients treated with SBRT. Three year PSA response, reported toxicity, erectile function preservation, and urinary function improvement, shows favorable results.

Is there a relationship between the severity of erectile dysfunction and the comorbidity profile in men with late onset hypogonadism?

ObjectiveTo determine whether the severity of erectile dysfunction (ED) in a man diagnosed with late-onset hypogonadism (LOH) gives information about his metabolic syndrome state, as patients with LOH often have sexual symptoms and associated cardiovascular and metabolic comorbidities, but the role of ED in predicting the prevalence of comorbid disease in men with low levels of testosterone is currently unknown. Patients and methodsMen (130) diagnosed with LOH and fulfilling the criteria of a total testosterone level of <3.5ng/mL (<12nmol/L), and with an erectile function domain score of <21 on the International Index of Erectile Function questionnaire (IIEF, questions 1–5), were enrolled for a subsequent trial of supplementation with testosterone undecanoate. Demographic data were recorded at baseline. The men completed three standardised questionnaires to assess sexual health, including the International Prostate Symptom Score, Ageing Males Symptoms (AMS) and IIEF Sexual Health Inventory for Men (SHIM). Patients were stratified by the severity of ED, with SHIM scores of 1–7 considered severe, 8–11 moderate, and 12–16 mild to moderate. Levels of serum testosterone, sex hormone binding globulin (SHBG) and lipids (total cholesterol, triglycerides, high-density and low-density lipoprotein) were assessed, along with plasma fasting glucose and glycated haemoglobin (HbA1c) levels. Body weight, body mass index and waist circumference were also recorded. ResultsThere was a significant association between the severity of ED and mean weight (P<0.001), waist circumference (P<0.001), triglycerides (P=0.009), total cholesterol (P=0.027), HbA1c (P<0.001), fasting glucose (P=0.003) and AMS scores (P=0.043). There were no significant differences in testosterone fractions and SHBG levels between the ED subgroups. There was a positive correlation between the prevalence of diabetes mellitus (type 1 and type 2) and the severity of ED in these men (P=0.018). ConclusionsThe descriptive data showed that a greater severity of ED in men with LOH correlated with an increased waist circumference, hyperglycaemia, hypertriglyceridaemia, hyperlipidaemia, and a history of diabetes mellitus. Severe ED is a prognostic indicator of comorbidities in men with LOH.

Patient-Reported Sexual Function After Staged Penile Urethroplasty

To evaluate sexual function after staged penile urethroplasty with oral mucosal graft (OMG). We identified men with completed staged penile urethroplasty with OMG from the Trauma and Urologic Reconstruction Network of Surgeons database between January 1, 2010 and May 1, 2014. Our primary outcome was change in total Sexual Health Inventory for Men (SHIM) and total Male Sexual Health Questionnaire Ejaculatory Domain (MSHQ-EjD) Short Form at baseline vs after the second stage of the procedure. Second, we assessed subjective changes in penile curvature, length, and sensation. Thirty-three patients were included with a mean age of 45years and mean body mass index of 27.6kg/m(2). Urethral strictures arose from failed hypospadias repair in 52% and lichen sclerosus in 27%. Fifty-two percent of patients reported a previous urethroplasty. The median follow-up time between the second stage procedure and postoperative questionnaires was 6.3months (interquartile range: 3.5-13.3). There was no significant change in the total SHIM (Δ0.64, 95% confidence interval [CI]:-3.00∼1.72) and MSHQ-EjD (Δ1.55, 95% CI:-1.53∼4.63) scores preoperatively vs postoperatively. In addition, 32% reported improved and 52% no change in satisfaction with sexual intercourse (SHIM Q5). Forty percent of patients reported reduced and 45% no change in bother with ejaculation after surgery (MSHQ-EjD Q4). Men reported new penile curvature (23%), loss of penile length (55%), and altered penile sensitivity (45%) after surgery. Patients undergoing staged penile urethroplasty with OMG are likely to have minimal changes in erectile and ejaculatory function postoperatively, although many may experience new penile curvature, reduced penile length, and/or reduced penile sensitivity.

Excision and Patch Grafting of a Lateral Peyronie's Plaque-Utilizing a Longitudinal "Window" Approach.

