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Kadıoğlu A, Ortaç M, Dinçer M, Brock G. Tadalafil therapy for erectile dysfunction following prostatectomy. Ther Adv Urol 2015; 7:146-51. [PMID: 26161145 PMCID: PMC4485415 DOI: 10.1177/1756287215576626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Erectile dysfunction is a major complication affecting the quality of life of patients and partners after radical prostatectomy. Evolving evidence suggests that early penile rehabilitation may provide better erectile function after surgery. Phosphodiesterase type 5 (PDE-5) inhibitors are routinely considered a first-line treatment option in most algorithms for penile rehabilitation owing to their efficacy, ease of use, wide availability and minimal morbidity. Tadalafil is a long-acting, potent PDE-5 inhibitor for erectile dysfunction, with demonstrated effect in animal studies at preserving penile smooth muscle content and prevention of fibrosis of cavernosal tissue. This article evaluates the existing literature on tadalafil and critically analyzes its impact on erectile function following radical prostatectomy.
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Affiliation(s)
- Ateş Kadıoğlu
- Department of Urology, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Mazhar Ortaç
- Department of Urology, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Murat Dinçer
- Department of Urology, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Gerald Brock
- University of Western Ontario, 268 Grosvenor St, London, Ontario, Canada N6A4V2
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52
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Sadeghi-Nejad H. Restoration of Erectile Dysfunction after Cavernous Nerve Injury. J Urol 2015; 193:1463-4. [DOI: 10.1016/j.juro.2015.02.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Hossein Sadeghi-Nejad
- Division of Urology, Rutgers New Jersey Medical School, Hackensack University Medical Center, Hackensack, New Jersey
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53
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Weyne E, Castiglione F, Van der Aa F, Bivalacqua TJ, Albersen M. Landmarks in erectile function recovery after radical prostatectomy. Nat Rev Urol 2015; 12:289-97. [PMID: 25868558 DOI: 10.1038/nrurol.2015.72] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The description of the nerve-sparing technique of radical prostatectomy by Walsh was one of the major breakthroughs in the surgical treatment of prostate cancer in the 20(th) century. However, despite this advance and consequent technological refinements to nerve-sparing surgery, a large proportion of men still suffer from erectile dysfunction (ED) as a complication of prostatectomy. A plethora of therapeutic approaches have been proposed to optimize erectile function recovery in these patients. Several preclinical and translational studies have shown benefits of therapies including PDE5 inhibitor (PDE5I) treatment, immunomodulation, neurotrophic factor administration, and regenerative techniques, such as stem cell therapy, in animal models. However, most of these approaches have either failed to translate to clinical use or have yet to be studied in human subjects. Penile rehabilitation with PDE5Is is currently the most commonly used clinical strategy, in spite of the absence of solid clinical evidence to support its use.
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Affiliation(s)
- Emmanuel Weyne
- Laboratory for Experimental Urology, Department of Development and Regeneration, University of Leuven, Herestraat 49, Box 802, 3000 Leuven, Belgium
| | - Fabio Castiglione
- Urological Research Institute, San Raffaele Scientific Institution, via Olgettina 60, 20132 Milano, Italy
| | - Frank Van der Aa
- Laboratory for Experimental Urology, Department of Development and Regeneration, University of Leuven, Herestraat 49, Box 802, 3000 Leuven, Belgium
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Marburg 420, Baltimore, MD 21287, USA
| | - Maarten Albersen
- Laboratory for Experimental Urology, Department of Development and Regeneration, University of Leuven, Herestraat 49, Box 802, 3000 Leuven, Belgium
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Yiou R, Bütow Z, Parisot J, Binhas M, Lingombet O, Augustin D, de la Taille A, Audureau E. Is it worth continuing sexual rehabilitation after radical prostatectomy with intracavernous injection of alprostadil for more than 1 year? Sex Med 2015; 3:42-8. [PMID: 25844174 PMCID: PMC4380913 DOI: 10.1002/sm2.51] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction Intracavernous alprostadil injection (IAI) is a widely used treatment for sexual rehabilitation (SR) after radical prostatectomy (RP). It is unknown whether the continuation of IAI beyond 1 year continues to improve erectile function. Aims To assess evolution of sexual function in patients using IAI who are nonresponsive to phosphodiesterase type 5 inhibitors (PDE5i) between 12 (M12) and 24 (M24) months after RP. Methods We retrospectively studied 75 men with a nerve-sparing laparoscopic RP, who had normal preoperative erectile function, and who regularly used IAI for SR for at least 24 months. At M12, no patients had responded to PDE5i. Main Outcome Measures At 12 and 24 months, sexual function was assessed with the UCLA Prostate Cancer Index (UCLA-PCI), International Index of Erectile Function (IIEF)-15, and erection hardness score (EHS) with and without IAI. We also assessed the satisfaction rate with IAI, injection-related penile pain, and satisfaction of treatment. Statistical analysis was performed by using t-tests for paired data and Spearman's rho correlation coefficients to assess the relationships between scores at M12 and M24. Results Improvement of nocturnal erection was noted (UCLA-PCI, question 25); however, no significant difference was found for IIEF-erectile function with (19.60 ± 9.80 vs. 18.07 ± 10.44) and without IAI (4.63 ± 2.93 vs. 4.92 ± 4.15), UCLA-PCI-sexual bother (37.14 ± 21.45 vs. 37.54 ± 19.67), nor the EHS score with (2.97 ± 1.30 vs. 2.57 ± 1.30) and without IAI (0.67 ± 1.11 vs. 0.76 ± 0.10). The rate of satisfaction with treatment decreased over time (66.6% vs. 46.7%, P = 0.013). Improved response to IAI at M12 was not correlated to improvement in spontaneous erections at M24. Conclusion The response to IAI remained stable after 2 years of treatment, and no significant improvement of spontaneous erections during intercourse attempts was found between M12 and M24. Patients should be informed of the limited effect of IAI on natural erections after 1 year. Yiou R, Bütow Z, Parisot J, Binhas M, Lingombet O, Augustin D, de la Taille A, and Audureau E. Is it worth continuing sexual rehabilitation after radical prostatectomy with intracavernous injection of alprostadil for more than 1 year? Sex Med 2015;3:42–48.
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Affiliation(s)
- René Yiou
- Department of Urology, Henri Mondor Teaching Hospital Créteil, France
| | - Zentia Bütow
- Department of Urology, Henri Mondor Teaching Hospital Créteil, France
| | - Juliette Parisot
- Department of Public Health, LIC EA4393, Université Paris Est (UPEC), Henri Mondor Teaching Hospital Créteil, France
| | - Michele Binhas
- Department of Anesthesiology, Henri Mondor Teaching Hospital Créteil, France
| | - Odile Lingombet
- Department of Urology, Henri Mondor Teaching Hospital Créteil, France
| | - Deborah Augustin
- Department of Urology, Henri Mondor Teaching Hospital Créteil, France
| | | | - Etienne Audureau
- Department of Public Health, LIC EA4393, Université Paris Est (UPEC), Henri Mondor Teaching Hospital Créteil, France
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Abstract
Many therapies for erectile dysfunction (ED) after prostate cancer treatment improve erectile firmness, yet, most couples stop using aids within 1-2 years. Patients and partners who expect immediate and complete success with their first ED treatment can be demoralized when they experience treatment failure, which contributes to reticence to explore other ED aids. Comprehensive patient education should improve sustainability and satisfaction with ED treatments. Pre-emptive and realistic information should be provided to couples about the probability of recovering natural erections. Beginning intervention early and using a couple-based approach is ideal. Recommendations are provided about the timing of ED treatment, the order of aid introduction, and combination therapies. Renegotiation of sexual activity is an essential part of sexual adaptation. From the outset of therapy, couples should be encouraged to broaden their sexual repertoire, incorporate erection-independent sexual activities, and continue to be sexual despite ED and reduced libido.
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56
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Belew D, Klaassen Z, Lewis RW. Intracavernosal Injection for the Diagnosis, Evaluation, and Treatment of Erectile Dysfunction: A Review. Sex Med Rev 2015; 3:11-23. [DOI: 10.1002/smrj.35] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Nelson CJ, Lacey S, Kenowitz J, Pessin H, Shuk E, Roth AJ, Mulhall JP. Men's experience with penile rehabilitation following radical prostatectomy: a qualitative study with the goal of informing a therapeutic intervention. Psychooncology 2015; 24:1646-54. [PMID: 25707812 DOI: 10.1002/pon.3771] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 01/06/2015] [Accepted: 01/15/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Erectile rehabilitation (ER) following radical prostatectomy (RP) is considered an essential component to help men regain erectile functioning; however, many men have difficulty adhering to this type of program. This qualitative study explored men's experience with ER, erectile dysfunction (ED), and ED treatments to inform a psychological intervention designed to help men adhere to ER post-RP. METHODS Thirty men, 1-to-3-years post-RP, who took part in an ER program, participated in one of four focus groups. Thematic analysis was used to identify the primary themes. RESULTS Average age was 59 years (standard deviation = 7); mean time since surgery was 26 months (standard deviation = 6). Six primary themes emerged: (1) frustration with the lack of information about postsurgery ED; (2) negative emotional impact of ED and avoidance of sexual situations; (3) negative emotional experience with penile injections and barriers leading to avoidance; (4) the benefit of focusing on the long-term advantage of ER versus short-term anxiety; (5) using humor to help cope; and (6) the benefit of support from partners and peers. CONCLUSIONS Men's frustration surrounding ED can lead to avoidance of sexual situations and ED treatments, which negatively impact men's adherence to an ER program. The theoretical construct of acceptance and commitment therapy was used to place the themes into a framework to conceptualize the mechanisms underlying both avoidance and adherence in this population. As such, acceptance and commitment therapy has the potential to serve as a conceptual underpinning of a psychological intervention to help men reduce avoidance to penile injections and adhere to an ER program.
