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Nasseh H, Asgari SA, Sarmadian R, Meshkat Z, Haji Aghabozorgi M, Kazemnejad E, Asadollahzade A. The effect of transrectal ultrasound-guided prostate biopsy on erectile function and lower urinary tract symptoms: a prospective study. AFRICAN JOURNAL OF UROLOGY 2023. [DOI: 10.1186/s12301-023-00345-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Abstract
Abstract
Background
Prostate biopsy (PB) is the gold standard for verifying the diagnosis of prostate cancer in men with clinical symptoms. Transrectal ultrasound (TRUS)-guided PB is the most common method for diagnosis; however, it has a few adverse effects. Mild consequences like bleeding and pain are prevalent but temporary. Since the relationship between erectile dysfunction and lower urinary tract symptoms (LUTS) and TRUS-guided PB is inconsistent in the literature, we aimed to conduct a study on these two consequences on males within 1 month following TRUS-guided PB.
Methods
Patients with a PSA ≥ 4 ml/ng who were determined to undergoTRUS-guided PB were enrolled in this prospective study. Patients' urinary symptoms and erectile function were evaluated using the International Prostate Symptom Score (IPSS) and International Index of Erectile Function-5 (IIEF-5) questionnaires the day before and 1 month after PB. Also, using uroflowmetry, the patients' urinary peak flow rate (Qmax) was recorded. SPSS version 18 was used to compare and analyze variables.
Results
The mean age of the participants was 67.47 ± 9.38 years. Before the PB, the IIEF-5 score was 20.19 ± 7.24, and after the PB, it was 20.25 ± 7.24 (p = 0.865). The Qmax level rose from 7.35 ± 2.15 to 7.74 ± 2 ml/s (p = 0.07). After TRUS-guided PB, the average IPSS score reduced from 11.48 ± 9.93 to 9.88 ± 8.22 which was statistically significant (p < 0.001).
Conclusions
This study indicated that TRUS-guided PB had no negative impact on erectile function or LUTS in participants and may even relieve urinary symptoms to some extent. Overally, TRUS-guided PB appears to be a safe strategy for evaluating prostate cancer suspects.
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Chen LK, Lai YW, Chiu LP, Chen SSS. Significant relationship between parameters measured by transrectal color Doppler ultrasound and sexual dysfunction in patients with BPH 12 months after TURP. BMC Urol 2021; 21:9. [PMID: 33435935 PMCID: PMC7805164 DOI: 10.1186/s12894-020-00776-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 12/21/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A link between sexual dysfunction and lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) has been noticed. Transurethral resection of the prostate (TURP) remains the standard treatment for symptomatic BPH, whether TURP causes sexual dysfunction is still uncertain. In this retrospective study, we investigated the relationship between parameters measured by color Doppler ultrasound (CDU) and sexual dysfunction in patients with BPH 12 months after TURP. METHODS The parameters include presumed circle area ratio (PCAR), maximal horizontal area of seminal vesicles (MHA), resistive index of the prostate (RIP), and peak systolic velocity in the flaccid penis (PSV). The international prostate symptom score was used to evaluate the lower urinary tract symptoms and the five-item version of the International Index of Erectile Function was used to evaluate sexual function before and after TURP. RESULTS Of the 103 patients without sexual dysfunction before TURP, 11 (10.7%) had erectile dysfunction (ED) after TURP. These 11 patients had significantly lower PCAR, RIP, PSV and MHA than those without ED. The patients with retrograde ejaculation after TURP had significantly lower PCAR than those without retrograde ejaculation, and the patients with premature ejaculation after TURP had significantly lower MHA than those without premature ejaculation. Comparing the parameters between baseline and after TURP, PCAR, RIP, and MHA decreased significantly in the patients with sexual dysfunction, but no significant differences were noted in the patients without sexual dysfunction after TURP. CONCLUSIONS More extended TURP can lead to a higher incidence of ED and retrograde ejaculation in BPH patients without sexual dysfunction before TURP. Patients with a lower volume of seminal vesicles after TURP may have a higher incidence of premature ejaculation.
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Affiliation(s)
- Li K Chen
- Department of Anesthesiology, China Medical University, Taichung City, Taiwan.,Department of Anesthesiology, China Medical University Hospital, Taichung City, Taiwan
| | - Yu W Lai
- Division of Urology, Taipei City Hospital Ren Ai Branch, Taipei, Taiwan.,Department of Urology, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Li P Chiu
- Division of Urology, Taipei City Hospital Chushing Branch, Taipei, Taiwan.,General Education Center, University of Taipei, Taipei, Taiwan
| | - Saint Shiou-Sheng Chen
- Department of Urology, National Yang-Ming University School of Medicine, Taipei, Taiwan. .,General Education Center, University of Taipei, Taipei, Taiwan. .,Division of Urology, Taipei City Hospital Zhong Xiao Branch, Taipei, Taiwan. .,Commission for General Education, College of Applied Science, National Taiwan University of Science and Technology, Taipei, Taiwan.
