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Bock M, Burns RT, Pereira TA, Bernie HL. A contemporary review of the treatments and challenges associated with penile rehabilitation after radical prostatectomy including a proposed optimal approach. Int J Impot Res 2023:10.1038/s41443-023-00782-6. [PMID: 37853240 DOI: 10.1038/s41443-023-00782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 10/01/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023]
Abstract
Prostate cancer is one of the most prevalent malignancies affecting men worldwide. Despite advancements in understanding prostate anatomy and minimally invasive approaches to surgical treatment, surgery can have significant adverse effects on sexual function. Penile rehabilitation strategies have emerged as a promising approach to mitigate the impact of prostate cancer treatments on erectile function and improve quality of life. Several methods have been employed for penile rehabilitation, including pharmacotherapy, vacuum erection devices, intracavernous injections, and emerging novel techniques. Yet, there is no consensus on the exact programs or timing of initiation that should be utilized for optimal recovery after surgery. This review discusses various rehabilitation protocols and long-term outcomes and explores the cost-effectiveness of different interventions. Additionally, this review discusses the importance of a multidisciplinary approach to penile rehabilitation which includes patient education, counseling, and the selection of an appropriate rehabilitation strategy tailored to each individual's needs and preferences. Continued research and collaboration among healthcare professionals are essential to refine rehabilitation approaches and ensure optimal outcomes for patients with prostate cancer.
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Affiliation(s)
- Megan Bock
- Department of Urology, Indiana University, Indianapolis, IN, USA
| | - Ramzy T Burns
- Department of Urology, Indiana University, Indianapolis, IN, USA.
| | - Thairo A Pereira
- Department of Urology, Indiana University, Indianapolis, IN, USA
| | - Helen L Bernie
- Department of Urology, Indiana University, Indianapolis, IN, USA
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2
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Penile Rehabilitation after Prostate Cancer Treatment: Which Is the Right Program? URO 2023. [DOI: 10.3390/uro3010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
The management of sexual complications after treatment of localized prostate cancer, such as erectile dysfunction, changes in the length of the penis, pain during sexual intercourse, and lack of orgasm, is still an unsolved problem with an important impact on patients’ quality of life. In this review, we summarize the current scientific literature about the rehabilitation of erectile dysfunction after prostate cancer treatment. The therapy for penile rehabilitation includes different types of treatments: the combination of phosphodiesterase type 5 inhibitors (PDE5-I) and the vacuum erectile device (VED) are considered first-line treatment options. When therapy begins, the duration of treatment, the dosage and the drug used all play very important roles in the treatment outcome. Intracavernous injection (ICI) therapy represents the second-line option for patients ineligible for PDE5-I therapy. Technological development has led to the emergence of devices for the stimulation of the penis without the use of drugs, such as penile vibratory stimulation (PVS) for stimulation of ejaculation in spinal cord injury and low-intensity extracorporeal shockwave therapy (LIESWT). The rapid diffusion of the latter, thanks to its easy use, attains good results without side effects. The panorama of penile rehabilitation after PC treatments is vast and many studies are needed, especially on new technologies, to find the best therapeutic regimen possible, personalized to the patient’s characteristics and the type of treatment for PC.
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Castiglione F, Albersen M, Fiorenzo S, Hedlund P, Cakir OO, Pavone C, Alnajjar HM, Joniau S, Muneer A. Long-term consequences of bilateral cavernous crush injury in normal and diabetic rats: a functional study. Int J Impot Res 2022; 34:781-785. [PMID: 34611324 DOI: 10.1038/s41443-021-00474-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/28/2021] [Accepted: 09/20/2021] [Indexed: 01/06/2023]
Abstract
A recent statement from the European-Society-for-Sexual-Medicine has highlighted the limitations of using the rat model for nerve-sparing prostatectomy. The use of young rats with no comorbidities and the early evaluation of the erectile function (EF) are deemed a source of bias. Our aim was to evaluate the long-term consequences in EF of bilateral nerve cavernous crush- injury (BNCI) in type 1 diabetic (DM) rats 30-male/12-week-old rats were divided into four groups: Sham, BNCI, DM, and BNCI + DM. Sham group underwent an intraperitoneal injection (IP) of saline solution and after 1 month underwent a sham laparotomy. BNCI underwent an IP of saline solution and after 1 month to BNCI. DM underwent an IP of 60 mg/kg-1-streptozotocin (STZ) and after 1 month to a sham laparotomy. BNCI + DM underwent an IP of 60 mg/kg-1-STZ and after 1 month to BNCI. After 5 months from the induction of diabetes, all rats underwent measurement of intracorporeal pressure (ICP) and mean arterial pressure (MAP) during CN-electrostimulation. Multiple groups were compared using Kruskal-Wallis one-way analysis of variance followed by Mann-Whitney U test for post hoc comparisons. Blood glucose-level was higher (p < 0.05) in the groups with DM and BNCI + DM. After 5-months, DM and BNCI + DM also showed a lower weight compared to other groups (p < 0.05). No differences were noted in ICP/MAP between the sham and BNCI. BNCI + DM showed lower ICP/MAP compared to all the groups (p < 0.05). DM Showed lower ICP/MAP compared to Sham and BNCI (p < 0.05). BNCI in rats without comorbidities did not induce long-term erectile dysfunction (ED) suggesting a spontaneous EF recovery. BNCI in DM induced long-term ED. The results of previous short-term studies can only provide evidence on the time to recovery of spontaneous EF as to the actual EF recovery rate.
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Affiliation(s)
- Fabio Castiglione
- Department of Urology, University College London Hospital, London, UK. .,Division of Surgery and Interventional Science, University College London, London, UK. .,Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Maarten Albersen
- Laboratory for Experimental Urology, Organ systems, Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Salvatore Fiorenzo
- Section of Urology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Petter Hedlund
- Department of Clinical and Experimental Pharmacology, Lund University, Lund, Sweden.,Division of Drug Research, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Omer Onur Cakir
- Department of Urology, University College London Hospital, London, UK
| | - Carlo Pavone
- Section of Urology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | | | - Steven Joniau
- Laboratory for Experimental Urology, Organ systems, Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Asif Muneer
- Department of Urology, University College London Hospital, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK.,Division of Surgery and Interventional Science and NIHR Biomedical Research Centre University College London Hospital, London, UK
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Management of male sexual dysfunction after cancer treatment. Urol Oncol 2022; 40:389-394. [PMID: 32859462 DOI: 10.1016/j.urolonc.2020.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 07/22/2020] [Accepted: 08/02/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND With an increase in the number of cancer survivors each year, male sexual dysfunction becomes an important topic for discussion between patients and providers who treat cancer. The aim of this article is to review types and mechanisms of sexual dysfunction after cancer therapy and discuss treatment options. METHODS Contemporary concepts regarding male sexual dysfunction after cancer treatment are reviewed and translated for clinical utility. FINDINGS To optimize recovery of erectile capacity after erectile dysfunction causing cancer treatments, a penile rehabilitation protocol involving phosphodiesterase inhibitors, vacuum erection device, intra corporal injections, or a combination is likely to provide some degree of clinically significant benefit. Treating hypogonadism post cancer treatment depends on the type of cancer that has been treated and patient comorbidities. Anejaculation after cancer treatments is typically not successfully or reliably treated due to the mechanism and severity of sympathetic nerve injury. Semen cryopreservation prior to cancer treatments that may injure nerve fibers essential for the ejaculatory response is highly recommended. CONCLUSION Management of post cancer treatment sexual dysfunction requires identification of this problem and referral to a specialist if necessary. There are several management options available that can greatly enhance quality of life in this often overlooked aspect of post cancer treatment care.