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Affiliation(s)
- Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephanie Lacey
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joslyn Kenowitz
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hayley Pessin
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elyse Shuk
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Roth
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John P Mulhall
- Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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58
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Cui Y, Liu X, Shi L, Gao Z. Efficacy and safety of phosphodiesterase type 5 (PDE5) inhibitors in treating erectile dysfunction after bilateral nerve-sparing radical prostatectomy. Andrologia 2015; 48:20-8. [PMID: 25684196 DOI: 10.1111/and.12405] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2014] [Indexed: 02/01/2023] Open
Abstract
We carried out a systematic review and meta-analysis to assess the efficacy and safety of phosphodiesterase type 5 (PDE5) inhibitors for treating erectile dysfunction (ED) after bilateral nerve-sparing radical prostatectomy (BNSRP). A literature review was performed to identify all published randomised double-blind, placebo-controlled trials of PDE5 inhibitors for the treatment of ED after BNSRP. The search included the following databases: MEDLINE, EMBASE and the Cochrane Controlled Trials Register. The reference lists of the retrieved studies were also investigated. Six publications involving a total of 1678 patients were used in the analysis, including six RCTs that compared PDE5 inhibitors (tadalafil, sildenafil, avanafil and vardenafil) with placebo. Co-primary efficacy end points: International Index of Erectile Function-Erectile Function (IIEF-EF) domain score [the standardised mean difference (SMD) = 4.04, 95% confidence interval (CI) = 2.87-5.22, P < 0.00001]; successful vaginal penetration (SEP2) [the odds ratio (OR) = 14.87, 95%CI = 4.57-48.37, P < 0.00001]; and successful intercourse (SEP3) (OR = 47, 95%CI = 3-13.98, P < 0.00001) indicated that PDE5 inhibitors was more effective than the placebo. Specific adverse events with PDE5 inhibitors included headache (12.08%), dyspepsia (6.76%) and flushing (6.52%), which were significantly less likely to occur with placebo. This meta-analysis indicates that PDE5 inhibitors to be an effective and well-tolerated treatment for ED after BNSRP.
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Affiliation(s)
- Y Cui
- Department of Urology, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, Yantai, China
| | - X Liu
- Department of Urology, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, Yantai, China
| | - L Shi
- Department of Urology, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, Yantai, China
| | - Z Gao
- Department of Urology, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, Yantai, China
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Aoun F, Peltier A, van Velthoven R. Penile rehabilitation after pelvic cancer surgery. ScientificWorldJournal 2015; 2015:876046. [PMID: 25785286 PMCID: PMC4345049 DOI: 10.1155/2015/876046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 01/16/2015] [Indexed: 01/19/2023] Open
Abstract
Erectile dysfunction is the most common complication after pelvic radical surgery. Rehabilitation programs are increasingly being used in clinical practice but there is no high level of evidence supporting its efficacy. The principle of early penile rehabilitation stems from animal studies showing early histological and molecular changes associated with penile corporal hypoxia after cavernous nerve injury. The concept of early penile rehabilitation was developed in late nineties with a subsequent number of clinical studies supporting early pharmacologic penile rehabilitation. These studies included all available phosphodiesterase type 5 inhibitors, intracavernosal injection and intraurethral use of prostaglandin E1 and to lesser extent vacuum erectile devices. However, these studies are of small number, difficult to interpret, and often with no control group. Furthermore, no studies have proven an in vivo derangement of endothelial or smooth muscle cell metabolism secondary to a prolonged flaccid state. The purpose of the present report is a synthetic overview of the literature in order to analyze the concept and the rationale of rehabilitation program of erectile dysfunction following radical pelvic surgery and the evidence of such programs in clinical practice. Emphasis will be placed on penile rehabilitation programs after radical cystoprostatectomy, radical prostatectomy, and rectal cancer treatment. Future perspectives are also analyzed.
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Affiliation(s)
- Fouad Aoun
- Department of Urology, Jules Bordet Institute, 1 Héger-Bordet Street, 1000 Brussels, Belgium
- Université Libre de Bruxelles, 50 Franklin Roosevelt Avenue, 1050 Brussels, Belgium
| | - Alexandre Peltier
- Department of Urology, Jules Bordet Institute, 1 Héger-Bordet Street, 1000 Brussels, Belgium
- Université Libre de Bruxelles, 50 Franklin Roosevelt Avenue, 1050 Brussels, Belgium
| | - Roland van Velthoven
- Department of Urology, Jules Bordet Institute, 1 Héger-Bordet Street, 1000 Brussels, Belgium
- Université Libre de Bruxelles, 50 Franklin Roosevelt Avenue, 1050 Brussels, Belgium
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Abstract
PURPOSE OF REVIEW Although no standard management of erectile dysfunction in prostate cancer (CaP) survivors exists, many treatment options are available. This review summarizes the current understanding of the cause and management of erectile dysfunction in CaP survivors. RECENT FINDINGS Erectile dysfunction after radical therapy for CaP may be more common than previously thought. Genetics and vascular comorbidities may have a significant impact on erectile dysfunction after CaP treatment. Although penile rehabilitation with medical modalities show good efficacy in motivated patients, the return of erectile function is never guaranteed with nonsurgical management. Penile prosthesis placement results in early return to sexual function after CaP treatment with high patient satisfaction rates. Various techniques allow safe placement of a three-piece penile prosthesis in patients with a history of pelvic surgery. SUMMARY To optimize recovery of erectile function and prevent loss of penile length, penile rehabilitation should be initiated expeditiously after prostatectomy or radiation. In patients with refractory erectile dysfunction, dexterous and motivated patients remain excellent candidates for first and second-line medical therapies. However, early placement of a penile prosthesis following radical prostatectomy is now a proven and viable option.
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61
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Kim JH, Lee SW. Current status of penile rehabilitation after radical prostatectomy. Korean J Urol 2015; 56:99-108. [PMID: 25685296 PMCID: PMC4325125 DOI: 10.4111/kju.2015.56.2.99] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 12/12/2014] [Indexed: 12/23/2022] Open
Abstract
Although disease-free survival remains the primary goal of prostate cancer treatment, erectile dysfunction (ED) remains a common complication that affects the quality of life. Even though several preventive and therapeutic strategies are available for ED after radical prostatectomy (RP), no specific recommendations have been made on the optimal rehabilitation or treatment strategy. Several treatment options are available, including phosphodiesterase-5 inhibitors, vacuum erection devices, intracavernosal or intraurethral prostaglandin injections, and penile prostheses. Urologists must consider more effective ways to establish optimal treatments for ED after RP. ED is an important issue among patients with prostate cancer, and many patients hope for early ED recovery after surgery. This review highlights the currently available treatment options for ED after RP and discusses the limitations of each.
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Affiliation(s)
- Jae Heon Kim
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seung Wook Lee
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
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62
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Padma-Nathan H. The Pharmacologic Management of Erectile Dysfunction: Sildenafil Citrate (Viagra). ACTA ACUST UNITED AC 2015. [DOI: 10.1080/01614576.1998.11074242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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63
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Alonso Gregorio S, Gómez Rivas J, Cuello Sánchez L, Tabernero Gómez Á, Cisneros Ledo J, de la Peña Barthel JJ. Erectile function rehabilitation after laparoscopic radical prostatectomy. Rev Int Androl 2015. [DOI: 10.1016/j.androl.2014.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hakky TS, Baumgarten AS, Parker J, Zheng Y, Kongnyuy M, Martinez D, Carrion RE. Penile rehabilitation: the evolutionary concept in the management of erectile dysfunction. Curr Urol Rep 2014; 15:393. [PMID: 24578299 DOI: 10.1007/s11934-014-0393-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
A compromise in erectile function is commonly experienced after radical prostatectomy and has been attributed to injury to vascular, neurogenic, and smooth muscle. The concept of rehabilitation after organ injury is not a novel concept and is one that has been applied to all aspects of medicine. Penile rehabilitation has been classically defined as the use of a device or pharmacologic agent to aid erectile function recovery after radical prostatectomy. Here we redefine penile rehabilitation as the use of any device, medication, or intervention to promote male sexual function as a primer before and after any insult to the penile erectile physiologic axis. We also review the epidemiology, rational and current literature on penile rehabilitation after prostatectomy.