IntroductionPeyronie’s disease (PD) is a debilitating disorder in which collagen deposition, fibrosis, and plaques in the tunica albuginea result in penile curvature, shortening, and pain. For severe curvatures requiring plaque incision or excision with grafting (PIEG), a subcoronal circumcising incision with penile degloving has historically been used.AimsThe aim of this study was to report our unique approach to PIEG via a longitudinal “window” incision for the correction of PD, minimizing the surgical manipulation and dissection accompanying the traditional circumcising incisional approach that may lead to increased postoperative edema, pain, and prolonged healing time.MethodsA patient presented with a stable, painless, 90-degree midshaft leftward curvature causing penetration difficulties and painful intercourse for his partner. His Sexual Health Inventory for Men (SHIM) score was 23. The patient opted for surgical correction with plaque excision and grafting via a 4-cm longitudinal incision overlying the point of maximal curvature along the left lateral penile shaft. This direct access to the left corpus cavernosum and plaque, along with dissecting skin, dartos, and Buck’s fascia, created a window with sufficient exposure for excision and patch grafting.Main Outcome MeasuresThe main outcome measures were objective data and subjective data in men undergoing PIEG via lateral longitudinal “window” incision for PD repair.ResultsThe plaque was excised and a porcine small intestinal submucosa graft was sewn in. Intraoperative artificial tumescence at the end of surgery revealed complete correction of the curvature. The patient experienced painless rigid erections by postoperative day three with minimal penile edema. By postoperative week four, he could successfully partake in coitus. His SHIM score remained unchanged. At maximum follow-up 6 months postoperatively, he still endorsed excellent cosmetic and functional outcomes with spontaneous unassisted erections and no recurrence of his curvature.ConclusionA lateral longitudinal incision for PIEG is a feasible technique and may reduce the postoperative morbidity and dissection required with traditional circumcising incision with penile degloving. Larger comparative studies are necessary for further evaluation.

Erectile dysfunction is a prognostic indicator of comorbidities in men with late onset hypogonadism

Introduction: The role of testosterone deficiency in erectile dysfunction (ED) is increasingly recognized; however, there is a need to clarify the nature of the relationship between ED and late onset hypogonadism (LOH).Aim: In this study, we sought to determine the correlators of ED severity amongst men with LOH.Methods: 130 patients diagnosed with LOH fulfilling the criteria of total testosterone ≤3.5 ng/ml (<12 nmol/l) and with an erectile function domain score <21 on the International Index of Erectile Function questionnaire (IIEF questions 1–5) were enrolled for a subsequent trial of Testosterone Undecanoate. Demographic data were recorded at baseline.Main outcome measures: Subjects completed three standardised questionnaires to assess sexual health including International Prostate Symptom Score (IPSS), Aging Males Symptoms (AMS) and IIEF Sexual Health Inventory for Men (SHIM). Patients were stratified by ED severity with SHIM scores of 1–7 considered severe ED, 8–11 moderate ED and 12–16 mild to moderate. Serum testosterone, sex hormone binding globulin (SHBG) and lipids (total cholesterol, triglycerides, high-density lipoprotein and low-density lipoprotein) were assessed along with plasma fasting glucose and HbA1c. Weight, BMI and waist circumference were also recorded.Results: A significant association was observed between severity of ED and mean weight (p = 0.000), waist circumference (p = 0.000), triglycerides (p = 0.009), total cholesterol (p = 0.027), HbA1c (p = 0.000), fasting glucose (p = 0.003) and AMS scores (p = 0.043). No significant differences were seen in testosterone fractions and SHBG levels between ED subgroups. A positive correlation existed between the prevalence of diabetes mellitus (type 1 and type 2) and ED severity in this cohort (p = 0.018).Conclusions: The descriptive data of our cohort show that increased severity of ED within LOH patients correlated with an increased waist circumference, hyperglycemia, hypertriglyceridemia, hyperlipidemia and a history of diabetes mellitus. Severe ED functions as a prognostic indicator of co-morbidities in men with LOH.

MP71-10 PREDICTORS OF PROSTATE CANCER IN PATIENTS UNDERGOING HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR SYMPTOMATIC BENIGN PROSTATIC HYPERPLASIA