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Asker H, Yilmaz-Oral D, Oztekin CV, Gur S. An update on the current status and future prospects of erectile dysfunction following radical prostatectomy. Prostate 2022; 82:1135-1161. [PMID: 35579053 DOI: 10.1002/pros.24366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/30/2022] [Accepted: 04/20/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Radical prostatectomy (RP) and radiation treatment are standard options for localized prostate cancer. Even though nerve-sparing techniques have been increasingly utilized in RP, erectile dysfunction (ED) due to neuropraxia remains a frequent complication. Erectile function recovery rates after RP remain unsatisfactory, and many men still suffer despite the availability of various therapies. OBJECTIVE This systematic review aims to summarize the current treatments for post-RP-ED, assess the underlying pathological mechanisms, and emphasize promising therapeutic strategies based on the evidence from basic research. METHOD Evaluation and review of articles on the relevant topic published between 2010 and 2021, which are indexed and listed in the PubMed database. RESULTS Phosphodiesterase type 5 inhibitors, intracavernosal and intraurethral injections, vacuum erection devices, pelvic muscle training, and surgical procedures are utilized for penile rehabilitation. Clinical trials evaluating the efficacy of erectogenic drugs in this setting are conflicting and far from being conclusive. The use of androgen deprivation therapy in certain scenarios after RP further exacerbates the already problematic situation and emphasizes the need for effective treatment strategies. CONCLUSION This article is a detailed overview focusing on the pathophysiology and mechanism of the nerve injury developed during RP and a compilation of various strategies to induce cavernous nerve regeneration to improve erectile function (EF). These strategies include stem cell therapy, gene therapy, growth factors, low-intensity extracorporeal shockwave therapy, immunophilins, and various pharmacological approaches that have induced improvements in EF in experimental models of cavernous nerve injury. Many of the mentioned strategies can improve EF following RP if transformed into clinically applicable safe, and effective techniques with reproducible outcomes.
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Affiliation(s)
- Heba Asker
- Department of Pharmacology, Faculty of Pharmacy, Ankara University, Ankara, Turkey
- Department of Medical Pharmacology, Faculty of Medicine, Lokman Hekim University, Ankara, Turkey
- Graduate School of Health Sciences, Ankara University, Ankara, Turkey
| | - Didem Yilmaz-Oral
- Department of Pharmacology, Faculty of Pharmacy, Cukurova University, Adana, Turkey
| | - Cetin Volkan Oztekin
- Department of Urology, Faculty of Medicine, University of Kyrenia, Girne, Turkey
| | - Serap Gur
- Department of Pharmacology, Faculty of Pharmacy, Ankara University, Ankara, Turkey
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Rubilotta E, Gubbiotti M, Balzarro M, Castellani D, Pirola GM, Gemma L, Teoh JYC, Polykarpova A, Autrán-Gómez AM, Tortolero Blanco L, Migliorini F, Tafuri A, Antonelli A. Current trends in erectile rehabilitation after radical prostatectomy: Results from a worldwide survey. Andrologia 2022; 54:e14506. [PMID: 35780809 DOI: 10.1111/and.14506] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/16/2022] [Accepted: 06/09/2022] [Indexed: 11/27/2022] Open
Abstract
We aimed to analyse the current trend of erectile rehabilitation (ER) following radical prostatectomy (RP) using a dedicated survey. An online survey was developed between July and September 2020, aiming to evaluate the ER protocols after RP in daily practice among urologists, andrologists, sexual medicine specialists and residents. We investigated demographics data, type of RP performed, and type, schedule, timing and duration of ER protocols. In total, 518 responders from 52 countries completed the survey. Surgical techniques reported were: 38.9% open, 22.9% laparoscopic and 38.2% robot-assisted RP. 33% of the responders begin ER at the catheter removal, 22% 1 month after surgery and 15% before surgery. Phosphodiesterase inhibitors were the most used medication as first-line treatment (99.4%). Tadalafil 20 mg was the most prescribed, and used daily in 48.2% of the cases, and 2-3 times/week in 46%. Intra-cavernosal injection of prostaglandin E1 was the second most common prescribed monotherapy (67.9%) followed by the association of phosphodiesterase inhibitors and vacuum-erection device (29.6%). The duration of ER was <6 months in 16.2%, between 6 and 11 months in 39%, between 12 and 18 months in 31.9%, between 19-24 months in 9.2% and >24 months in 3.7%. This study showed that the approach to ER after RP was inhomogeneous. International guidelines are urgently needed to standardise ER protocols.
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Affiliation(s)
- Emanuele Rubilotta
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | | | - Matteo Balzarro
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Daniele Castellani
- Faculty of Medicine, School of Urology, Le Marche Polytechnic University, Ancona, Italy
| | | | - Luca Gemma
- Department of Urology, Careggi Hospital, Florence, Italy
| | - Jeremy Yuen-Chen Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | | | | | | | - Filippo Migliorini
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Alessandro Tafuri
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy.,Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti-Pescara, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
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Gromicho A, Costa P, Araújo D, Pereira D, Ferraz L. Sexual rehabilitation with intracavernous alprostadil after radical prostatectomy: Outcomes from a nursing program. Arch Ital Urol Androl 2021; 93:404-407. [PMID: 34933528 DOI: 10.4081/aiua.2021.4.404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/14/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Erectile dysfunction (ED) is a common complication after radical prostatectomy that affects quality of life. There are several therapeutic options, including intracavernous alprostadil injections (IAI). However, no specific recommendations have been made on the optimal rehabilitation strategy. In this study we evaluated a sexual rehabilitation program (SRP) with IAI for patients with ED after radical prostatectomy, assessing the rate of compliance and reasons for dropout. METHODS The sexual rehabilitation program (SRP) was offered to all patients who underwent radical prostatectomy from 1 January 2010 to 31 December 2019. The first consultations were performed by a urology specialist nurse, explaining the IAI procedure and possible complications. The program was considered successful when the patients achieved autonomy in the drug preparation with a good injection technique. A medical consultation was performed at 6 months evaluating the IAI usage and adverse events. In case of dropout, a questionnaire about reasons for dropout was performed. The primary endpoint was the rate of compliance and dropout of the program. Secondary endpoints were the reasons for dropout and adverse events. RESULTS 340 patients underwent radical prostatectomy at our institution, and 123 patients accepted to participate in the rehabilitation program. A total of 96 patients (78%) successfully completed the SRP, and at 6 months 60 (62.5%) still used IAI. Concerning the reasons for dropping out, the most frequent were the need of injectable therapy and pain. Regarding complications, 17 patients (13.8%) reported pain related to the injection and 1 patient (0.8%) had a priapism, managed with conservative treatment. CONCLUSIONS Management of post-radical prostatectomy ED by a nursing program achieved good rates of patients' self-injection accomplishment and treatment compliance. Close monitoring for dose adjustment and management of post-injection penile pain is required during the follow-up.