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Affiliation(s)
- Tariq S Hakky
- Department of Urology, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33606, USA,
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65
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Tar M, Cabrales P, Navati M, Adler B, Nacharaju P, Friedman AJ, Friedman J, Davies KP. Topically applied NO-releasing nanoparticles can increase intracorporal pressure and elicit spontaneous erections in a rat model of radical prostatectomy. J Sex Med 2014; 11:2903-14. [PMID: 25302850 DOI: 10.1111/jsm.12705] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Patients undergoing radical prostatectomy (RP) suffer from erectile dysfunction (ED) refractory to phosphodiesterase 5 inhibitors, which act downstream of cavernous nerve (CN)-mediated release of nitric oxide (NO). Direct delivery of NO to the penis could potentially circumvent this limitation. AIM This study aimed to determine if topically applied NO-releasing nanoparticles (NO-NPs) could elicit erections in a rat model of RP through increased blood flow. METHODS Twenty-six Sprague Dawley rats underwent bilateral transection of the CN. One week later, NO-NPs were applied topically to the penile shaft in dimethylsulfoxide (DMSO) gel (10 animals) or coconut oil (6 animals). Control animals were treated with empty NPs. Erectile function was determined through the intracorporal pressure/blood pressure ratio (ICP/BP). The effect of the NO-NPs on blood flow was determined using a hamster dorsal window chamber. MAIN OUTCOME MEASURES Animals were investigated for spontaneous erections, onset and duration of erectile response, and basal ICP/BP ratio. Microcirculatory blood flow was determined through measurements of arteriolar and venular diameter and red blood cell velocity. RESULTS Eight of 10 animals treated with NO-NPs suspended in DMSO gel had significant increases in basal ICP/BP, and 6 out of these 10 animals demonstrated spontaneous erections of approximately 1 minute in duration. Time to onset of spontaneous erections ranged from 5 to 37 minutes, and they occurred for at least 45 minutes. Similar results were observed with NO-NPs applied in coconut oil. No erectile response was observed in control animal models treated with empty NPs. The hamster dorsal window chamber experiment demonstrated that NO-NPs applied as a suspension in coconut oil caused a significant increase in the microcirculatory blood flow, sustained over 90 minutes. CONCLUSIONS Topically applied NO-NPs induced spontaneous erections and increased basal ICP in an animal model of RP. These effects are most likely due to increased microcirculatory blood flow. These characteristics suggest that NO-NPs would be useful in penile rehabilitation of patients following RP.
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Affiliation(s)
- Moses Tar
- Department of Urology, Albert Einstein College of Medicine, New York, NY, USA
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66
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Pugh TJ, Mahmood U, Swanson DA, Munsell MF, Wang R, Kudchadker RJ, Bruno TL, Frank SJ. Sexual potency preservation and quality of life after prostate brachytherapy and low-dose tadalafil. Brachytherapy 2014; 14:160-5. [PMID: 25255712 DOI: 10.1016/j.brachy.2014.08.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/01/2014] [Accepted: 08/04/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To prospectively determine sexual function, bother, and potency preservation in men treated with prostate brachytherapy and twice-weekly tadalafil. METHODS AND MATERIALS From 2005 to 2011, men treated with low-dose-rate prostate brachytherapy were treated on a prospective registration study. All patients were prescribed tadalafil 10mg twice weekly. The expanded prostate cancer index composite questionnaire was administered before treatment and at each followup. A subgroup analysis of men with sexual potency at baseline was performed. RESULTS A total of 237 men were analyzed. Median age was 64 years (range, 44-86). Median followup was 24.8 months (range, 1-60). At baseline, 175 men (74%) reported erections firm enough for sexual activity and 148 (62%) were potent (erections firm enough for intercourse). Statistically significant changes in sexual function/bother were appreciated from baseline throughout the analysis period, although absolute changes were relatively small and did not meet criteria for clinical significance. At 24-months followup, 72% reported erections firm enough for sexual activity and 56% were potent. Of men with potency at baseline, 89% had erections firm enough for sexual activity and 76% remained potent 24 months after treatment. CONCLUSIONS Peri-procedural tadalafil and prostate brachytherapy resulted in high rates of sexual potency preservation and no clinically significant effect on sexual quality of life.
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Affiliation(s)
- Thomas J Pugh
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX.
| | - Usama Mahmood
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - David A Swanson
- Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Mark F Munsell
- Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Run Wang
- Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Rajat J Kudchadker
- Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Teresa L Bruno
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
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Terrier JE, Ferretti L, Journel NM, Ben-Naoum K, Graziana JP, Huyghe E, Marcelli F, Methorst C, Montaigne O, Savareux L, Faix A. [Should we recommend an erectile rehabilitation after radical prostatectomy? Systematic review of the literature by the Sexual Medicine Committee of the French Urology Association]. Prog Urol 2014; 24:1043-9. [PMID: 25218439 DOI: 10.1016/j.purol.2014.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 07/02/2014] [Accepted: 07/17/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Radical prostatectomy has evolved considerably during the last 20 years, with one hand, a thorough knowledge of the anatomy of the prostate, and secondly, the introduction of new conservation techniques of neurovascular bundles. Despite this progress, the rate of post-prostatectomy erectile dysfunction varies between 30 and 90% depending on the series and this element impacts the quality of life after radical prostatectomy. The objective of this work was to conduct a review of the literature in order to evaluate the various protocols of post-radical prostatectomy erectile rehabilitation. PATIENTS AND METHODS A systematic review of the literature from the basic PubMed search was performed using the following keywords. Therapy erectile dysfunction, radical prostatectomy, penile rehabilitation, phosphodiesterase 5 inhibitor, intracavernous injection. RESULTS The critical analysis of selected studies highlights the lack of standard protocol that established erectile rehabilitation early after radical prostatectomy. These studies have shown that early treatment, injections or intracavernous PDE5 inhibitors improved recovery of erections as recommended by the French Association of Urology. CONCLUSION Management of disorders of post-radical prostatectomy sexuality is essential, it must be organized in a well-established protocol combining pharmacological and therapeutic education assistances delivered by practitioners or nurses. It would need to develop in a clinical trial a standard protocol.
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Affiliation(s)
- J-E Terrier
- Service d'urologie-andrologie, université Jean-Monnet, CHU de Saint-Étienne, 34, rue Francis-Baulier, 42023 Saint-Étienne cedex 2, France.
| | - L Ferretti
- Service d'urologie-andrologie, CHU de Bordeaux, 33000 Bordeaux, France
| | - N Morel Journel
- Service d'urologie-andrologie, CHU Lyon sud, hospices civiles de Lyon, 69495 Lyon, France
| | - K Ben-Naoum
- Service d'urologie-andrologie, CHU de Nîmes, 30029 Nîmes, France
| | - J-P Graziana
- Service d'urologie-andrologie, clinique mutualiste de la Porte de l'Orient, 56100 L'Orient, France
| | - E Huyghe
- Service d'urologie-andrologie, CHU de Toulouse, 31059 Toulouse, France
| | - F Marcelli
- Service d'urologie-andrologie, CHU de Lille, 59000 Lille, France
| | - C Methorst
- Service d'urologie-andrologie, hôpital Foch, 92151 Suresnes, France
| | - O Montaigne
- Service d'urologie-andrologie, CHU de Lille, 59000 Lille, France
| | - L Savareux
- Service d'urologie-andrologie, clinique de la Chataigneraie, 63110 Clermont-Ferrand, France
| | - A Faix
- Service d'urologie-andrologie, clinique Beausoleil, 34070 Montpellier, France
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Yang F, Zhao JF, Shou QY, Huang XJ, Chen G, Yang KB, Zhang SG, Lv BD, Fu HY. Phenotypic modulation of corpus cavernosum smooth muscle cells in a rat model of cavernous neurectomy. PLoS One 2014; 9:e105186. [PMID: 25127037 PMCID: PMC4134279 DOI: 10.1371/journal.pone.0105186] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 07/17/2014] [Indexed: 02/02/2023] Open
Abstract
Background Patients undergoing radical prostatectomy (RP) are at high risk for erectile dysfunction (ED) due to potential cavernous nerve (CN) damage during surgery. Penile hypoxia after RP is thought to significantly contribute to ED pathogenesis. Aim We previously showed that corpora cavernosum smooth muscle cells (CCSMCs) undergo phenotypic modulation under hypoxic conditions in vitro. Here, we studied such changes in an in vivo post-RP ED model by investigating CCSMCs in bilateral cavernous neurectomy (BCN) rats. Methods Sprague-Dawley rats underwent sham (n = 12) or BCN (n = 12) surgery. After 12 weeks, they were injected with apomorphine to determine erectile function. The penile tissues were harvested and assessed for fibrosis using Masson trichrome staining and for molecular markers of phenotypic modulation using immunohistochemistry and western blotting. CCSMC morphological structure was evaluated by hematoxylin-eosin (H&E) staining and transmission electron microscopy (TEM). Results Erectile function was significantly lower in BCN rats than in sham rats. BCN increased hypoxia-inducible factor-1α and collagen protein expression in corpora cavernous tissue. H&E staining and TEM showed that CCSMCs in BCN rats underwent hypertrophy and showed rough endoplasmic reticulum formation. The expression of CCSMC phenotypic markers, such as smooth muscle α-actin, smooth muscle myosin heavy chain, and desmin, was markedly lower, whereas vimentin protein expression was significantly higher in BCN rats than in control rats. Conclusions CCSMCs undergo phenotype modulation in rats with cavernous neurectomy. The results have unveiled physiological transformations that occur at the cellular and molecular levels and have helped characterize CN injury–induced ED.