INTRODUCTION AND OBJECTIVES: The purpose of this study was to assess functional and QoL outcomes associated with various forms of benign prostatic hyperplasia (BPH) surgical treatment using an independent third party survey center. METHODS: An independent third party survey center was employed to send a comprehensive questionnaire to all patients who underwent surgical intervention for BPH at our institution between Jan. 2007 to Jan. 2013. Patients were identified using Current Procedural Terminology codes and our institutional billing records. Overall satisfaction, urinary and sexual functional outcomes were evaluated as part of this survey. After IRB approval, the validated instruments were Sexual Health Inventory for Men (SHIM), the International Prostate Symptoms Score (IPSS) and the International Continence Society e Short Form questionnaires (ICSmaleSF). Overall SHIM, IPSS and ICS scores were analyzed as were the individual domains in each questionnaire, comparing them individually and as a function of specific procedure. RESULTS: There were 906 patients who underwent BPH surgery at our institution during the study interval. Of the 862 alive patients, there were 479 respondents (55.6%). Among responders there were 214 Holmium Laser Enucleation of the Prostate (HoLEP), 210 Transurethral Resection of the Prostate (TURP), 21 Holmium Laser Ablation of the Prostate, 18 Photoselective Vaporization, 9 transurethral Incision of the Prostate and 7 simple prostatectomy. Preoperatively, patient reported continence rates as 55.3%, 58.2%, 71.4%, 57.1%, 66.7% and 80%, respectively (P1⁄4 0.651). Postoperatively, there were no significant differences in SHIM scores. However, total IPSS varied significantly among procedures (p<0.0001). Mean ( SD) IPSS was lowest for simple prostatectomy 4.0 ( 2.6) followed by HoLEP 5.8 ( 5.4). When Individual domains were analyzed, there were significant differences in intermittency (p1⁄40.0004), weak stream (p1⁄40.0029), straining (p< 0.0001) and quality of life QoL (p1⁄40.001). In all domains HoLEP had the lowest scores. Regarding ICSmaleSF, there was a significant difference in favor of TURP in the incontinence domain(p<0.0001) and in favor of HoLEP in the voiding (p1⁄40.0192) and QoL domains (p1⁄40.0344).The majority of the patients were satisfied with their intervention, regret was least in HoLEP 64.1% (p1⁄40.0175). CONCLUSIONS: Patients were generally satisfactied. However, those who underwent a HoLEP tended to have the best functional outcomes and highest QoL scores.

MP71-09 FUNCTIONAL ANALYSIS OF PATIENT OUTCOMES FOLLOWING DIFFERENT SURGICAL INTERVENTIONS FOR BENIGN PROSTATE HYPERPLASIA THROUGH THE ADMINISTRATION OF AN INDEPENDENT SURVEY

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Evaluation and Symptoms1 Apr 2015MP71-09 FUNCTIONAL ANALYSIS OF PATIENT OUTCOMES FOLLOWING DIFFERENT SURGICAL INTERVENTIONS FOR BENIGN PROSTATE HYPERPLASIA THROUGH THE ADMINISTRATION OF AN INDEPENDENT SURVEY Haidar Abdul-Muhsin, Mark Tyson, Paul Andrews, Erik Castle, Robert Ferrigni, Wolter Christopher, Swanson Scott, and Mitchell Humphreys Haidar Abdul-MuhsinHaidar Abdul-Muhsin More articles by this author , Mark TysonMark Tyson More articles by this author , Paul AndrewsPaul Andrews More articles by this author , Erik CastleErik Castle More articles by this author , Robert FerrigniRobert Ferrigni More articles by this author , Wolter ChristopherWolter Christopher More articles by this author , Swanson ScottSwanson Scott More articles by this author , and Mitchell HumphreysMitchell Humphreys More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2622AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The purpose of this study was to assess functional and QoL outcomes associated with various forms of benign prostatic hyperplasia (BPH) surgical treatment using an independent third party survey center. METHODS An independent third party survey center was employed to send a comprehensive questionnaire to all patients who underwent surgical intervention for BPH at our institution between Jan. 2007 to Jan. 2013. Patients were identified using Current Procedural Terminology codes and our institutional billing records. Overall satisfaction, urinary and sexual functional outcomes were evaluated as part of this survey. After IRB approval, the validated instruments were Sexual Health Inventory for Men (SHIM), the International Prostate Symptoms Score (IPSS) and the International Continence Society – Short Form questionnaires (ICSmaleSF). Overall SHIM, IPSS and ICS scores were analyzed as were the individual domains in each questionnaire, comparing them individually and as a function of specific procedure. RESULTS There were 906 patients who underwent BPH surgery at our institution during the study interval. Of the 862 alive patients, there were 479 respondents (55.6%). Among responders there were 214 Holmium Laser Enucleation of the Prostate (HoLEP), 210 Transurethral Resection of the Prostate (TURP), 21 Holmium Laser Ablation of the Prostate, 18 Photoselective Vaporization, 9 transurethral Incision of the Prostate and 7 simple prostatectomy. Preoperatively, patient reported continence rates as 55.3%, 58.2%, 71.4%, 57.1%, 66.7% and 80%, respectively (P= 0.651). Postoperatively, there were no significant differences in SHIM scores. However, total IPSS varied significantly among procedures (p<0.0001). Mean (±SD) IPSS was lowest for simple prostatectomy 4.0 (±2.6) followed by HoLEP 5.8 (±5.4). When Individual domains were analyzed, there were significant differences in intermittency (p=0.0004), weak stream (p=0.0029), straining (p< 0.0001) and quality of life QoL (p=0.001). In all domains HoLEP had the lowest scores. Regarding ICSmaleSF, there was a significant difference in favor of TURP in the incontinence domain(p<0.0001) and in favor of HoLEP in the voiding (p=0.0192) and QoL domains (p=0.0344).The majority of the patients were satisfied with their intervention, regret was least in HoLEP 64.1% (p=0.0175). CONCLUSIONS Patients were generally satisfactied. However, those who underwent a HoLEP tended to have the best functional outcomes and highest QoL scores. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e915 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Haidar Abdul-Muhsin More articles by this author Mark Tyson More articles by this author Paul Andrews More articles by this author Erik Castle More articles by this author Robert Ferrigni More articles by this author Wolter Christopher More articles by this author Swanson Scott More articles by this author Mitchell Humphreys More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD18-12 USE OF HYALURONIC ACID-CARBOXYMETHYLCELLULOSE ADHESION BARRIER ON THE NEUROVASCULAR BUNDLE DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY: LONG TERM OUTCOMES