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García Rojo E, García Gómez B, González Padilla DA, Abad López P, García González L, Rodríguez Antolín A, Romero Otero J. Assessment of the influence of transrectal and transperineal prostate biopsies on erectile function: A prospective observational single-center study. Int J Urol 2019; 26:1054-1058. [PMID: 31475394 DOI: 10.1111/iju.14088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 07/19/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess the impact of transrectal versus transperineal prostate biopsy on erectile function. METHODS This was a single-center, observational, prospective study of consecutive patients who underwent a prostate biopsy (transrectal or transperineal/fusion biopsy). Study participants completed the International Index of Erectile Function-5 questionnaire before the procedure, and 3 and 6 months after. Prostatic biopsies were carried out following the standard procedure for both techniques. RESULTS The study included 135 male patients with a mean age of 63.5 years. At baseline, 28 patients (21%) presented normal erectile function, whereas 107 patients (82%) presented erectile dysfunction, which was severe in four (3%), moderate in 49 (36%) and mild in 54 (40%), with an overall mean International Index of Erectile Function-5 score of 17.70. After 3 months, the rates were 29%, 3%, 27% and 38%, respectively (mean International Index of Erectile Function-5 score 17.95). At 6 months, the rates were 30%, 6%, 28% and 34%, respectively (mean International Index of Erectile Function-5 score of 17.77). No significant differences between pre- and post-biopsy International Index of Erectile Function-5 scores at 3 and 6 months were observed, even when analyzing transrectal and transperineal separately. The number of biopsy cores and number of previous biopsies did not influence the International Index of Erectile Function-5 scores. CONCLUSIONS Our findings suggest that prostate biopsy technique, number of biopsy cores and history of previous biopsy do not significantly impact erectile function in the medium term up to 6 months.
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Affiliation(s)
| | | | | | - Pablo Abad López
- Department of Urology, University Hospital 12 de Octubre, Madrid, Spain
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Yıldız A, Karamık K, Aktaş Y, Anıl H, İslamoğlu E, Ateş M, Savaş M. When should the evaluation of erectile function be done before radical prostatectomy? Urologia 2019; 86:148-151. [PMID: 30983532 DOI: 10.1177/0391560319842956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study is to assess the erectile function of patients before and after transrectal ultrasound prostate biopsy comparatively in order to determine the appropriate time to evaluate erectile function before radical prostatectomy. A total of 44 patients underwent transrectal ultrasound biopsy. We used the International Index of Erectile Function-5 questionnaire to assess all the patients. In total, 44 volunteered patients were included in this study. All patients were evaluated with the International Index of Erectile Function-5 questionnaire before the biopsy and at 4 weeks after the transrectal ultrasound biopsy. A total of 50% of patients were potent before the biopsy was done. A month after the biopsies, erectile dysfunction was reported by 29 of 44 patients (66%) as mild in 10 (22.7%), as mild-moderate in 14 (31.8%), as moderate in 4 (9.1%), and severe in 1 (2.3%). The differences were statistically significant in the first month of the biopsy (p < 0.05). The effect of prostate biopsy upon the erectile function is non-negligible. However, this situation is temporary and transient. Therefore, it is recommended that the International Index of Erectile Function-5 questionnaire is to be administered prior to prostate biopsy rather than before surgical treatment.
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Affiliation(s)
- Ali Yıldız
- 1 Antalya Training and Research Hospital, Antalya, Turkey.,2 Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Kaan Karamık
- 1 Antalya Training and Research Hospital, Antalya, Turkey
| | - Yasin Aktaş
- 1 Antalya Training and Research Hospital, Antalya, Turkey
| | - Hakan Anıl
- 1 Antalya Training and Research Hospital, Antalya, Turkey
| | | | - Mutlu Ateş
- 1 Antalya Training and Research Hospital, Antalya, Turkey
| | - Murat Savaş
- 1 Antalya Training and Research Hospital, Antalya, Turkey
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Sönmez MG, Kozanhan B, Demirelli E, Öztürk Sönmez L, Kara C. What should be done to minimize pain without any sexual function deterioration in transrectal prostate biopsy? Cent European J Urol 2018; 70:372-377. [PMID: 29410888 PMCID: PMC5791401 DOI: 10.5173/ceju.2017.1442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 10/05/2017] [Accepted: 10/07/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this study was to find an ideal method for the application of a transrectal ultrasound-guided prostate biopsy (TRUS-Bx) without deteriorating patient comfort. Material and methods TRUS-Bx was applied in a total of 93 patients. Taking the application method into consideration, these patients were divided into three groups, each consisting of 31 patients. Methods applied for pain control in the different groups were compared (groups 1, 2 and 3). Age, prostate specific antigen (PSA), prostate volume, cancer detection rate, re-biopsy consent ratio, complication rates, visual analog scale (VAS), and International Index of Erectile Function (IIEF-5) scores were compared among the groups. Results Age, PSA, prostate volume, cancer detection rate, and fever complication rate were not statistically different between the three groups. However, a statistically significant difference was detected among the groups for the VAS measured during and after TRUS-Bx, re-biopsy consent ratio, and hematuria (p <0.001, p <0.001, p <0.001, and p = 0.027, respectively). There was no detected difference in pre-operation IIEF-5 scores, but the difference in IIEF-5 scores in the first month after the operation was significant (p = 0.116, p = 0.024, respectively). Conclusions Anal dilatation after the application of intrarectal topical anesthetic to provide anesthesia during TRUS-Bx and giving lidocaine hydrochloride with epinephrine for periprostatic nerve blockage (PNB) is a successful and effective method to maintain patient comfort, especially as it relates to pain control and sexual function. Anal dilatation seems to minimize any pain that may occur due to probe transition, and adding epinephrine as a vasopressor to the anesthetic agent chosen during the operation will be rather helpful for hemostasis control and pain that results from the needle.