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Affiliation(s)
- Fan Yang
- Department of Urology, The Second Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jian F. Zhao
- Department of Urology, The Second Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Qi Y. Shou
- Laboratory Animal Research Center, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiao J. Huang
- Department of Urology, The Second Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Gang Chen
- Department of Urology, The Second Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ke B. Yang
- Department of Urology, The Second Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shi G. Zhang
- Department of Urology, The Second Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Bo D. Lv
- Department of Urology, The Second Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
- Andrology Laboratory on Integration of Chinese and Western Medicine, Zhejiang provincial Key Laboratory of Traditional Chinese Medicine, Hangzhou, China
- * E-mail: (BDL); (HYF)
| | - Hui Y. Fu
- Central Laboratory, The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
- Andrology Laboratory on Integration of Chinese and Western Medicine, Zhejiang provincial Key Laboratory of Traditional Chinese Medicine, Hangzhou, China
- * E-mail: (BDL); (HYF)
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A comparison of different oral therapies versus no treatment for erectile dysfunction in 196 radical nerve-sparing radical prostatectomy patients. Int J Impot Res 2014; 27:1-5. [DOI: 10.1038/ijir.2014.27] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 06/05/2014] [Accepted: 06/13/2014] [Indexed: 11/08/2022]
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Li J, Shi Q, Pu C, Tang Y, Bai Y, Yuan H, Li X, Dong Q, Wei Q, Yuan J, Han P. Phosphodiesterase type 5 inhibitors for the treatment of post-nerve sparing radical prostatectomy erectile dysfunction in men. Sci Rep 2014; 4:5801. [PMID: 25052550 PMCID: PMC4107345 DOI: 10.1038/srep05801] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/07/2014] [Indexed: 02/05/2023] Open
Abstract
Prostate cancer (PCa) is the most common solid neoplasm diagnosed in developed countries. Nerve-sparing radical prostatectomy (NS-RP) has been widely accepted as the best choice treatment for localised PCa. However, erectile dysfunction (ED) and urinary incontinence are commonly observed after NS-RP. Using meta-analysis, we examined if phosphodiesterase type 5 inhibitors (PDE5-Is) could improve the symptoms of ED in patients undergoing NS-RP. This review contained seven randomised placebo-controlled trials with a total of 2,655 male patients. Patients in PDE5-Is group showed significant improvement in the International Index of Erectile Function-Erectile Function domain score (IIEF-EF), Global Assessment Questionnaire (GAQ), Sexual Encounter Profile question 2 (SEP-2) and SEP-3. Although the incidence of treatment-emergent adverse events (TEAEs) were high in both groups (56.44% vs. 40.63%), the safety profile were acceptable, with low incidence of discontinuation rate due to adverse events. Therefore, PDE5-Is are recommended for the treatment of post-NS-RP ED. Patients should be informed of possible adverse events.
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Affiliation(s)
- Jinhong Li
- Department of Urology, West china hospital, Sichuan University, Chengdu, China
- These authors contributed equally to this work
| | - Qingquan Shi
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- These authors contributed equally to this work
| | - Chunxiao Pu
- Department of Urology, West china hospital, Sichuan University, Chengdu, China
| | - Yin Tang
- Department of Urology, West china hospital, Sichuan University, Chengdu, China
| | - Yunjin Bai
- Department of Urology, West china hospital, Sichuan University, Chengdu, China
| | - Haichao Yuan
- Department of Urology, West china hospital, Sichuan University, Chengdu, China
| | - Xiang Li
- Department of Urology, West china hospital, Sichuan University, Chengdu, China
| | - Qiang Dong
- Department of Urology, West china hospital, Sichuan University, Chengdu, China
| | - Qiang Wei
- Department of Urology, West china hospital, Sichuan University, Chengdu, China
| | - Jiuhong Yuan
- Department of Urology, West china hospital, Sichuan University, Chengdu, China
| | - Ping Han
- Department of Urology, West china hospital, Sichuan University, Chengdu, China
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Xu Y, Guan R, Lei H, Li H, Wang L, Gao Z, Song W, Xin Z. Therapeutic potential of adipose-derived stem cells-based micro-tissues in a rat model of postprostatectomy erectile dysfunction. J Sex Med 2014; 11:2439-48. [PMID: 25042722 DOI: 10.1111/jsm.12636] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Stem cells (SCs) show significant benefits in the treatment of postprostatectomy erectile dysfunction (ED). However, the low retention rate of the traditional single-cell strategy at the injection sites limits its therapeutic potential. AIM This study aims to investigate the feasibility and mechanism of adipose-derived stem cells (ADSCs)-based micro-tissues (MTs) in the treatment of ED in a rat model of bilateral cavernous nerves (CNs) injury. METHODS ADSCs labeled with 5-ethynyl-2-deoxyuridine (EdU) were used to generate MTs with hanging drop method. 10 Sprague-Dawley (SD) rats underwent sham surgery and intracavernous (IC) injection of phosphate buffer solution (PBS) (the sham group). Another 70 rats underwent bilateral CN crush and were then treated with PBS (n = 10, the crush group), dissociated ADSCs (n = 30, the ADSCs group), and MTs (n = 30, the MTs group), respectively. At day 1, 3, 7, 14 (n = 5), and 28 (n = 10) postsurgery, specimens were harvested for histology. At day 28, 10 rats in each group were examined for erectile function before tissue harvest. MAIN OUTCOME MEASURES Light microscopy of the dynamic aggregation of the MT, immunohistologic examination of the MTs, the retention and distribution of EdU + ADSCs in the corpus cavernosum (CC), and the penis histological analyses of collagen content, Western blot of functional proteins in MTs, intracavernous pressure recording on CN electrostimulation. RESULTS Three-day-old MTs became stable and expressed nerve growth factor, vascular endothelial growth factor, C-X-C chemokine receptor type 4, Wnt5a, and collagen IV. More EdU + ADSCs retained in the CC in the MTs group than that in the ADSCs group. IC injection of MTs resulted in significant restoration of the erectile function and histopathological changes compared with the ADSCs group. CONCLUSION IC-injected MTs resulted in a better restoration of erectile function than traditional single-cell strategy. The underlying mechanisms of recovery appear to involve enhanced cellular retention in the penis and upregulation of some paracrine factors.
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Affiliation(s)
- Yongde Xu
- Andrology Center, Peking University First Hospital, Peking University, Beijing, China
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72
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Modh RA, Mulhall JP, Gilbert SM. Sexual dysfunction after cystectomy and urinary diversion. Nat Rev Urol 2014; 11:445-53. [PMID: 24980191 DOI: 10.1038/nrurol.2014.151] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Erectile dysfunction (ED) in men and sexual dysfunction in men and women are common after cystectomy and urinary diversion. Research has focused on both qualifying the prevalence of ED following cystectomy and identifying surgical approaches to limit sexual dysfunction after surgery, but most studies have been limited by small patient populations, an absence of control groups, and a lack of adjustment for confounding factors. Similarly, quality of life (QoL) research studies have also emerged in the context of bladder cancer and cystectomy, and increase our understanding of sexual outcomes associated with cystectomy. A number of instruments for collection of patient-reported outcomes among patients with bladder cancer treated with cystectomy are available for the assessment of condition-specific and procedure-specific QoL. However, other factors that negatively affect sexual function after removal of the bladder, such as psychological issues, age, and health-related competing risks for ED, body image, partner response, and change in life course and sexual priorities, have received less attention. Nevertheless, ED and sexual dysfunction are important complications of cystectomy and urinary diversion. Although changes in the approach to surgery, such as nerve-sparing cystectomy, might improve outcomes, evaluation and management of the source factors of ED and sexual dysfunction are necessary to optimize recovery of function.
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Affiliation(s)
- Rishi A Modh
- Department of Urology, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32603, USA
| | - John P Mulhall
- Male Sexual and Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Scott M Gilbert
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA
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Chung E, Gillman M. Prostate cancer survivorship: a review of erectile dysfunction and penile rehabilitation after prostate cancer therapy. Med J Aust 2014; 200:582-5. [DOI: 10.5694/mja13.11028] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Eric Chung
- St Andrew's Pelvic Medicine Centre, St Andrew's War Memorial Hospital, Brisbane, QLD
- Department of Surgery, University of Queensland, Brisbane, QLD
| | - Michael Gillman
- St Andrew's Pelvic Medicine Centre, St Andrew's War Memorial Hospital, Brisbane, QLD
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Wright C, Sujka J, Shin D. Current State of Penile Rehabilitation After Robotic Prostatectomy. CURRENT SEXUAL HEALTH REPORTS 2014. [DOI: 10.1007/s11930-014-0019-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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75
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Parisot J, Yiou R, Salomon L, de la Taille A, Lingombet O, Audureau E. Erection hardness score for the evaluation of erectile dysfunction: further psychometric assessment in patients treated by intracavernous prostaglandins injections after radical prostatectomy. J Sex Med 2014; 11:2109-18. [PMID: 24840184 DOI: 10.1111/jsm.12584] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) affects quality of life in patients treated by radical prostatectomy (RP). The Erection Hardness Score (EHS) is a single-item scale that has demonstrated good psychometric properties for assessing erectile function (EF) in patients treated by sildenafil, but its applicability to other treatment contexts has not yet been tested. AIM This study aims to test the validity and time and treatment responsiveness of the EHS to assess ED in men with post-RP ED treated with alprostadil injections. METHODS This is a 1-year follow-up cohort study of 75 patients treated by RP for localized prostate cancer in a urology department setting between January 2007 and December 2008. Data were prospectively collected at 6 and 12 months post-RP. MAIN OUTCOME MEASURES The EHS, the International Index of Erectile Function (IIEF) reference questionnaire, the Global Assessment Questionnaire (GAQ), and Numeric Pain Scale (NPS) were collected. Convergent validity (Spearman correlation coefficients with IIEF domains), known-groups validity (comparing EHS scores across ED severity groups), time and treatment responsiveness (effect size with/without treatment and over the follow-up period), and predictive ability (area under the receiver operating characteristics curve [AUC-ROC]) were analyzed for this study. RESULTS The EHS showed good convergent validity (all Spearman coefficients significant at the P<0.05 level), adequate known-groups validity (global differentiation between IIEF-EF severity groups; P<0.001), and treatment responsiveness (effect size: +1.8 [6 months], +2.1 [12 months]), but limited time responsiveness and predictive ability of the EHS for a normal EF at 12 months follow-up when compared with the IIEF-EF domain (AUC-ROC: 0.72 vs. 0.85; P<0.01). CONCLUSION Our findings support the overall good psychometric properties of the EHS in patients with post-RP ED treated with alprostadil injections. However, evidence for limited predictive validity and responsiveness to change over time should be considered for its use in clinical follow-up in this population.