You have accessJournal of UrologyTechnology & Instruments: Laparoscopy and Robotics: Malignant Disease II1 Apr 2015PD18-12 USE OF HYALURONIC ACID-CARBOXYMETHYLCELLULOSE ADHESION BARRIER ON THE NEUROVASCULAR BUNDLE DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY: LONG TERM OUTCOMES Rutveej Patel, Parth Modi, and Isaac Kim Rutveej PatelRutveej Patel More articles by this author , Parth ModiParth Modi More articles by this author , and Isaac KimIsaac Kim More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.697AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Hyaluronic acid-carboxymethylcellulose (HCAM) adhesion barrier has been used to prevent postoperative peritoneal adhesions after abdominal surgery. Limited published evidence suggests its application at the neurovascular bundle may hasten the return of erectile function after robotic-assisted radical prostatectomy (RARP). METHODS A retrospective review of a single-surgeon, prospectively maintained database identified 462 consecutive patients who underwent nerve sparing RARP between the years of 2009 and 2012. In the first 246 patients in this cohort, HCAM was delivered to the location of the neurovascular bundle (NVB) after prostate removal. These patients were assigned to the experimental group, while the 216 who did not receive HCAM were used as the control group. Postoperative erectile function and oncologic outcomes were compared. Independent t-test was used to compare mean Sexual Health Inventory for Men (SHIM) values. Kaplan-Meier analysis was used to determine biochemical recurrence (BCR) free survival. P < 0.05 was considered significant. RESULTS The two groups were well matched, without significant differences in age, weight, operative time, prostate size, preoperative PSA, SHIM, or AUA symptom scores. The mean SHIM was significantly higher for the experimental group at 6 months (6.39 v 4.75, P=0.008), 9 months (7.32 v 5.44, P=0.006), 1 year (8.52 v 6.90, P=0.049), and 18 months (10.01 v 7.60, P=0.018). This effect was not significant beyond 18 months. A subgroup analysis of patients with initial SHIM scores 22 or greater demonstrated a higher rate of return to pre-operative SHIM score for the HCAM 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. CONCLUSIONS HCAM application at the NVB during RARP may decrease the time to return of EF, with improved SHIM at 6-18 months after surgery. This effect seems to be more pronounced in patients with better baseline erectile function. HCAM application has no significant effect on BCR. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e390-e391 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rutveej Patel More articles by this author Parth Modi More articles by this author Isaac Kim More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP43-17 ASSESSMENT OF THE MALE SEXUAL QUOTIENT SCALE RELIABILITY TO EVALUATE SEXUAL FUNCTION OF MEN WITH SPINAL CORD INJURY