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Affiliation(s)
| | - Pedro Costa
- Urology Department, Centro Hospitalar Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia.
| | - Débora Araújo
- Urology Department, Centro Hospitalar Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia.
| | - Daniela Pereira
- Urology Department, Centro Hospitalar Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia.
| | - Luís Ferraz
- Urology Department, Centro Hospitalar Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia.
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8
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Karakose A, Yitgin Y. Penile rehabilitation with low-intensity extracorporeal shock wave therapy in patients after prostate cancer surgery. Early physiological changes and postoperative follow-up outcomes. Int J Clin Pract 2021; 75:e14804. [PMID: 34487369 DOI: 10.1111/ijcp.14804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION To investigate the efficacy, safety and postoperative outcomes of using tadalafil and low-intensity extracorporeal shock wave therapy (Li-ESWT) on penile rehabilitation and preventing urinary incontinence after radical prostatectomy. METHODS In total, we included 66 patients who used only tadalafil (n = 32) in group 1 and used tadalafil and treated by Li-ESWT (n = 34) in group 2. We noted International Index of Erectile Function (IIEF) 5, daily incontinence pad measurements at preoperative, postoperative 3rd, 6th and 12th months respectively. We also evaluated penis blood flow and neovascularisation by penile doppler ultrasonography at postoperative 3rd and 12th months for all patients. Statistical analyses were performed with SPSS version 18. A P-value < .05 was considered significant. RESULTS Preoperative demographic characteristics were similar in the two groups. There was a statistically significant improvement in IIEF-5, which started at the 6th month and continued increasingly at the 12th month in group 2 compared with group 1. Also, there was a significant decrease in incontinence rate in group 2 compared with group 1 in the sixth month. CONCLUSIONS Combined use of tadalafil and Li-ESWT is highly effective and safe for the treatment of erectile dysfunction and for the prevention of urinary incontinence after prostate cancer surgery.
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Affiliation(s)
- Ayhan Karakose
- Depatment of Urology, Istinye Universtiy Faculty of Medicine, Esenyurt/Istanbul, Turkey
| | - Yasin Yitgin
- Depatment of Urology, Istinye Universtiy Faculty of Medicine, Esenyurt/Istanbul, Turkey
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Basourakos SP, Kowalczyk K, Moschovas MC, Dudley V, Hung AJ, Shoag JE, Patel V, Hu JC. Robot-Assisted Radical Prostatectomy Maneuvers to Attenuate Erectile Dysfunction: Technical Description and Video Compilation. J Endourol 2021; 35:1601-1609. [PMID: 34015959 PMCID: PMC8820193 DOI: 10.1089/end.2021.0081] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Erectile dysfunction (ED) remains a significant problem in up to 63% of men after robot-assisted radical prostatectomy (RARP). After the discovery of the neurovascular bundle (NVB), additional anatomic description and variation in nerve-sparing (NS) techniques have been described to improve post-RARP ED. However, it remains questionable whether ED rates have improved over time, and this is concerning as competing treatments are introduced that have better ED outcomes. In this review, we describe RARP NS technical modifications that improve erectile function recovery. We focused on reports that included detailed anatomical descriptions as well as video illustrations to disseminate technique. We found that the alternative RARP NS surgical techniques provide better outcomes compared with standard NS RARP. The use of validated quality of life questionnaires is necessary for the appropriate comparison of outcomes. However, the retrospective character and inherent weaknesses of the included studies do not allow one to conclude which is the best NS approach. Overall, there is significant variation in RARP NS techniques and outcomes, and the ideal technical maneuvers to optimize outcomes remains subject to debate. However, there is a consensus on the importance of anatomically dissecting the NVB, minimizing traction and thermal injury as well as preserving the periprostatic fascia. Well-designed randomized controlled trials with videos describing details of different surgical techniques for generalizability are needed to consistently and objectively evaluate sexual function outcomes after RARP to optimize postoperative potency.
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Affiliation(s)
- Spyridon P. Basourakos
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Keith Kowalczyk
- Department of Urology, MedStar Georgetown University Hospital, Lombardi Cancer Center, Washington, District of Columbia, USA
| | | | - Vanessa Dudley
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Andrew J Hung
- Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, University of Southern California Institute of Urology, Los Angeles, California, USA
| | - Jonathan E. Shoag
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA.,Department of Urology, Case Western University Hospital, Cleveland, Ohio, USA
| | - Vipul Patel
- AdventHealth Global Robotics Institute, Celebration, Florida, USA
| | - Jim C. Hu
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA.,Address correspondence to: Jim C. Hu, MD, Department of Urology, New York Presbyterian Hospital-Weill Cornell Medicine, 525 East 68th Street, Starr 900, New York, NY 10021, USA
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Schoentgen N, Califano G, Manfredi C, Romero-Otero J, Chun FKH, Ouzaid I, Hermieu JF, Xylinas E, Verze P. Is it Worth Starting Sexual Rehabilitation Before Radical Prostatectomy? Results From a Systematic Review of the Literature. Front Surg 2021; 8:648345. [PMID: 33968975 PMCID: PMC8098976 DOI: 10.3389/fsurg.2021.648345] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Sexual dysfunction (SD) is a frequent side effect associated with radical prostatectomy (RP) for prostate cancer (PCa). Some studies have showed the benefit associated with preoperative sexual rehabilitation (prehabilitation) and Enhanced Recovery After Surgery (ERAS) for RP, but no clear clinical recommendations are available yet. Our aim was to conduct a systematic review on sexual prehabilitation prior to RP for patients with a localized PCa and analyze the impact on postoperative sexual health compared with the standard post-operative care. Methods: We performed a systematic review of the literature following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) recommendations. Results: Four randomized control trials and one retrospective comparative study were included in the analyses. Three of the five studies showed an improved EF recovery post-RP in the prehabilitation group compared to the standard of care represented by: higher International Index of Erectile Function 5 score (IIEF5) or IIEF score (p < 0.0001) and a higher percentage of patients reporting return of EF based on the Sexual Encounter Profile (SEP) (56 vs. 24%, p = 0.007). Self-confidence, therapeutic alliance, and adherence to treatment were stronger for patients with preoperative consultations (p < 0.05) and EF recovery was better in cases of a higher number of follow-up visits (OR 4-5 visits vs. 1:12.19, p = 0.002). Discussion: Despite heterogenous methods and high risks of bias in this systematic review, starting sexual rehabilitation prior to surgery seems to ensure better EF recovery. This prehabilitation should include information of both the patient and his or her partner, with a closer follow up and the use of a multimodal treatment approach that still remains to be defined and validated (oral medication, vacuum devices, pelvic floor muscle training, etc.).