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Affiliation(s)
- Juliette Parisot
- Public Health Department, Henri Mondor Teaching Hospital, Créteil, France; Laboratoire d'Investigation Clinique, EA 4393, Université Paris Est Créteil, Créteil, France
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Kirby MG, White ID, Butcher J, Challacombe B, Coe J, Grover L, Hegarty P, Jackson G, Lowndes A, Payne H, Rees J, Sangar V, Thompson A. Development of UK recommendations on treatment for post-surgical erectile dysfunction. Int J Clin Pract 2014; 68:590-608. [PMID: 24188207 PMCID: PMC4279873 DOI: 10.1111/ijcp.12338] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AIM To develop a management strategy (rehabilitation programme) for postsurgical erectile dysfunction (ED) among men experiencing ED associated with treatment of prostate, bladder or rectal cancer that is suitable for use in a UK NHS healthcare context. METHODS PubMed literature searches of ED management together with a survey of 13 experts in the management of ED from across the UK were conducted. RESULTS Data from 37 articles and completed questionnaires were collated. The results discussed in this study demonstrate improved objective and subjective clinical outcomes for physical parameters, sexual satisfaction, and rates of both spontaneous erections and those associated with ED treatment strategies. CONCLUSION Based on the literature and survey analysis, recommendations are proposed for the standardisation of management strategies employed for postsurgical ED.
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Affiliation(s)
- M G Kirby
- The Prostate Centre, London and the University of Hertfordshire, London, UK
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Barazani Y, Stahl PJ, Nagler HM, Stember DS. Is there a rationale for penile rehabilitation following radical prostatectomy? Am J Mens Health 2014; 9:35-43. [PMID: 24692247 DOI: 10.1177/1557988314528237] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Erectile function recovery after radical prostatectomy (RP) is an increasingly prominent quality-of-life outcome following surgery. Following RP many men, despite the advent of cavernous nerve-sparing surgical technique, have moderately or significantly impaired erectile function (EF). The term penile rehabilitation (PR) is used to define interventions that maintain the health of erectile tissue in the context of nervous, vascular, and structural tissue injury. The goal of PR is to regain, as closely re-approximate, preoperative erectile function. PR is based on an increasing volume of preclinical and clinical data, but conclusive evidence of efficacy has not been established, and therefore the concept of PR remains controversial. The optimal PR regimen has not been established, but all strategies rely on one or more erectile dysfunction treatments to be administered on a regular basis regardless of actual use for sexual activity. This review highlights recent studies and evidence related to PR.
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Welliver RC, Mechlin C, Goodwin B, Alukal JP, McCullough AR. A Pilot Study to Determine Penile Oxygen Saturation Before and After Vacuum Therapy in Patients with Erectile Dysfunction After Radical Prostatectomy. J Sex Med 2014; 11:1071-1077. [DOI: 10.1111/jsm.12445] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Atilgan D, Parlaktas BS, Uluocak N, Erdemir F, Markoc F, Saylan O, Erkorkmaz U. The effects of trimetazidine and sildenafil on bilateral cavernosal nerve injury induced oxidative damage and cavernosal fibrosis in rats. ScientificWorldJournal 2014; 2014:970363. [PMID: 24782681 PMCID: PMC3977563 DOI: 10.1155/2014/970363] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 03/06/2014] [Indexed: 12/02/2022] Open
Abstract
AIM The aim of this study was to compare the effects of sildenafil and trimetazidine on bilateral cavernosal nerve injury-induced oxidative damage and fibrotic changes in cavernosal tissue in rat model. MATERIAL AND METHODS A total of 32 male Sprague-Dawley rats were randomly divided into 4 groups; each group consist 8 rats (control, BCI, BCI + TMZ, and BCI + sildenafil groups). Tissue superoxide dismutase (SOD), malondialdehyde (MDA), and protein carbonyl (PC) levels were determined biochemically and distribution of cavernosal fibrosis density among groups was performed histopathologically. RESULTS Tissue SOD levels in BCI group were significantly lower than the control group (P < 0.05). Tissue MDA and PC levels in BCI group were significantly higher than the control group (P < 0.05). TMZ and sildenafil administration significantly increased tissue SOD levels (P < 0.05) and reduced tissue MDA and PC levels (P < 0.05). Histologically, the degree of cavernosal fibrosis and collagen density was higher in BCI group in comparison to control, TMZ-treated, and sildenafil-treated groups. CONCLUSION BCI caused oxidative damage and increased cavernosal fibrosis in rat penis. TMZ and sildenafil treatment decreased oxidative damage and reduced the degree of fibrosis in penile tissue due to BCI.
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Affiliation(s)
- Dogan Atilgan
- Department of Urology, Medical Faculty, Gaziosmanpasa University, 60100 Tokat, Turkey
| | - Bekir S. Parlaktas
- Department of Urology, Medical Faculty, Gaziosmanpasa University, 60100 Tokat, Turkey
| | - Nihat Uluocak
- Department of Urology, Medical Faculty, Gaziosmanpasa University, 60100 Tokat, Turkey
| | - Fikret Erdemir
- Department of Urology, Medical Faculty, Gaziosmanpasa University, 60100 Tokat, Turkey
| | - Fatma Markoc
- Department of Pathology, Medical Faculty, Gaziosmanpasa University, 60100 Tokat, Turkey
| | - Oguzhan Saylan
- Department of Biochemistry, Medical Faculty, Gaziosmanpasa University, 60100 Tokat, Turkey
| | - Unal Erkorkmaz
- Department of Biostatistics, Medical Faculty, Gaziosmanpasa University, 60100 Tokat, Turkey
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80
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Wang X, Wang X, Liu T, He Q, Wang Y, Zhang X. Systematic review and meta-analysis of the use of phosphodiesterase type 5 inhibitors for treatment of erectile dysfunction following bilateral nerve-sparing radical prostatectomy. PLoS One 2014; 9:e91327. [PMID: 24618671 PMCID: PMC3949994 DOI: 10.1371/journal.pone.0091327] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 02/09/2014] [Indexed: 11/18/2022] Open
Abstract
Prostate cancer is relatively common cancer occurring in males. Radical prostatectomy (RP) is the most effective treatment for a localized tumor but erectile dysfunction (ED) is common complication, even when bilateral nerve-sparing RP (BNSRP) is performed. Clinical trials have shown varied effectiveness of phosphodiesterase type-5 inhibitors (PDE5-Is) for treatment of post-BNSRP ED, but there remains controversy over the application of this treatment and no formal systematic review and meta-analysis for the use of PDE5-Is for this condition has been conducted. This review was to systematically assess the efficacy and safety of oral PDE5-Is for post-BNSRP ED. A database search was conducted to identify randomized controlled trials (RCTs). The comparative efficacy of treatments was analyzed by fixed or random effect modeling. Erectile function was measured using the International Index of Erectile Function (IIEF), Sexual Encounter Profile (SEP) question-2, 3 and the Global Assessment Question (GAQ). The rate and incidence of adverse events (AEs) were determined. The quality of included studies was appraised using the Cochrane Collaboration bias appraisal tool. Eight RCTs were included in the analyses. PDE5-Is were effective for treating post-BNSRP ED compared to placebo when erectile function was determined using the IIEF score [mean difference (MD) 5.63, 95% confidence interval (CI) (4.26-6.99)], SEP-2 [relative risk (RR) 1.63, 95% CI (1.18-2.25) ], SEP-3 [RR 2.00, 95% CI (1.27-3.15) ] and GAQ [RR 3.35, 95% CI (2.68-4.67) ]. The subgroup analysis could find a trend that longer treatment duration, higher dosage, on-demand dosing, sildenafil and mild ED are associated with more responsiveness to PDE5-Is. PDE5-Is were overall well tolerated with headache being the most commonly reported AE. Our data provides compelling evidence for the use of PDE5-Is as a primary treatment for post-BNSRP ED. However, further studies are required to optomize usage parameters (such as dosage and duration of treatment).
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Affiliation(s)
- Xiao Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan city, Hubei province, P. R. China
| | - Xinghuan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan city, Hubei province, P. R. China
- * E-mail: (XZ); (XW)
| | - Tao Liu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan city, Hubei province, P. R. China
| | - Qianwen He
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan city, Hubei province, P. R. China
| | - Yipeng Wang
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan city, Hubei province, P. R. China
| | - Xinhua Zhang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan city, Hubei province, P. R. China
- * E-mail: (XZ); (XW)
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Abstract
To provide a critical contemporary review of daily PDE5-inhibitor (PDE5-I) use in urological and nonurological conditions. PDE5-Is can be taken up to once a day. However, at present only tadalafil is approved for use in both erectile dysfunction (ED) and benign prostate hyperplasia (BPH) with lower urinary tract symptoms (LUTS). Evolving research in penile rehabilitation, Peyronie's disease, male infertility, pulmonary arterial hypertension, muscular dystrophy and Raynaud's phenomenon shows these therapeutic areas may also benefit from PDE5i therapy. This review examines the role of chronic PDE5 inhibition in ED, BPH-LUTS and other therapeutic targets which may shape our clinical practice in the years to come.