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Evaluation I1 Apr 2015MP43-17 ASSESSMENT OF THE MALE SEXUAL QUOTIENT SCALE RELIABILITY TO EVALUATE SEXUAL FUNCTION OF MEN WITH SPINAL CORD INJURY Eduardo Miranda, Cristiano Gomes, Jose de Bessa Júnior, Jose de Castro Filho, Carlos Bellucci, Linamara Battistella, Tarcisio Barros Filho, Fabricio Carvalho, Carmita Abdo, Homero Bruschini, William Nahas, and Miguel Srougi Eduardo MirandaEduardo Miranda More articles by this author , Cristiano GomesCristiano Gomes More articles by this author , Jose de Bessa JúniorJose de Bessa Júnior More articles by this author , Jose de Castro FilhoJose de Castro Filho More articles by this author , Carlos BellucciCarlos Bellucci More articles by this author , Linamara BattistellaLinamara Battistella More articles by this author , Tarcisio Barros FilhoTarcisio Barros Filho More articles by this author , Fabricio CarvalhoFabricio Carvalho More articles by this author , Carmita AbdoCarmita Abdo More articles by this author , Homero BruschiniHomero Bruschini More articles by this author , William NahasWilliam Nahas More articles by this author , and Miguel SrougiMiguel Srougi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1624AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Assessing sexual function of spinal cord injury (SCI) men remains a challenge. The Male Sexual Quotient (MSQ) is a newly developed questionnaire designed to thoroughly assess sexual function and satisfaction with various aspects of male sexuality. The purpose of this study is to assess the sexual function of SCI men and its impact in their sexual satisfaction using MSQ and to compare it with the Sexual Health Inventory for Men (SHIM). METHODS We performed a cross-sectional study of SCI men presenting for evaluation in a tertiary rehabilitation center. We analyzed epidemiological data such as age, level, completeness and duration of SCI. All patients completed the SHIM and the MSQ questionnaire. We analyzed the correlation between these instruments. RESULTS A total of 295 men with a mean age of 40.7 ± 14.5 years (range 18-75 years) were evaluated. The median time of injury was 3.6 (1.6 to 7.0) years. Erectile function, ejaculation and orgasm were the most severely affected domains. The median SHIM score after SCI was 5 (range 0 to 16) and the mean MSQ score was 40 (range 8 to 66). The diagnostic properties of two instruments were quite similar in the discrimination of sexually active individuals. The area under the ROC curve (AUC) was 0.942 (0.915 95% - 0.968) for the SHIM and 0.950 (95% CI 0.923 to 0.979) for the MSQ. Pearson Correlation Test revealed a strong correlation between the two variables (r= 0.8258, p< 0.0001) as demonstrated in Figure 1. CONCLUSIONS The MSQ score has a strong correlation with the SHIM and both instruments have high discriminatory power in the assessment of sexual dysfunction in patients with SCI. The MSQ also assesses ejaculation and orgasmic functions and provides a comprehensive evaluation of sexual function in SCI men. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e524-e525 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eduardo Miranda More articles by this author Cristiano Gomes More articles by this author Jose de Bessa Júnior More articles by this author Jose de Castro Filho More articles by this author Carlos Bellucci More articles by this author Linamara Battistella More articles by this author Tarcisio Barros Filho More articles by this author Fabricio Carvalho More articles by this author Carmita Abdo More articles by this author Homero Bruschini More articles by this author William Nahas More articles by this author Miguel Srougi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Can robot-assisted radical prostatectomy be taught to chief residents and fellows without affecting operative outcomes?

PurposeTo determine whether robot-assisted radical prostatectomy (RARP) may be taught to chief residents and fellows without influencing operative outcomes.MethodsBetween August 2011 and June 2012, 388 patients underwent RARP by a single primary surgeon (DIL) at our institution. Our teaching algorithm divides RARP into five stages, and each trainee progresses through the stages in a sequential manner. Statistical analysis was conducted after grouping the cohort according to the surgeons operating the robotic console: attending only (n = 91), attending and fellow (n = 152), and attending and chief resident (n = 145). Approximately normal variables were compared utilizing one-way analysis of variance, and categorical variables were compared utilizing two-tailed χ2 test; P < 0.05 was considered statistically significant.ResultsThere was no difference in mean age (P = 0.590), body mass index (P = 0.339), preoperative SHIM (Sexual Health Inventory for Men) score (P = 0.084), preoperative AUASS (American Urologic Association Symptom Score) (P = 0.086), preoperative prostate-specific antigen (P = 0.258), clinical and pathological stage (P = 0.766 and P = 0.699, respectively), and preoperative and postoperative Gleason score (P = 0.775 and P = 0.870, respectively). Operative outcomes such as mean estimated blood loss (P = 0.807) and length of stay (P = 0.494) were similar. There was a difference in mean operative time (P < 0.001; attending only = 89.3 min, attending and fellow 125.4 min, and attending and chief resident 126.9 min). Functional outcomes at 3 months and 1 year postoperatively such as urinary continence rate (P = 0.977 and P = 0.720, respectively), and SHIM score (P = 0.661 and P = 0.890, respectively) were similar. The rate of positive surgical margins (P = 0.058) was similar.ConclusionsTraining chief residents and fellows to perform RARP may be associated with increased operative times, but does not compromise short-term functional and oncological outcomes.