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Affiliation(s)
- Nadja Schoentgen
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France
| | - Gianluigi Califano
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France.,Department of Neurosciences, Reproductive Sciences, Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Celeste Manfredi
- Department of Neurosciences, Reproductive Sciences, Odontostomatology, University of Naples Federico II, Naples, Italy.,Department of Urology, Instituto de Investigation Sanitaria Hospital 12 de October (imas12), Hospital Universitario 12 October, Madrid, Spain
| | - Javier Romero-Otero
- Department of Urology, Instituto de Investigation Sanitaria Hospital 12 de October (imas12), Hospital Universitario 12 October, Madrid, Spain
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Idir Ouzaid
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France.,University of Paris, Paris, France
| | - Jean-François Hermieu
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France.,University of Paris, Paris, France
| | - Evanguelos Xylinas
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France.,University of Paris, Paris, France
| | - Paolo Verze
- Department of Medicine, Surgery, Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
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Moussa M, Papatsoris A, Abou Chakra M, Dellis A. Erectile dysfunction post radical cystectomy. The role of early rehabilitation with pharmacotherapy in nerve sparing and non-nerve sparing group: A randomized, clinical trial. ACTA ACUST UNITED AC 2021; 93:58-64. [PMID: 33754604 DOI: 10.4081/aiua.2021.1.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/27/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES No clinical studies testing erectile function (EF) post radical cystectomy (RC) were done. Our objective was to assess the effect of early pharmacologic therapy after RC using intracorporeal injection (ICI), phosphodiesterase inhibitor (PDE5i) and PDE5i+ICI. MATERIALS AND METHODS In our randomized, double-blinded study, we prospectively enrolled 160 potent male patients with invasive bladder cancer. Patients were operated by RC using the nerve-sparing (NS) or non-nerve sparing (NNS) technique. They were treated since 1 month postoperatively by different regimens (PDE5i vs. ICI vs. ICI+PDE5i). Patients were evaluated using the international index of erectile function questionnaire and were followed up regularly at 1, 3, 6, and 12 months using the same parameters. RESULTS One month after therapy, the mean of EF domain improved in both NS and NNS group. In the NNS group, in patients treated with ICI alone and ICI+PDE5i, the EF domain at 12 months moved to the moderate and to the mild category respectively. In patients treated by the NS approach, the mean value remained in the mild category with or without therapy. CONCLUSIONS Early pharmacotherapy since one-month post RC using ICI and a combination of ICI+PDE5i can improve the erectile function of patients operated with a NNS approach.
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Affiliation(s)
- Mohamad Moussa
- Head of Urology department ,Zahraa Hospital, University Medical Center,Beirut ,Lebanon.
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece..
| | | | - Athanasios Dellis
- Department of Urology/General Surgery, Areteion Hospital, Athens, Greece.
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12
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Nicolai M, Urkmez A, Sarikaya S, Fode M, Falcone M, Albersen M, Gul M, Hatzichristodoulou G, Capogrosso P, Russo GI. Penile Rehabilitation and Treatment Options for Erectile Dysfunction Following Radical Prostatectomy and Radiotherapy: A Systematic Review. Front Surg 2021; 8:636974. [PMID: 33738297 PMCID: PMC7961076 DOI: 10.3389/fsurg.2021.636974] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/13/2021] [Indexed: 11/13/2022] Open
Abstract
After radical prostatectomy (RP) or radiotherapy (RT) for prostate cancer, erectile dysfunction (ED) is the main complication next to urinary incontinence, affecting quality of life. The pathophysiology of ED after these treatments is believed to include neuropraxia causing reduced oxygenation and structural changes of the tissue in the corpora cavernosa. Next to the option of sparing the nerves during RP, research has been focusing on methods for penile rehabilitation after RP and RT, since it occurs often, even after nerve-sparing techniques were used. In animal studies, the use of phosphodiesterase type 5 inhibitors (PDE5i) after cavernous nerve damage is supported, but results in human studies are contradictory. Non-medical treatment options such as vacuum device therapy, hyperbaric oxygen therapy, yoga, aerobic, or pelvic floor training may be helpful, but evidence is scarce. Clear guidelines for penile rehabilitation are not yet available. However, care and support for ED after RP and RT is highly demanded by a large group of patients, so measures have to be taken even though the evidence is not strong yet. In this systematic review, an overview of the literature for penile rehabilitation and treatment options for ED after RP and RT is provided, using only randomized controlled trials (RCT).
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Affiliation(s)
- Melianthe Nicolai
- Urology Department, The Netherlands Cancer Institute (NKI), Amsterdam, Netherlands.,Urology Department, Diakonessenhospital, Utrecht, Netherlands
| | - Ahmet Urkmez
- Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | | | - Mikkel Fode
- Urology Department, University of Copenhagen, Copenhagen, Denmark
| | - Marco Falcone
- Urology Department, Molinette Hospital, Turin, Italy
| | - Maarten Albersen
- Urology Department, University Hospitals Leuven, Leuven, Belgium
| | - Murat Gul
- School of Medicine, Selcuk University, Konya, Turkey
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Yang J, Jian ZY, Wang J. Phosphodiesterase type-5 inhibitors for erectile dysfunction following nerve-sparing radical prostatectomy: A network meta-analysis. Medicine (Baltimore) 2021; 100:e23778. [PMID: 33663041 PMCID: PMC7909136 DOI: 10.1097/md.0000000000023778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 11/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND To verify which phosphodiesterase type 5 inhibitors (PDE5is) strategy is better for erectile dysfunction (ED) following nerve-sparing radical prostatectomy (NSRP). METHODS This systematic literature search was conducted in MEDLINE, Web of Science and Cochrane Central Register of Controlled Trials database to identify eligible studies from the startup of these databases to 1 November, 2019. The ED recovery rate was the main outcome. Traditional pair-wise meta-analysis and multivariate random-effects network meta-analysis (NMA) were performed to explore direct and indirect comparisons, respectively. The surface under the cumulative ranking (SUCRA) probabilities was used to evaluate the efficacy of treatments. RESULTS A total of 14 randomized controlled trials with four kinds of PDE5is were included. Further pooled evidence suggested that PDE5is followed by NSRP had a benefit for penile rehabilitation compared to placebo using traditional pair-wise meta-analyses. Our NMA showed that Avanafil 200 mg on demand might be most likely to be the best treatment option according to the first rank of SUCRA both in NMA (SUCRA 83.5) and sensitivity analysis (SUCRA 90.2). CONCLUSION Avanafil 200 mg on demand has the highest probability of being the best intervention among PDE5is in treating ED following NSRP. However, more randomized controlled trials are needed to validate this in consideration of the published data regarding Avanafil is relatively small scale.