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Affiliation(s)
- King Chien Joe Lee
- Department of Urology, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block, Level 8, Singapore, 119228, Singapore.
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Zelefsky MJ, Shasha D, Branco RD, Kollmeier M, Baser RE, Pei X, Ennis R, Stock R, Bar-Chama N, Mulhall JP. Prophylactic sildenafil citrate improves select aspects of sexual function in men treated with radiotherapy for prostate cancer. J Urol 2014; 192:868-74. [PMID: 24603102 DOI: 10.1016/j.juro.2014.02.097] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE We studied adjuvant daily sildenafil citrate during and after radiotherapy for prostate cancer for erectile function preservation. MATERIALS AND METHODS We performed a randomized, prospective trial of 279 patients with localized prostate cancer treated with radiotherapy who received sildenafil citrate (50 mg daily) or placebo (2:1 randomization). Medication/placebo was initiated 3 days before treatment and continued daily for 6 months. Before therapy and 3, 6, 9, 12, 18 and 24 months after radiotherapy patients completed the IIEF questionnaire, including the erectile function domain, the I-PSS questionnaire and the RAND SF-36®. All IIEF domains were scored. RESULTS At 12 months erectile function scores were better for sildenafil citrate than placebo (p = 0.018), 73% of patients on sildenafil citrate vs 50% on placebo had mild/no erectile dysfunction (p = 0.024) and the sildenafil citrate arm had superior overall satisfaction (p = 0.027) and IIEF total scores (p = 0.043). At 24 months erectile function and IIEF scores were no longer significantly better for sildenafil citrate (p = 0.172 and 0.09, respectively) and yet overall satisfaction scores were higher (p = 0.033). Sexual desire scores in patients who received sildenafil citrate were higher at 24 months although they had completed drug therapy 18 months previously (p = 0.049). At 24 months 81.6% of patients on sildenafil citrate and 56.0% of those on placebo achieved functional erection with or without erectile dysfunction medication (p = 0.045). CONCLUSIONS Daily sildenafil citrate during and after radiotherapy for prostate cancer was associated with improved overall sexual function compared with placebo for various sexual function domains. To our knowledge this is the largest randomized, prospective, controlled trial to show the usefulness of a phosphodiesterase-5 inhibitor as a rehabilitation strategy in patients with prostate cancer who received radiation therapy.
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Affiliation(s)
- Michael J Zelefsky
- Departments of Radiation Oncology and Urology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Daniel Shasha
- Department of Radiation Oncology, Continuum Cancer Center of New York, New York, New York
| | - Rebekah Dunn Branco
- Departments of Radiation Oncology and Urology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marisa Kollmeier
- Departments of Radiation Oncology and Urology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Raymond E Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Xin Pei
- Departments of Radiation Oncology and Urology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ronald Ennis
- Department of Radiation Oncology, Continuum Cancer Center of New York, New York, New York
| | - Richard Stock
- Departments of Radiation Oncology and Urology, Mt. Sinai Medical Center, New York, New York
| | - Natan Bar-Chama
- Departments of Radiation Oncology and Urology, Mt. Sinai Medical Center, New York, New York
| | - John P Mulhall
- Departments of Radiation Oncology and Urology, Memorial Sloan Kettering Cancer Center, New York, New York
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Seo YE, Kim SD, Kim TH, Sung GT. The Efficacy and Safety of Tadalafil 5 mg Once Daily in the Treatment of Erectile Dysfunction After Robot-Assisted Laparoscopic Radical Prostatectomy: 1-Year Follow-up. Korean J Urol 2014; 55:112-9. [PMID: 24578807 PMCID: PMC3935067 DOI: 10.4111/kju.2014.55.2.112] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 10/31/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of tadalafil 5 mg once daily use in the treatment of erectile dysfunction (ED) after robot-assisted laparoscopic radical prostatectomy (RALP). MATERIALS AND METHODS The study retrospectively evaluated 92 patients who underwent RALP at Dong-A University Hospital. The patients were surveyed by use of the abridged five-item version of the International Index of Erectile Function (IIEF-5) questionnaire, which was self-administered before surgery and at 6 months and 1 year after surgery. The 92 patients were classified into the tadalafil group (n=47) and the non-tadalafil group (n=45). Each group was then classified depending on the nerve-sparing (NS) procedure used: bilateral NS or unilateral NS. RESULTS At 6 months, the total IIEF-5 scores of the tadalafil group and the non-tadalafil group were 10.0±3.4 and 7.0±4.0, respectively. At 1 year, the total IIEF-5 score in the tadalafil group was significantly greater than that in the non-tadalafil group (13.2±5.6 vs. 7.7±4.8, p<0.0001). Statistically significant improvements (p<0.05) were observed in the tadalafil group for all 5 domains of the IIEF-5 score, whereas in the non-tadalafil group there was no significant improvement in any of the domains at 1 year. The reported side effects were flushing (8.5%, n=4), headache (4.3%, n=2), and dizziness (2.1%, n=1). CONCLUSIONS In ED patients after NS RALP, a once-daily dose of tadalafil 5 mg was well tolerated and significantly improved EF compared with that in the non-tadalafil group.
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Affiliation(s)
- Young Eun Seo
- Department of Urology, Dong-A University College of Medicine, Busan, Korea
| | - Soo Dong Kim
- Department of Urology, Dong-A University College of Medicine, Busan, Korea
| | - Tae Hyo Kim
- Department of Urology, Dong-A University College of Medicine, Busan, Korea
| | - Gyung Tak Sung
- Department of Urology, Dong-A University College of Medicine, Busan, Korea
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84
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Fode M, Borre M, Ohl DA, Lichtbach J, Sønksen J. Penile vibratory stimulation in the recovery of urinary continence and erectile function after nerve-sparing radical prostatectomy: a randomized, controlled trial. BJU Int 2014; 114:111-7. [PMID: 24127838 PMCID: PMC4282032 DOI: 10.1111/bju.12501] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine the effect of penile vibratory stimulation (PVS) in the preservation and restoration of erectile function and urinary continence in conjunction with nerve-sparing radical prostatectomy (RP). PATIENTS AND METHODS The present study was conducted between July 2010 and March 2013 as a randomized prospective trial at two university hospitals. Eligible participants were continent men with an International Index of Erectile Function-5 (IIEF-5) score of at least 18, scheduled to undergo nerve-sparing RP. Patients were randomized to a PVS group or a control group. Patients in the PVS group were instructed in using a PVS device (FERTI CARE(®) vibrator). Stimulation was performed at the frenulum once daily by the patients in their own homes for at least 1 week before surgery. After catheter removal, daily PVS was re-initiated for a period of 6 weeks. Participants were evaluated at 3, 6 and 12 months after surgery with the IIEF-5 questionnaire and questions regarding urinary bother. Patients using up to one pad daily for security reasons only were considered continent. The study was registered at http://clinicaltrials.gov/ (NCT01067261). RESULTS Data from 68 patients were available for analyses (30 patients randomized to PVS and 38 patients randomized to the control group). The IIEF-5 score was highest in the PVS group at all time points after surgery with a median score of 18 vs 7.5 in the control group at 12 months (P = 0.09), but the difference only reached borderline significance. At 12 months, 16/30 (53%) patients in the PVS group had reached an IIEF-5 score of at least 18, while this was the case for 12/38 (32%) patients in the control group (P = 0.07). There were no significant differences in the proportions of continent patients between groups at 3, 6 or 12 months. At 12 months 90% of the PVS patients were continent, while 94.7% of the control patients were continent (P = 0.46). CONCLUSION The present study did not document a significant effect of PVS. However, the method proved to be acceptable for most patients and there was a trend towards better erectile function with PVS. More studies are needed to explore this possible effect further.
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Affiliation(s)
- Mikkel Fode
- Department of Urology, Herlev University Hospital, Herlev, Denmark
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85
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Carrasco-Valiente J, Campos-Hernández JP, Ruiz-García J, Márquez-López FJ, Requena-Tapia MJ, Prieto-Castro R. Importancia de la rehabilitación precoz de los cuerpos cavernosos tras prostatectomía radical. Rev Int Androl 2014. [DOI: 10.1016/j.androl.2013.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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86
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Castiglione F, Nini A, Briganti A. Penile rehabilitation with phosphodiesterase type 5 inhibitors after nerve-sparing radical prostatectomy: are we targeting the right patients? Eur Urol 2013; 65:673-4. [PMID: 24388439 DOI: 10.1016/j.eururo.2013.11.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 11/29/2013] [Indexed: 10/25/2022]
Abstract
The results reported in all trials comparing chronic versus on-demand phosphodiesterase type 5 inhibitor use after bilateral nerve-sparing radical prostatectomy may be affected by improper patient selection. Targeting the right patients is the key to optimizing the efficacy of these drugs.
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Affiliation(s)
- Fabio Castiglione
- San Raffaele Scientific Institute, Urological Research Institute, Milan, Italy
| | - Alessandro Nini
- San Raffaele Scientific Institute, Urological Research Institute, Milan, Italy
| | - Alberto Briganti
- San Raffaele Scientific Institute, Urological Research Institute, Milan, Italy.