The effect of spinal cord level on sexual function in the spina bifida population

Sexual dysfunction and infertility are prevalent in the spina bifida (SB) population; however, the mechanism of how they affect a person with spina bifida is poorly understood. Additionally, the management of children with spina bifida becomes more difficult as they exit from pediatric institutes. The present study sought to evaluate sexual health (using validated questionnaires) and fertility in adults with spina bifida and to correlate spinal cord level and ambulatory status with degree of sexual function. After institutional board review approval, 199 adult patients with SB, aged 18 and older and who were followed in one pediatric institution, were identified. Patients who were non-English speaking, cognitively and/or developmentally delayed, or unable to be contacted were excluded. Surveys regarding demographics, sexual health and infertility were mailed to the patients and administered in the clinic with the option to opt-out of the survey. Survey questions regarding sexual health were constructed using validated questionnaires: Female Sexual Function Index (FSFI) for females, and International Index of Erectile Function (IIEF) and Sexual Health Inventory for Men (SHIM) for males. Sexual dysfunction scores were correlated to the patients' spinal level and ambulatory status. Of the 121 eligible patients, 45 replied, with a response rate of 39%. For females, using a cut-off value of 26.5 for FSFI scoring, 25 out of 28 (89%) had sexual dysfunction. No association was seen between spinal level or ambulatory status and overall FSFI, satisfaction, or desire scores. For males, 10 out of 17 (59%) had severe erectile dysfunction (ED), and one out of 17 (6%) had no ED. No association was seen between ambulatory status and sexual function scores for the males. However, SHIM, satisfaction, and ED scores were higher in males with lower spinal lesions. People with spina bifida of both genders tended to have more severe dysfunction compared to those with sexual dysfunction of other etiologies, except with similar sexual desire scores. Regarding questions on fertility, no participant attempted to have children; thus, there was no infertility reported. Few studies have been conducted on sexual health and fertility in adults with SB. Three studies have utilized validated questionnaires and found varying degrees of sexual dysfunction in this subset of patients; however, only one study found sexual activity to be more likely in patients with more caudal levels of neurologic impairment. The present study also showed that SHIM, satisfaction, and ED scores were higher in males with lower spinal lesions. Limitations to this study primarily included the small sample size and low survey response rate. Limited information is known about adults with SB, and sexual function and fertility. While expressing sexual desire, adults with SB appear to experience high rates of sexual dysfunction. Fertility rates were inadequately assessed; this was possibly due to the high rate of sexual dysfunction. Sexual health in the SB population is an important component of the myriad of urologic care issues for these people. Due to the disparity in their care after reaching adulthood, it is prudent to follow these patients and understand their pathophysiology as they continue to mature through life.

The impact of patient characteristics on voiding symptoms, irritative symptoms, and sexual function, following stereotactic body radiotherapy for prostate cancer.

245 Background: Urinary symptoms and sexual dysfunction are the two most common complaints following prostate radiotherapy. There is limited clinical data evaluating the impact of baseline patient characteristics on response to hypofractionated treatment. This study sought to evaluate how patient age and prostate size affects voiding symptoms, irritative symptoms, and sexual function, following stereotactic body radiotherapy (SBRT). Methods: This retrospective analysis includes 102 non-metastatic patients treated with SBRT at a single institution between May 2008 and September 2014. The course of radiotherapy consisted of 36.25 Gy (range 35–40) over 5 daily fractions. International Prostate Symptom Score (IPSS) and Sexual Health Inventory for Men (SHIM) were recorded at baseline, 1, 3, 6, 9, 12, 18, 24, and 36 months after treatment. Results: Median patient age was 68 years old (range 47-88) and median prostate volume was 43 cc (range 18.7-170.7). Baseline IPSS irritative score, IPSS voiding score, and SHIM score were 5.34, 5.42, and 13.55. A statistically significant increase in voiding (7.02), irritative (7.21), and decrease in SHIM score (11.77) was observed after one month (p &lt; .05). The IPSS irritative score and IPSS voiding scores returned to baseline in &gt;90% of patients by 9 months and SHIM scores returned to baseline in &gt;90% of patients by 2 years. Prostate size ≤ 50 cc showed higher baseline IPSS voiding and irritative resolution rates after 3 months (p &lt; .05). Conclusions: While an increase in IPSS irritative score, and a decrease in SHIM score initially occurred, all symptoms return to baseline within three years. Age did not affect urinary or sexual dysfunction following radiotherapy. Patients with smaller prostate volumes had significantly better voiding and irritative outcomes when compared to larger volumes.

Predictors of early continence following robot-assisted radical prostatectomy.