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Affiliation(s)
- Jie Yang
- Department of Urology, Chengdu First People's Hospital
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Guoxue Xiang, Chengdu, Sichuan, P.R.C
| | - Zhong-Yu Jian
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Guoxue Xiang, Chengdu, Sichuan, P.R.C
- West China Biomedical Big Data Center, Sichuan University, Chengdu, China
| | - Jia Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Guoxue Xiang, Chengdu, Sichuan, P.R.C
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14
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Prevalence of post-prostatectomy erectile dysfunction and a review of the recommended therapeutic modalities. Int J Impot Res 2020; 33:401-409. [PMID: 33204007 DOI: 10.1038/s41443-020-00374-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/22/2020] [Accepted: 11/02/2020] [Indexed: 12/11/2022]
Abstract
Radical prostatectomy (RP) represents one of the most commonly used first-line treatment modalities in men with localized prostate cancer. One of the most feared post-surgical complications is erectile dysfunction (ED), usually caused by direct damage to the cavernous nerves or due to neuropraxia. Penile rehabilitation is an emerging concept that was proposed to stimulate and accelerate recovery of erectile function after RP. The goal is to improve blood flow to the penis, increasing cavernous oxygenation and avoiding fibrosis. The most common used modalities include oral phosphodiesterase type 5 inhibitors (PDE5-I), vacuum erection devices (VEDs), intracorporeal injection (ICI) therapy, medicated urethral system for erections (MUSE), and a combination of these treatments. For those patients with severe ED, ED refractory to medical therapy and/or seeking long term reliable results, the penile prosthesis implant remains an excellent alternative. We conducted a broad review of post-prostatectomy ED prevalence with different techniques and the success rates of the different therapeutic approaches.
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Feng D, Tang C, Liu S, Yang Y, Han P, Wei W. Current management strategy of treating patients with erectile dysfunction after radical prostatectomy: a systematic review and meta-analysis. Int J Impot Res 2020; 34:18-36. [PMID: 33099581 DOI: 10.1038/s41443-020-00364-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/27/2020] [Accepted: 10/08/2020] [Indexed: 02/05/2023]
Abstract
The aim of this study is to present a summary of current evidence concerning the various treatments in the management of penile rehabilitation after radical prostatectomy (RP) and provide recommendations for future research. Randomized controlled trials (RCTs) were identified from electronic databases including PubMed, the Cochrane Library, Embase, and Web of Science from inception through March 2020 with no limitation to language. Comparable data from each study were combined in a meta-analysis where possible, otherwise data were synthesized narratively. The data analysis was completed by Review Manager version 5.3. A total of 39 RCTs were included in this study. At present, phosphodiesterase type 5 inhibitors (PDE5is) remain the first-line treatment for patients with erectile dysfunction (ED) after RP. Compared with the placebo group, patients in regular PDE5is group (mean difference (MD): 0.76; 95% confidence interval (CI): 1.69-4.44; p < 0.0001) and on demand group (MD: 3.92; 95% CI: 2.95-4.88; p < 0.00001) had a significantly higher mean Erectile Function domain of the International Index of Erectile Function (IIEF-EF) scores within 3 months after RP. As for the proportion of IIEF-EF ≥ 22, patients in regular PDE5is group and on demand PDE5is group had significantly higher proportion than those in placebo group 6 months after RP, and the odds ratios were 1.87 (95% CI: 1.32-2.66; p = 0.0005) and 2.17 (95% CI: 1.20-3.93; p = 0.01), respectively. No significant difference was observed between regular PDE5is group and on demand group regardless of mean IIEF-EF score or the proportion of IIEF-EF ≥ 22. Intracorporeal injection therapy seemed to have similar efficacy to PDE5is. The International Index of Erectile Function-5 items (IIEF-5) scores were significantly higher in vacuum constriction devices group than control group at 6-9 months after RP (MD: 6.70, 95% CI: 2.30-11.10, p = 0.003) with great between-study heterogeneity (p = 0.06, I2 = 72%). The other therapeutics including low-intensity extracorporeal shockwave therapy, statin therapy, psychotherapy interventions, and pelvic floor muscle training plus electrical stimulation showed certain improvement on erectile function. We found that the combination therapy showed certain advantages over monotherapy. Currently, PDE5is-based combination therapy remains the mainstream treatment for ED after RP. Intracorporeal injection therapy and vacuum therapy could be served as alternative treatments if PDE5is are ineffective and contraindicated.
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Affiliation(s)
- Dechao Feng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Cai Tang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Shengzhuo Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yubo Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ping Han
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wuran Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Pavone C, Abrate A, Agiato S, Billeci S, Tulone G, Vella M, Serretta V, Simonato A. Sildenafil orodispersible film in the treatment of erectile dysfunction after radical prostatectomy: A single-centre open-label uncontrolled trial. Andrologia 2020; 52:e13705. [PMID: 32501569 DOI: 10.1111/and.13705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/05/2020] [Accepted: 05/15/2020] [Indexed: 01/22/2023] Open
Abstract
Phosphodiesterase-5 inhibitors are the first-line therapy for erectile dysfunction (ED) after radical prostatectomy (RP). This single-centre open-label uncontrolled study evaluated the efficacy and safety of the new sildenafil orodispersible film (ODF) in ED treatment after RP. Sildenafil 100 mg ODF was administered twice a week for 3 months to patients under 75 years of age, with a Framingham cardiovascular risk score < 20% and a pre-operative International Index of Erectile Function (IIEF)-5 score ≥ 17, who had undergone open RP between 2016 and 2018. Erectile function was assessed pre-operatively, post-operatively and after treatment through the IIEF-5 score, the Sexual Encounter Profile Question (SEP-Q) 2 and SEP-Q3; adverse events (AE) were also investigated after 3 months. A total of 65 patients with a median (25th-75th percentile) post-operative IIEF-5 score of 8 (7-9) were treated. Nine (13.8%) patients reported AE of mild/moderate grade and discontinued treatment. A significant IIEF-5 score median (25th-75th percentile) increase of 10 (0-12) was found after treatment in the other 56 patients (p < .001). Sildenafil 100 mg ODF was effective in ED after RP in terms of improved IIEF-5 score and improved SEP-Q2 and SEP-Q3 in 67.9% of patients. It could represent a valid alternative for those patients with low compliance to tablet intake.