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Affiliation(s)
- Mehmet Giray Sönmez
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Betül Kozanhan
- Department of Anesthesiology and Reanimation, Konya Education and Research Hospital, Konya, Turkey
| | - Erhan Demirelli
- Department of Urology, Giresun Medical Faculty, Giresun University, Giresun, Turkey
| | - Leyla Öztürk Sönmez
- Department of Physiology, Selcuklu Medical School, Selcuk University, Konya, Turkey
| | - Cengiz Kara
- Medical Park Ankara Hospital, Department of Urology, Ankara, Turkey
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Chong JJ, Van Hemelrijck M, Cahill D, Kinsella J. Serial transperineal sector prostate biopsies: impact on long-term erectile dysfunction. Ecancermedicalscience 2016; 10:643. [PMID: 27350788 PMCID: PMC4898939 DOI: 10.3332/ecancer.2016.643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Indexed: 11/24/2022] Open
Abstract
We wanted to determine whether serial transperineal sector prostate biopsies have a long-term effect on erectile dysfunction (ED). A total of 64 men with prostate cancer entered our active surveillance (AS) programme after a transrectal prostate biopsy as well as a confirmatory initial transperineal sector prostate biopsy (TPSBx). A repeat TPSBx was performed 24 months later as part of our active surveillance protocol. The International Index of Erectile Function-5 (IIEF-5) questionnaire assessed ED at baseline prior to each TPSBx, and at one, three, and six months after first and second TPSBx. There was a significant short-term deterioration in erectile function on mean IIEF-5 score between baseline (19.5), when compared to one month (10.5) (P <0.001) and three months (18.7) (P = 0.001) following first TPSBx. This resolved at six month follow-up (19.6) (P = 0.681). Following second TPSBx, there was a deterioration in erectile function between baseline (16.6), compared to one month (7.3), three months (13.8), and six months (15.9) (P <0.05) following second TPSBx. Initial TPSBx caused significant short-term ED, which resolved by six months. Serial TPSBx appears to have an adverse impact on erectile function in men monitored on AS, increasing the risk of long-term ED. This risk should be highlighted and discussed during the consent process.
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Affiliation(s)
- James Jy Chong
- Faculty of Life Sciences and Medicine, King's College London, London SE1 1UL, UK
| | - Mieke Van Hemelrijck
- Division of Cancer Studies, Cancer Epidemiology Group, Research Oncology, King's College London, London SE1 9RT, UK
| | - Declan Cahill
- Department of Urology, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Janette Kinsella
- Department of Urology, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
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Pepe P, Pennisi M. Erectile dysfunction in 1050 men following extended (18 cores) vs saturation (28 cores) vs saturation plus MRI-targeted prostate biopsy (32 cores). Int J Impot Res 2015; 28:1-3. [PMID: 26289906 DOI: 10.1038/ijir.2015.18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 05/10/2015] [Accepted: 07/06/2015] [Indexed: 11/10/2022]
Abstract
Erectile dysfunction (ED) following transperineal prostate biopsy (TPB) was prospectively evaluated. From January 2011 to January 2014, 1050 patients were submitted to TPB: 18 core (extended TPB) in 610 cases, 28 core (saturation TPB) in 360 cases and 32 core (saturation plus magnetic resonance imaging (MRI) targeted TPB) in 210 cases. The indications for biopsy were increasing prostate-specific antigen (PSA) or PSA>10 ng ml(-1). All patients were prospectively evaluated with the 5-item version of the International Index of Erectile Function (IIEF-5) at time zero and at 1, 3 and 6 months from TPB. Prostate cancer was diagnosed in 385/1050 (36.6%) patients; 560 men (350 vs 110 vs 100) having benign histology and normal sexual activity also completed the study. Overall, IEEF-5 score at time zero and at 1, 3 and 6 months did not significantly worsen (P>0.05); in detail, at 1 month from biopsy 15 extended TPB (4.2%) vs 7 saturation TPB (6.4%) vs 7 saturation plus MRI targeted TPB (7%) men referred mild ED that disappeared after 3 months. Irrespective of method (18 vs 28 vs 32 core) TPB did not significantly worsen erectile function at 3-6 months from the procedure.
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Affiliation(s)
- P Pepe
- Urology Unit, Cannizzaro Hospital, Catania, Italy
| | - M Pennisi
- Urology Unit, Cannizzaro Hospital, Catania, Italy
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