Functional outcomes after robot-assisted radical prostatectomy (RARP) greatly influence patient quality of life. Data regarding predictors of early continence, especially 1 month following RARP, are limited. Previous reports mainly address immediate or 3-month postoperative continence rates. We examine preoperative predictors of pad-free continence recovery at the first follow-up visit 1 month after RARP. Between January 2007 and January 2013, preoperative and follow-up data were prospectively collected for 327 RARP patients operated on by 2 fellowship-trained surgeons (AEH and KCZ). Patient and operative characteristics included age, body mass index (BMI), staging, preoperative prostate-specific antigen (PSA), prostate weight, International Prostate Symptom Score (IPSS), Sexual Health Inventory for Men (SHIM) score and type of nerve-sparing performed. Continence was defined by 0-pad usage at 1 month follow-up. Univariate and multivariate logistic regression models were used to assess for predictors of early continence. Overall, 44% of patients were pad-free 1 month post-RARP. In multivariate regression analysis, age (odds ratio [OR] 0.946, confidence interval [CI] 95%: 0.91, 0.98) and IPSS (OR: 0.953, CI 95%: 0.92, 0.99) were independent predictors of urinary continence 1 month following RARP. Other variables (BMI, staging, preoperative PSA, SHIM score, prostate weight and type of nerve-sparing) were not statistically significant predictors of early continence. Limitations of this study include missing data for comorbidities, patient use of pelvic floor exercises and patient maximal activity. Moreover, patient-reported continence using a 0-pad usage definition represents a semiquantitative and subjective measurement. In a broad population of patients who underwent RARP at our institution, 44% of patients were pad-free at 1 month. Age and IPSS were independent predictors of early continence after surgery. Men of advanced age and those with significant lower urinary tract symptoms prior to RARP should be counselled on the increased risk of urinary incontinence in the early stages.

Reduced radiation tolerance of penile structures associated with dose-escalated hypofractionated prostate radiotherapy.

To investigate the effect of hypofractionated external beam radiation therapy (RT) on sexual function in patients treated for localized prostate cancer, and also to determine the effect of radiation dose to the penile bulb or crura of the corpus cavernosum on sexual function outcome. Forty-one patients treated with hypofractionated RT without androgen deprivation were prescribed 67.6-70.2 Gy to the prostate, delivered in 26-28 fractions. The primary endpoint was erectile dysfunction (ED) category based on the Sexual Health Inventory for Men (SHIM) score closest to 2 years from RT. The penile bulb and crura were contoured and mean radiation dose calculated for each structure. The mean pretreatment SHIM score was 19.8, and the mean posttreatment SHIM score was 15.1. The ED category was decreased by ≥ 2 in 50% of patients with a mean penile bulb of >20 Gy compared with that in 9% of patients with a mean penile bulb dose of ≤ 20 Gy (P = .003). Mean dose to the crura was highly correlated with mean dose to the penile bulb (Pearson correlation = 0.842; P <.001) but did not reach statistical significance as a predictor of ED after radiation. Radiation dose to the penile bulb is predictive of posttreatment ED in patients treated with dose-escalated hypofractionated prostate RT. The cutpoint at which this effect was observed with this treatment is substantially lower than the previous reports.

Correlation between erection hardness score and nocturnal penile tumescence measurement.

The Erection Hardness Score (EHS) and the Sexual Health Inventory for men (SHIM) are patient-reported outcome scoring systems for erectile function. It is unclear which is more reliable for predicting the objective erectile function. The aim of this study was to evaluate whether the EHS could predict objective erectile function by measuring the maximal penile circumferential change (MPCC) with an erectometer. The study included 98 patients who visited our clinic from 2005 to 2010. The erectile function was evaluated using the SHIM, EHS, and MPCC. The MPCC was measured with the largest circumferential change of three consecutive occurrences of nocturnal penile tumescence (NPT) determined using the erectometer. We defined erectile dysfunction (ED) as MPCC < 20 mm and carried out multivariate analysis using logistic regression analysis to clarify the predictors for ED, with the variables including age, the SHIM score, and the EHS. We compared the tendency for MPCC ≥ 20 mm when EHS was 3 or more with that when EHS was 2 or less. The median age of the patients was 59.5 years (range 18-83). In logistic regression analysis, the EHS was the only predictor for ED with MPCC < 20 mm. The mean EHS in the MPCC < 20 mm group was 1.64 ± 0.20 (mean ± SEM) and that in the MPCC ≥ 20 mm group was 2.46 ± 0.13 (P = 0.0018). There was a correlation between the EHS and the MPCC (correlation coefficient = 0.33). In comparison with the group having an EHS of 2 or less, that with an EHS of 3 or more tended to have MPCC ≥ 20 mm (P = 0.013). The EHS was correlated with the MPCC. The EHS represents the objective erectile function shown by the measurement of NPT.

Long-acting testosterone injections for treatment of testosterone deficiency after brachytherapy for prostate cancer.