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Affiliation(s)
- Carlo Pavone
- Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Italy
| | - Alberto Abrate
- Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Italy
| | - Sonia Agiato
- Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Italy
| | - Sandro Billeci
- Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Italy
| | - Gabriele Tulone
- Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Italy
| | - Marco Vella
- Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Italy
| | - Vincenzo Serretta
- Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Italy
| | - Alchiede Simonato
- Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Italy.,Department of Surgery, Urology Unit, S. Croce e Carle Hospital, Cuneo, Italy
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Falcone M, Preto M, Ammirati E, Blecher G, Carone R, Gontero P, Giammò A. Dual implantation of penile prosthesis and ATOMS® system for post-prostatectomy erectile dysfunction and urinary incontinence: a feasibility study. Int J Impot Res 2020; 33:577-582. [DOI: 10.1038/s41443-020-0320-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 04/28/2020] [Accepted: 05/21/2020] [Indexed: 11/09/2022]
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Ramos N, Ramos R, Silva E. Anterior resection of the rectum vs radical prostatectomy. Are there any differences in sexual rehabilitation? ACTA ACUST UNITED AC 2020; 47:e20202469. [PMID: 32491031 DOI: 10.1590/0100-6991e-20202469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/29/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE The aim of this study was to evaluate the impact of penile rehabilitation in restoring erectile function in patients submitted to anterior resection of the rectum (ARR) or radical prostatectomy (RP), comparing the results between these two groups. MATERIALS AND METHODS We performed a unicenter retrospective cohort study, on patients evaluated in our multidisciplinary oncosexology consultation, between January 2015 and January 2018, submitted to RP or ARR (males) and presenting sexual dysfunction. We evaluate the patient and oncologic characteristics, the type of sexual dysfunction, marital status, assessed the International Index of Erectile Function (IIEF-5) on the first and last consultation and the therapeutic approach. A statistical analysis was performed. RESULTS A total of 55 patients were included, 60% (33) performed ARR and 40% (22) RP. Regarding the sexual dysfunction after surgery, erectile dysfunction (ED) was found in the majority of patients (>95%). On the initial IIEF-5 scoring, ARR and RP patients had, most frequently, severe or moderate ED (score 5-11), 78.8% and 59.1% respectively. When reassessed the IIEF-5 scoring of each patient during follow-up, there was an improvement in 69.7% of ARR patients and 72.7% of RP patients (p=0.81). Regarding the therapeutic approach, 84.8% of ARR patients used phosphodiesterase-5 inhibitors (PDE5I) exclusively, 3% used Alprostadil injection, while RP patients used 63.6% and 31.8%, respectively (p<0.05). CONCLUSIONS Despite the technical differences of these surgeries, from the sexual point of view these patients benefit with a penile rehabilitation.
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Affiliation(s)
- Nuno Ramos
- Garcia de Orta Hospital, Almada, Portugal
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19
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Penile Length and Its Preservation in Men After Radical Prostatectomy. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00226-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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20
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de Toledo AC, Kawano PR, Yamamoto HA, Guerra R, Gomes FF, Pajolli PIR, Amaro JL, Cardoso LEM, Sampaio FJ. Effects of tadalafil to prevent injury on corpus cavernosum after vascular or nervous peri-prostatic bundle injury. Experimental model in rats. Acta Cir Bras 2019; 34:e201900901. [PMID: 31800678 PMCID: PMC6889859 DOI: 10.1590/s0102-865020190090000001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/11/2019] [Accepted: 08/08/2019] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate the effects of tadalafil (TD) in preventing histological alterations of the corpus cavernosum caused by isolated lesions of cavernous nerve (ILCN) and artery (ILCA) in rats. METHODS Fifty male Wistar rats were randomly assigned in five groups: G1: control; G2: bilateral ILCN; G3: bilateral ILCA; G4: ILCN+TD; G5: ILCA+TD. The cavernous bodies were submitted to histomorphometry, immunohistochemistry and biochemical analysis. RESULTS Nerve density was significantly higher in G2 and G4 compared to control (22.62±2.84 and 19.53±3.47 vs. 15.72±1.82; respectively, p<0.05). Smooth muscle density was significantly lower in G2 and G3 in comparison to G1 (12.87±1.90 and 18.93±1.51 vs. 21.78±1.81, respectively; p<0.05). A significant decrease in the sinusoidal lumen area was observed in G2 compared to controls (5.01±1.62 vs. 9.88±3.66, respectively; p<0.05) and the blood vessel density was increased in G2 and G3 (29.32±4.13 e 20.80±2.47 vs. 10.13±2.71, p<0.05). Collagen density was higher in G3 compared to G1 (93.76±15.81 vs. 64.59±19.25; p<0.05). CONCLUSIONS Histomorphometric alterations caused by ILCN were more intense than those produced by vascular injury, but the collagen analyses showed more fibrosis in animals with ILCA. TD was effective in preventing the majority of the alterations induced by the periprostatic bundle injury.
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Affiliation(s)
- Antônio Carlos de Toledo
- PhD, Postgraduate Program in Bases General Surgery, Botucatu
School of Medicine, Universidade Estadual Paulista (UNESP), Botucatu-SP, Brazil.
Acquisition, analysis and interpretation of data; technical procedures;
histopathological examinations; manuscript preparation
| | - Paulo Roberto Kawano
- Associated Professor, Department of Urology, Botucatu School of
Medicine, UNESP, Botucatu-SP, Brazil. Design, intellectual and scientific
content of the study; manuscript writing, critical revision, final
approval
| | - Hamilto Akihissa Yamamoto
- Assistant Professor, Department of Urology, Botucatu School of
Medicine, UNESP, Botucatu-SP, Brazil. Statistics analysis, manuscript writing,
critical revision
| | - Rodrigo Guerra
- PhD, Department of Urology, Botucatu School of Medicine, UNESP,
Botucatu-SP, Brazil. Acquisition, analysis and interpretation of data;
manuscript writing
| | - Fernando Ferreira Gomes
- Fellow Master degree, Postgraduate Program in Bases General
Surgery, Botucatu School of Medicine, UNESP, Botucatu-SP, Brazil. Acquisition,
analysis and interpretation of data; technical procedures
| | - Pedro Ivo Rochetti Pajolli
- Assistant Physician, Department of Urology, Botucatu School of
Medicine, UNESP, Botucatu-SP, Brazil. Acquisition of data, technical
procedures
| | - João Luiz Amaro
- Full Professor, Department of Urology, Botucatu School of
Medicine, UNESP, Botucatu-SP, Brazil. Conception and design of the study,
critical revision, final approval
| | - Luiz Eduardo Macedo Cardoso
- Associate Professor; Urogenital Research Unit, Universidade
Estadual do Rio de Janeiro (UERJ), Brazil. Conception and design of the study,
histopathological examinations, critical revision, final approval
| | - Francisco José Sampaio
- Full Professor, Urogenital Research Unit, UERJ, Rio de
Janeiro-RJ, Brazil. Critical revision, final approval
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Della Camera PA, Tellini R, Cito G, Rastrelli G, Maggi M, Chini T, Nunzio CD, Altieri VM, Serni S, Gacci M, Natali A. Efficacy and safety of avanafil 200 mg versus sildenafil 100 mg in the treatment of erectile dysfunction after robot-assisted unilateral nerve-sparing prostatectomy: A prospective multicentre study. Urologia 2019; 87:23-28. [PMID: 31441379 DOI: 10.1177/0391560319867809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Phosphodiesterase type 5 inhibitors represent the standard treatment of erectile dysfunction after nerve-sparing prostatectomy. Avanafil is a second-generation phosphodiesterase type 5 inhibitor with a high selectivity for phosphodiesterase type 5 isoform. To date, there are no studies comparing the outcomes of avanafil versus sildenafil in this scenario. In this study, we evaluated the efficacy and safety of avanafil versus sildenafil as a drug for post-prostatectomy rehabilitation. Overall, 160 patients submitted to robot-assisted nerve-sparing prostatectomy for localized prostate cancer at three hospitals were enrolled for the present study. After 6 months of treatment, patients in the two groups showed no significantly different sexual function scores, except for the Erection Hardness Score and Sexual Encounter Profile-Q2 that were higher in the Sildenafil group. Adverse events in the Avanafil group occurred in four (5%) patients and in 16 (20%) patients in the Sildenafil group. According to our experience, in patients undergoing nerve-sparing prostatectomy, penile rehabilitation with avanafil compared to sildenafil showed a lower ability to produce a valid erection in the initial phase of sexual intercourse, a difference that disappears in the continuation of the same. Avanafil showed a greater tolerance profile with a lower rate of AEs and discontinuation of therapy due to AEs.