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88
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Ball M, Nelson CJ, Shuk E, Starr TD, Temple L, Jandorf L, Schover L, Mulhall JP, Woo H, Jennings S, DuHamel K. Men's experience with sexual dysfunction post-rectal cancer treatment: a qualitative study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2013; 28:494-502. [PMID: 23821133 PMCID: PMC3755110 DOI: 10.1007/s13187-013-0492-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In an effort to address reports from men that their sex life is worse after treatment for rectal cancer, this qualitative study was designed to better understand their experience with sexual dysfunction following rectal cancer treatment, thus providing information on the adaptation of a psycho-educational sexual health intervention for male rectal cancer survivors and simultaneously investigating barriers and promoters that would influence their participation in a psycho-educational sexual health intervention. Thirteen male rectal cancer survivors who were treated at Memorial Sloan-Kettering Cancer Center (MSKCC) for rectal cancer participated (median time post-treatment was 6.4 years). Six survivors participated in individual semi-structured phone interviews, and seven others took part in focus groups. We performed standard procedures of qualitative thematic text analysis, which involved independent review of interview and focus group transcripts by several analysts followed by consensus meetings to identify key themes. Participants reported bowel dysfunction (N = 13, or 100%) and erectile dysfunction (N = 12, or 92%) as chief complaints. The participants thought a psychoeducational sexual health intervention post-surgery would be helpful because it would provide educational information regarding the etiology of their problems and treatments to improve their sexual health (N = 8, or 62%). Most participants' primary concern immediately after treatment was surviving their disease; improving sexual functioning seemed to become more important over time. Barriers to potentially participating in a psycho-educational sexual health intervention included geographical distance from MSKCC (N = 3, or 3/13) and the risk of embarrassment when discussing sexual issues (N = 5, or 5/13). Men reported that a psycho-educational sexual health intervention would be helpful to improve their sexual functioning post-treatment. Discussion of bowel issues and logistical concerns gave information on the psycho-educational sexual health intervention.
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Affiliation(s)
- Melinda Ball
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY 10022, USA
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89
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Ryu JK, Cho KS, Kim SJ, Oh KJ, Kam SC, Seo KK, Shin HS, Kim SW. Korean Society for Sexual Medicine and Andrology (KSSMA) Guideline on Erectile Dysfunction. World J Mens Health 2013; 31:83-102. [PMID: 24044105 PMCID: PMC3770856 DOI: 10.5534/wjmh.2013.31.2.83] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/20/2013] [Accepted: 06/04/2013] [Indexed: 11/20/2022] Open
Abstract
In February 2011, the Korean Society for Sexual Medicine and Andrology (KSSMA) realized the necessity of developing a guideline on erectile dysfunction (ED) appropriate for the local context, and established a committee for the development of a guideline on ED. As many international guidelines based on objective evidence are available, the committee decided to adapt these guidelines for local needs instead of developing a new guideline. Considering the extensive research activities on ED in Korea, data with a high level of evidence among those reported by Korean researchers have been collected and included in the guideline development process. The latest KSSMA guideline on ED has been developed for urologists. The KSSMA hopes that this guideline will help urologists in clinical practice.
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Affiliation(s)
- Ji Kan Ryu
- Department of Urology, Inha University School of Medicine, Incheon, Korea
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90
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Diallo D, Zaitouna M, Alsaid B, Quillard J, Droupy S, Benoit G, Bessede T. What is the origin of the arterial vascularization of the corpora cavernosa? A computer-assisted anatomic dissection study. J Anat 2013; 223:489-94. [PMID: 23981086 DOI: 10.1111/joa.12094] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2013] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was to identify the microscopic arterial vascularization of the corpora cavernosa (CC) of the penis using computer-assisted anatomic dissection (CAAD), determine the contribution of the different penile arteries towards this vascularization, detail the nature of cavernospongiosum shunts, and locate the anastomoses between these different arteries. Tissue specimens were taken from five donors who donated their bodies to science. The specimens were fixed in 10% formalin and sliced into a series of five 5-μm sections at intervals of 200 μm. The first section was stained with hematoxylin-eosin or Masson's trichrome and the second with anti-protein S100. The cavernous artery of the penis is not the only source of arterial vascularization of the CC. In four of the five cases studied, we found two to four perforating branches arising from the dorsal arteries of the penis that join up with the cavernous artery of the penis or that are solely responsible for the vascularization of the distal third of the penis. The bulbo-urethral and urethral arteries are situated outside of the tunica albuginea of the corpus spongiosum on their lateral and dorsal sides. The anastomoses do not occur between the cavernous artery of the penis and the corpus spongiosum but between the cavernous artery of the penis and the urethral artery on the surface of the tunica albuginea. All of these arteries are accompanied by nerve branches. The CC were found to be vascularized by both cavernous and dorsal arteries of the penis. Intrapenile vascularization is organized around four arterial axes, which are anastomosed by multiple neurovascular shunts.
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Affiliation(s)
- Djibril Diallo
- Laboratory of Experimental Surgery EA4122, University Paris-Sud, Le Kremlin-Bicêtre, France; Urology Department, G.H. Paris-Sud APHP, University Paris-Sud, Le Kremlin-Bicêtre, France
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91
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Nelson CJ, Hsiao W, Balk E, Narus J, Tal R, Bennett NE, Mulhall JP. Injection anxiety and pain in men using intracavernosal injection therapy after radical pelvic surgery. J Sex Med 2013; 10:2559-65. [PMID: 23898886 DOI: 10.1111/jsm.12271] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Intracavernosal injection (ICI) therapy is a well-recognized treatment strategy with high success rates for men with erectile dysfunction. Despite this, injection anxiety and pain related to injection are significant barriers to its use. AIMS This study aims to examine injection anxiety and injection pain in patients using ICI. METHODS Men starting ICI therapy post radical pelvic surgery completed questionnaires at initial visit, at each of the two ICI training sessions and at a 4-month follow-up visit. MAIN OUTCOME MEASURES Injection Anxiety Scale, Injection Pain Scale, Injection Reaction Inventory, and the Erectile Function Domain of the International Index of Erectile Function. RESULTS Average age of the 68 men was 60±8 years. At 4 months, the self-reported frequency of ICI use was: 29%<1/week, 26% 1/week, 40% 2/week, and 5% 3/week. Mean injection anxiety score at first injection was 5.7±2.8 (range 0-10) and significantly decreased to a 4.1±3 at 4 months (P<0.001). At first injection, 65% reported high injection anxiety (≥5) and this significantly decreased to 42% (P=0.003) at 4 months. Anxiety at first injection was negatively related to ICI frequency at 4 months (r=-0.23, P=0.08). Mean injection pain score at first injection was low (2.2±1.8, range 0-10) and 59% rated injection pain≤2. Injection pain remained consistent across time periods. At first injection, injection anxiety (assessed prior to injection) was related to injection pain (r=0.21, P=0.04) and subjects (n=21) who reported high injection anxiety (≥5) across time points, reported an increase in injection pain scores from first injection to 4 months (2.7 vs. 3.7, P=0.05). CONCLUSIONS Although injection anxiety decreased with ICI use, mean injection anxiety remained at a moderate level (4.4) and 42% of men continued to report "high" injection anxiety at 4 months. While injection pain was low, injection anxiety and pain were related. These data suggest the need for a psychological intervention to help lower injection anxiety related to ICI.
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Affiliation(s)
- Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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92
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Abstract
PURPOSE OF REVIEW Radical prostatectomy, regardless of the technology used intraoperatively, induces erectile dysfunction for most men who undergo the procedure. For many men, this proves to be transient. Penile rehabilitation strategies have been developed with the goal of increasing the probability and speed of return of sexual function. The purpose of this work is to review the fundamentals of erectile dysfunction relevant to the postprostatectomy patient as well as the components that are often included in penile rehabilitation strategies. RECENT FINDINGS Preservation of smooth muscle tissue is the key to preserving erectile function. This can be accomplished by providing the penis with regular exposure to oxygenated blood through intracaversonal injection therapy or vacuum erection device therapy. Dietary supplementation aimed to increase the nitric oxide production can also be beneficial. As well, chronic administration of PDE5 inhibitors may also help maintain the smooth muscle/collagen ratio in the corporal tissue. SUMMARY These findings have led to the development of our management model that includes daily vacuum erection device therapy, dietary supplementation and PDE5 inhibitors which is described in detail. The success of any rehabilitation strategy is dependent on the patient compliance which needs to be facilitated by care-giver encouragement and the setting of realistic expectations.
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93
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Fode M, Ohl DA, Ralph D, Sønksen J. Penile rehabilitation after radical prostatectomy: what the evidence really says. BJU Int 2013; 112:998-1008. [PMID: 23826962 DOI: 10.1111/bju.12228] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The pathophysiology of erectile dysfunction after radical prostatectomy (RP) is believed to include neuropraxia, which leads to temporarily reduced oxygenation and subsequent structural changes in penile tissue. This results in veno-occlusive dysfunction, therefore, penile rehabilitation programmes focus on tissue oxygenation. Animal studies support the use of phosphodiesterase type 5 inhibitors (PDE5Is) after cavernous nerve damage but results from human studies are contradictory. The largest study to date found no long-term effect of either daily or on-demand PDE5I administration after RP compared with placebo. The effects of prostaglandin and vacuum erection devices are questionable and high-quality studies are lacking. Better documentation for current penile rehabilitation and/or better rehabilitation protocols are needed. One must be careful not to repeat the statement that penile rehabilitation improves erectile function after RP so many times that it becomes a truth even without the proper scientific backing.