To evaluate the clinical and biochemical effects of long-acting testosterone undecanoate injections in men with prostate cancer treated with brachytherapy, as the use of testosterone therapy (TTh) in men with prostate cancer is highly controversial, with limited published safety data, particularly after brachytherapy treatment. In all, 20 men treated with brachytherapy for prostate cancer received TTh for symptoms of testosterone deficiency from February 2005 to August 2013. Symptoms of testosterone deficiency included low libido, erectile dysfunction, and fatigue. The mode of TTh was long-acting testosterone undecanoate injections in all cases. Sexual function was assessed by Sexual Health Inventory for Men (SHIM) questionnaire. Serum PSA and testosterone concentrations were recorded monthly for 3 months, then every 3 months for the first year, every 6 months for the second year, and annually then after. The mean (range) age was 62 (49-74) years and the mean (range) serum PSA level at the time of prostate cancer diagnosis was 6.2 (2-11.5) ng/mL. The Gleason score was 2 + 3 in one patient, 3 + 3 in 15 patients, 3 + 4 in three patients and 4 + 4 in one patient. In all, 15 men were stage T1c and five were T2a. The mean (range) baseline total testosterone concentration was 343 (200-592) ng/dL, and 6.9 (2.1-9.7) ng/dL for free testosterone. The mean SHIM scores improved with treatment from 16.1 at baseline to 22.1 with TTh (P = 0.002). There was a decrease in mean PSA level from baseline of 0.7 ng/mL before initiation of TTh to 0.1 ng/mL at last follow-up (P < 0.001), with a median (range) follow-up of 31 (12-48) months. There were no cases of prostate cancer progression or recurrence. With a median of 31-months follow-up, long-acting testosterone injections in men with prostate cancer treated with brachytherapy produced significant clinical benefits. There were no cases of rising serum PSA, prostate cancer progression or recurrence.

PD6-10 DOES FELLOW AND CHIEF-RESIDENT TRAINING AFFECT PERIOPERATIVE OUTCOMES OF ROBOT-ASSISTED RADICAL PROSTATECTOMY?

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment I1 Apr 2014PD6-10 DOES FELLOW AND CHIEF-RESIDENT TRAINING AFFECT PERIOPERATIVE OUTCOMES OF ROBOT-ASSISTED RADICAL PROSTATECTOMY? Ziho Lee, Andrew Lightfoot, Shailen Sehgal, Reid Graves, Phillip Mucksavage, and David Lee Ziho LeeZiho Lee More articles by this author , Andrew LightfootAndrew Lightfoot More articles by this author , Shailen SehgalShailen Sehgal More articles by this author , Reid GravesReid Graves More articles by this author , Phillip MucksavagePhillip Mucksavage More articles by this author , and David LeeDavid Lee More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.518AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To determine whether fellow and chief-resident participation during robot-assisted radical prostatectomy (RARP) influences perioperative outcomes. METHODS Between August 2011 and June 2012, 388 patients underwent RARP by a single primary surgeon (DIL) at our institution. Our teaching algorithm divides RARP into six stages. Each trainee may progress to the next stage in a sequential manner once the trainee demonstrates competency as determined by the primary surgeon. Patient characteristics and perioperative outcomes were compared after dividing our cohort according to the surgeon(s) operating the robotic console: attending only (n=91), attending and fellow (n=152), and attending and chief-resident (n=145). Approximately normal variables were compared utilizing one-way analysis of variance test, and categorical variables were compared utilizing two-tailed chi-square (χ2) test; p<0.05 was considered statistically significant. RESULTS Among the three groups, there was no difference in patient characteristics such as mean age (p=0.590), body mass index (p=0.339), preoperative Sexual Health Inventory for Men (SHIM) score (p=0.084), preoperative American Urology Association Symptom Score (p=0.086), preoperative prostate-specific antigen (p=0.258), preoperative Gleason score (p=0.176), postoperative Gleason score (p= 0.779), clinical stage (p=0.766), and pathological stage (p=0.699). There was no difference in perioperative outcomes such as mean estimated blood loss (p=0.807), length of stay (p=0.494), and rate of positive surgical margins (p=0.058). Procedures involving trainees had longer mean operative times (p<.001; attending only=89.3 min, attending and fellow=125.4 min, and attending and chief-resident=126.9 min). At 3 months and 1 year postoperatively, there was no difference in urinary continence rate (p=0.977 and p=0.720, respectively) and SHIM score (p=0.661 and p=0.890, respectively). CONCLUSIONS Fellow and chief-resident involvement during RARP may be associated with increased operative times, but does not compromise oncologic and functional outcomes at 3 months and 1 year postoperatively. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e134 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Ziho Lee More articles by this author Andrew Lightfoot More articles by this author Shailen Sehgal More articles by this author Reid Graves More articles by this author Phillip Mucksavage More articles by this author David Lee More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...