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Affiliation(s)
| | - Riccardo Tellini
- Department of Urology, University of Florence, Careggi University Hospital, Florence, Italy
| | - Gianmartin Cito
- Department of Urology, University of Florence, Careggi University Hospital, Florence, Italy
| | - Giulia Rastrelli
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Tommaso Chini
- Department of Urology, University of Siena, Le Scotte Hospital, Siena, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital and Faculty of Health Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Sergio Serni
- Department of Urology, University of Florence, Careggi University Hospital, Florence, Italy
| | - Mauro Gacci
- Department of Urology, University of Florence, Careggi University Hospital, Florence, Italy
| | - Alessandro Natali
- Department of Urology, University of Florence, Careggi University Hospital, Florence, Italy
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23
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Doherty W, Bridge P. A Systematic Review of the Role of Penile Rehabilitation in Prostate Cancer Patients Receiving Radiotherapy and Androgen Deprivation Therapy. J Med Imaging Radiat Sci 2019; 50:171-178. [DOI: 10.1016/j.jmir.2018.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/16/2018] [Accepted: 09/12/2018] [Indexed: 12/23/2022]
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Qin F, Wang S, Li J, Wu C, Yuan J. The Early Use of Vacuum Therapy for Penile Rehabilitation After Radical Prostatectomy: Systematic Review and Meta-Analysis. Am J Mens Health 2018; 12:2136-2143. [PMID: 30182794 PMCID: PMC6199422 DOI: 10.1177/1557988318797409] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Vacuum therapy has been widely used for penile rehabilitation after radical prostatectomy (RP), but its efficacy and safety are unclear. The study was to evaluate the efficacy and safety of the early use of vacuum therapy for post-RP men. Randomized clinical trials were selected according to predefined inclusion and exclusion criteria. RevMan 5.3 software was used for meta-analyses. In total, six randomized controlled trials were included with a total of 273 post-RP patients. The meta-analysis revealed that the early use of vacuum therapy could significantly improve the five-item International Index of Erectile Function and penile shrinkage in post-RP patients. Few adverse events were reported across the included studies. This review suggests that the early use of vacuum therapy appears to have excellent therapeutic effect on post-RP patients and no serious side effects were identified. Due to overall limited quality of the included studies, the therapeutic benefit of vacuum therapy in penile rehabilitation needs be substantiated to a limited degree in the future. Better methodological, large controlled trials are expected to verify the therapeutic effect of vacuum therapy in penile rehabilitation.
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Affiliation(s)
- Feng Qin
- 1 Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Shuzhen Wang
- 2 Laboratory of Infectious Disease and Vaccine, West China Hospital, Sichuan University, Chengdu, China
| | - Jinhong Li
- 1 Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China
- 3 Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Changjing Wu
- 1 Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Jiuhong Yuan
- 1 Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China
- 3 Department of Urology, West China Hospital, Sichuan University, Chengdu, China
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Philippou YA, Jung JH, Steggall MJ, O'Driscoll ST, Bakker CJ, Bodie JA, Dahm P. Penile rehabilitation for postprostatectomy erectile dysfunction. Cochrane Database Syst Rev 2018; 10:CD012414. [PMID: 30352488 PMCID: PMC6517112 DOI: 10.1002/14651858.cd012414.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Despite efforts to preserve the neurovascular bundles with nerve-sparing surgery, erectile dysfunction remains common following radical prostatectomy. Postoperative penile rehabilitation seeks to restore erectile function but results have been conflicting. OBJECTIVES To evaluate the effects of penile rehabilitation strategies in restoring erectile function following radical prostatectomy for prostate cancer. SEARCH METHODS We performed a comprehensive search of multiple databases (CENTRAL, MEDLINE, Embase), the Cochrane Library, Web of Science, clinical trial registries (ClinicalTrials.gov, International Clinical Trials Registry Platform) and a grey literature repository (Grey Literature Report) from their inception through to 3 January 2018. We also searched the reference lists of other relevant publications and abstract proceedings. We applied no language restrictions. SELECTION CRITERIA We included randomised or quasi-randomised trials with a parallel or cross-over design. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. Two review authors independently screened the literature, extracted data, assessed risk of bias and rated quality of evidence according to GRADE on a per-outcome basis. Primary outcomes were self-reported potency, erectile function measured by validated questionnaires (with potency defined as an International Index of Erectile Function (IIEF-EF) score of 19 or greater and or an IIEF-5 of score of 17 or greater) and serious adverse events. For all quality of life assessments on a continuous scale, higher values indicated better quality of life. MAIN RESULTS We included eight randomised controlled trials with 1699 participants across three comparisons. This abstract focuses on the primary outcomes of this review only.Scheduled phosphodiesterase type 5 inhibitors (PDE5I) versus placebo or no treatmentScheduled PDE5I may have little or no effect on short-term (up to 12 months) self-reported potency (risk ratio (RR) 1.13, 95% confidence interval (CI) 0.91 to1.41; very low quality evidence), which corresponds to 47 more men with self-reported potency per 1000 (95% CI 33 fewer to 149 more) and short-term erectile function as assessed by a validated instrument (RR 1.11, 95% CI 0.80 to 1.55; very low quality evidence), which corresponds to 28 more men per 1000 (95% CI 50 fewer to 138 more), but we are very uncertain of both of these findings. Scheduled PDE5I may result in fewer serious adverse events compared to placebo (RR 0.32, 95% CI 0.11 to 0.94; low quality evidence), though this does not appear biologically plausible and may represent a chance finding. We are also very uncertain of this finding. We found no long-term (longer than 12 months) data for any of the three primary outcomes.Scheduled PDE5I versus on-demand PDE5I Daily PDE5I appears to result in little to no difference in both short-term and long-term (greater than 12 months) self-reported potency (short term: RR 0.97, 95% CI 0.62 to 1.53; long term: RR 1.00, 95% CI 0.60 to 1.67; both very low quality evidence); this corresponds to nine fewer men with self-reported short-term potency per 1000 (95% CI 119 fewer to 166 more) and zero fewer men with self-reported long-term potency per 1000 (95% CI 153 fewer to 257 more). We are very uncertain of these findings. Daily PDE5I appears to result in little to no difference in short-term and long-term erectile function (short term: RR 1.00, 95% CI 0.65 to 1.55; long term; RR 0.74, 95% CI 0.48 to 1.14; both very-low quality evidence), which corresponds to zero men with short-term erectile dysfunction per 1000 (95% CI 80 fewer to 125 more) and 119 fewer men with long-term erectile dysfunction per 1000 (95% CI 239 fewer to 64 more). We are very uncertain of these findings. Scheduled PDE5I may result in little or no effects on short-term adverse events (RR 0.69 95% CI 0.12 to 4.04; very low quality evidence), which corresponds to seven fewer men with short-term serious adverse events (95% CI 18 fewer to 64 more), but we are very uncertain of these findings. We found no long-term data for serious adverse events.Scheduled PDE5I versus scheduled intraurethral prostaglandin E1At short-term follow-up, daily PDE5I may result in little or no effect on self-reported potency (RR 1.10, 95% CI 0.79, to 1.52; very low quality evidence), which corresponds to 46 more men per 1000 (95% CI 97 fewer to 241 more). Daily PDE5I may result in a small improvement of erectile function (RR 1.64, 95% CI 0.84 to 3.20; very low quality evidence), which corresponds to 92 more men per 1000 (95% CI 23 fewer to 318 more) but we are very uncertain of both these findings. We found no long-term (longer than 12 months) data for any of the three primary outcomes.We found no evidence for any other comparisons and were unable to perform any of the preplanned subgroup analyses based on nerve-sparing approach, age or baseline erectile function. AUTHORS' CONCLUSIONS Based on mostly very-low and some low-quality evidence, penile rehabilitation strategies consisting of scheduled PDE5I use following radical prostatectomy may not promote self-reported potency and erectile function any more than on demand use.