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Affiliation(s)
- Mikkel Fode
- Department of Urology, Herlev University Hospital, Herlev, Denmark
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94
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Segal RL, Bivalacqua TJ, Burnett AL. Current penile-rehabilitation strategies: Clinical evidence. Arab J Urol 2013; 11:230-6. [PMID: 26558087 PMCID: PMC4443015 DOI: 10.1016/j.aju.2013.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 03/13/2013] [Accepted: 03/16/2013] [Indexed: 01/03/2023] Open
Abstract
We review the current strategies used for penile rehabilitation (PR) after a radical prostatectomy, where PR is defined as the attempt to restore spontaneous erectile function so that the patient can generate erections with no need for erectile aids. We searched PubMed for relevant reports, using the keywords ‘radical prostatectomy’, ‘penile rehabilitation’, ‘phosphodiesterase inhibitors’, ‘vacuum erection device’, ‘injection therapy’, ‘urethral suppository’, and ‘erectile dysfunction’. In all, 155 articles were identified and reviewed, and had a level of evidence ranging from 1b-4. The use of PR strategies should be based on the patient’s goals after a thorough explanation of realistic expectations, and the risks and consequences of the various treatment options. While a multitude of studies suggest a benefit with PR strategies, there are no established, proven regimens. Further research is needed to establish the optimal approaches to PR.
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Key Words
- CCI, Charlson comorbidity index
- ED, erectile dysfunction
- Erectile dysfunction
- ICI, intracavernous injection
- IIEF-EF, international index of erectile function-erectile function domain
- IUA, intraurethral alprostadil
- Injection therapy
- PDE-5, phosphodiesterase-5
- PR, penile rehabilitation
- Phosphodiesterase inhibitor
- RP, radical prostatectomy
- Radical prostatectomy
- SHIM, sexual health in men (questionnaire)
- VED, vacuum erection device
- Vacuum erection device
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Affiliation(s)
- Robert L Segal
- The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Arthur L Burnett
- The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
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95
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Yiou R, Ebrahiminia V, Mouracade P, Lingombet O, Abbou C. Sexual Quality of Life in Women Partnered with Men Using Intracavernous Alprostadil Injections after Radical Prostatectomy. J Sex Med 2013; 10:1355-62. [DOI: 10.1111/jsm.12109] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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96
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Chung E, Brock G. Sexual Rehabilitation and Cancer Survivorship: A State of Art Review of Current Literature and Management Strategies in Male Sexual Dysfunction Among Prostate Cancer Survivors. J Sex Med 2013; 10 Suppl 1:102-11. [DOI: 10.1111/j.1743-6109.2012.03005.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brison D, Seftel A, Sadeghi-Nejad H. The resurgence of the vacuum erection device (VED) for treatment of erectile dysfunction. J Sex Med 2013; 10:1124-35. [PMID: 23347150 DOI: 10.1111/jsm.12046] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Vacuum erection devices (VEDs) have been approved in the United States since 1982 and offer a viable alternative to oral phosphodiesterase type 5 inhibitors (PDE5i), injections and transurethral suppositories. Studies have demonstrated efficacy in erectile dysfunction (ED) associated with a variety of conditions. More recently, this modality has been evaluated in initial phosphodiesterase inhibitor nonresponders as well as for post-prostatectomy penile rehabilitation. AIM This article provides a detailed overview of the history of VEDs, a review of the literature, and a concise description of their new applications in modern urological practice. METHODS A retrospective review of publications relevant to the field of VEDs. MAIN OUTCOME MEASURES Review of the historical milestones, evolution, and modern utilization of VEDs in modern urological protocols. RESULTS Studies have demonstrated efficacy in ED associated with a variety of conditions. Early penile rehabilitation after surgery for prostate cancer with the VED appears to improve erectile function and penile length. Adverse events are transient and not serious. CONCLUSIONS The VED has continued to show efficacy for treatment of ED due to various etiologies and should be considered an attractive second-line therapy. In select cases such post-prostatectomy penile rehabilitation, as well as in men who cannot use a PDE5i, the vacuum device should be considered first-line treatment.
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Affiliation(s)
- Daniel Brison
- Urology, Facey Medical Group, Mission Hills, CA, USA
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98
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Kaiho Y, Yamashita S, Arai Y. Optimization of sexual function outcome after radical prostatectomy using phosphodiesterase type 5 inhibitors. Int J Urol 2013; 20:285-9. [DOI: 10.1111/iju.12071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 12/09/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Yasuhiro Kaiho
- Department of Urology; Tohoku University Graduate School of Medicine; Sendai; Japan
| | - Shinichi Yamashita
- Department of Urology; Tohoku University Graduate School of Medicine; Sendai; Japan
| | - Yoichi Arai
- Department of Urology; Tohoku University Graduate School of Medicine; Sendai; Japan
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99
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Megas G, Papadopoulos G, Stathouros G, Moschonas D, Gkialas I, Ntoumas K. Comparison of efficacy and satisfaction profile, between penile prosthesis implantation and oral PDE5 inhibitor tadalafil therapy, in men with nerve-sparing radical prostatectomy erectile dysfunction. BJU Int 2012; 112:E169-76. [PMID: 23253640 DOI: 10.1111/j.1464-410x.2012.11561.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Erectile dysfunction after nerve-sparing radical retropubic prostatectomy constitutes a challenge to the urologist. The mainstay of medical treatment after radical prostatectomy to restore spontaneous erectile function remains phosphodiesterase (PDE5) inhibitors, despite the fact that data from animal studies suggesting that PDE5 inhibitors can prevent smooth muscle apoptosis and fibrosis have not yet been extrapolated to humans because of a lack of standardized protocols. If the above treatment fails, second-line therapies such as intraurethral prostaglandins, penile injection therapy and vacuum devices are offered. When less invasive therapies are ineffective, interventions that preserve sexual function such as penile prosthesis implantation become the treatment of choice. Our study reveals the alternative of penile prosthesis implantation as first-line treatment in erectile dysfunction after nerve-sparing radical prostatectomy. It also highlights its superiority to the oral PDE5 inhibitor treatment, regarding the erection, frequency, firmness, maintenance and penetration ability. This suggests that a concept of an early penile intervention in the future would be promising for those patients who wish to remain sexually active without depending on oral formulations with doubtful and delayed results. OBJECTIVE To evaluate the outcome of penile prosthesis surgery in comparison to oral phosphodiesterase type 5 (PDE5) inhibitor administration, in men with erectile dysfunction after nerve-sparing radical prostatectomy, as early penile intervention therapy. PATIENTS AND METHODS A total of 174 patients treated by nerve-sparing retropubic radical prostatectomy (RRP) for clinically localized prostate cancer, between January 2006 and September 2009 enrolled in the study, 153 patients fulfilled the inclusion criteria, and 69 (45%) patients presented with post-RRP erectile dysfunction 6 months after primary surgery. Fifty-four patients were disease-free and subdivided into two arms according to treatment modality, either tadalafil three times/week or penile prosthesis implantation. All patients were evaluated using the International Index of Erectile Function (IIEF) questionnaire preoperatively and at 6, 12 and 24 month postoperatively. Repeated measurements analysis of variance was conducted to evaluate the effect of time and group on IIEF total score. RESULTS There was a significant reduction in IIEF score from preoperative values to the first measurement after surgery in both treatment groups. The overall degree of change from the first time point immediately after surgery to 2 years was greater in the penile prosthesis group than the tadalafil group (20.4 ± 1.3 vs 8.1 ± 2.4, P < 0.001). CONCLUSIONS The efficacy and satisfaction results of both treatment types are considered acceptable. However, regarding the erection frequency, firmness, penetration ability, maintenance and erection confidence it seems that penile prosthesis implantation is superior to oral treatment. The concept of early penile intervention should be considered and is promising for all patients with post-RRP erectile dysfunction.
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Affiliation(s)
- Georgios Megas
- Urology Department, General Hospital of Athens G. Gennimatas, Athens, Greece.
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100
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Tutolo M, Briganti A, Suardi N, Gallina A, Abdollah F, Capitanio U, Bianchi M, Passoni N, Nini A, Fossati N, Rigatti P, Montorsi F. Optimizing postoperative sexual function after radical prostatectomy. Ther Adv Urol 2012; 4:347-65. [PMID: 23205061 PMCID: PMC3491757 DOI: 10.1177/1756287212450063] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Erectile dysfunction (ED) is one of the complications associated with pelvic surgery. The significance of ED as a complication following pelvic surgery, especially radical prostatectomy (RP), lies in the negative impact that it has on patients' sexual and overall life. In the literature, rates of ED following RP range from 25% to 100%. Such variety is associated with pelvic dissection and conservation of neurovascular structures. Another important factor impacting on postoperative ED is the preoperative erectile function of the patient. Advances in the knowledge of pelvic anatomy and pathological mechanisms led to a refinement of pelvic surgical techniques, with attention to the main structures that if damaged compromise erectile function. These improvements resulted in lower postoperative ED rates and better erectile recovery, especially in patients undergoing RP. Furthermore, surgery alone is not sufficient to prevent this complication, and thus, several medical strategies have been tested with the aim of maximizing erectile function recovery. Indeed it seems that prevention of postoperative ED must be addressed by a multimodal approach. The aim of this review is to give a picture of recent knowledge, novel techniques and therapeutic approaches in order to reach the best combination of treatments to reduce the rate of ED after pelvic surgery.
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Affiliation(s)
- Manuela Tutolo
- Department of Urology, Vita Salute University, Urological Research Institute, San Raffaele Hospital, Milan, Italy
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