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Affiliation(s)
- Yiannis A Philippou
- University of OxfordNuffield Department of Surgical SciencesJohn Radcliffe HospitalHeadingtonOxfordUKOX39DU
| | - Jae Hung Jung
- Yonsei University Wonju College of MedicineDepartment of Urology20 Ilsan‐roWonjuGangwonKorea, South26426
- Yonsei University Wonju College of MedicineInstitute of Evidence Based Medicine20 Ilsan‐roWonjuGangwonKorea, South26426
| | - Martin J Steggall
- University of South WalesFaculty of Life Sciences and EducationPontypriddWalesUKCF37 4BD
| | | | - Caitlin J Bakker
- University of MinnesotaHealth Sciences Libraries303 Diehl Hall, 505 Essex Street SEMinneapolisMinnesotaUSA55455
| | - Joshua A Bodie
- University of MinnesotaDepartment of UrologyMinneapolisMinnesotaUSA
| | - Philipp Dahm
- University of MinnesotaDepartment of UrologyMinneapolisMinnesotaUSA
- Minneapolis VA Health Care SystemUrology SectionOne Veterans DriveMail Code 112DMinneapolisMinnesotaUSA55417
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Puigvert AM, Prieto R, García F. [Continuous use of PDE5 inhibitors in the treatment of erectile dysfunction: New insights and opportunities]. Rev Int Androl 2018; 16:28-33. [PMID: 30063020 DOI: 10.1016/j.androl.2017.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/15/2017] [Accepted: 02/24/2017] [Indexed: 11/28/2022]
Abstract
At present, there is debate regarding the continuous use of phosphodiesterase 5 inhibitors in the treatment of erectile dysfunction. Cumulative evidence supports the benefit, even at low doses, thatcontinuous treatment has on erectile function -even in difficult-to-treat patients-, and on the spontaneity and naturalness of sexual relationships. Safety and tolerability have also proven to be good. Beyond phosphodiesterase 5 inhibition, the effect of continuous treatment of erectile function appears to be based on improvement of endothelial function and oxygenation of the penile vascular bed as a result of the increased number of erections, hence playing down the importance of pharmacokinetics. Although evidence is still limited, this new scenario opens new paths for the treatment of erectile dysfunction patients in whom on-demand treatments are not effective or deemed appropriate, and would benefit the spontaneity of sexual life.
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Affiliation(s)
- Ana María Puigvert
- Instituto de Andrología y Medicina Sexual (IANDROMS), Barcelona, España.
| | - Rafael Prieto
- Unidad de Andrología, Medicina Sexual y Reproductiva, Hospital Regional Universitario Reina Sofía, Córdoba, España
| | - Ferran García
- Unidad de Andrología, Servicio de Reproducción, Instituto Marqués, Barcelona, España
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Faure Walker NA, Norris JM, Shah TT, Yap T, Cathcart P, Moore CM, Ahmed HU, Emberton M, Minhas S. A comparison of time taken to return to baseline erectile function following focal and whole gland ablative therapies for localized prostate cancer: A systematic review. Urol Oncol 2017; 36:67-76. [PMID: 29277585 DOI: 10.1016/j.urolonc.2017.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/24/2017] [Accepted: 12/04/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To systematically review erectile function (EF) outcomes following primary whole gland (WG) and focal ablative therapies for localized prostate cancer to ascertain whether the treatment modality or intended treatment volume affects the time taken to recover baseline EF. METHOD AND MATERIALS A systematic review was performed according to the preferred reporting items for systematic review and meta-analysis statement. Inclusion criteria were men with localized prostate cancer treated with primary, ablative therapy. Primary outcome was the return to baseline EF measured with objective, validated symptoms scores. Secondary outcome was use of phosphodiesterase inhibitors or erectile aids. Meta-analysis was not performed owing to heterogenous outcome measures. RESULTS Of 222 articles identified in February 2017, 55 studies which reported EF after ablative therapy were identified but only 17 used validated outcome measures and met inclusion criteria. WG cryotherapy was used in 2 studies, WG high-intensity focused ultrasound (HIFU) in 5, focal cryotherapy in 2, focal HIFU in 3, focal phototherapy or laser therapy in 4, vascular-targeted photodynamic therapy in 3, and irreversible electroporation in 2. WG cryotherapy was associated with a significant decline in EF at 6 months with minimal improvement at 36 months. Baseline IIEF-15 of patients undergoing focal HIFU fell 30 points at 1 month but returned to baseline by 6 months. The remaining focal therapies demonstrated minimal or no effect on EF, but the men in these studies had small foci of disease. The review is limited by lack of randomized studies and heterogenous outcome measures. CONCLUSIONS Most studies assessing the outcomes of focal therapy on sexual function were not of high quality, used heterogenous outcomes, and had relatively short follow up, highlighting the need for more robustly designed studies using validated patient reported outcome measures for comparison. However, FT in general resulted in less effect on EF than WG ablation.
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Affiliation(s)
| | - Joseph M Norris
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Taimur T Shah
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, Whittington Hospitals NHS Trust, London, UK
| | - Tet Yap
- Department of Urology, Guys and St Thomas NHS Foundation Trust, London, UK
| | - Paul Cathcart
- Department of Urology, Guys and St Thomas NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Hashim U Ahmed
- Department of Surgery and Cancer, Imperial College, London, UK; Department of Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Suks Minhas
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
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Blecher G, Almekaty K, Kalejaiye O, Minhas S. Does penile rehabilitation have a role in the treatment of erectile dysfunction following radical prostatectomy? F1000Res 2017; 6:1923. [PMID: 29152231 PMCID: PMC5664996 DOI: 10.12688/f1000research.12066.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 12/17/2022] Open
Abstract
In men undergoing radical treatment for prostate cancer, erectile function is one of the most important health-related quality-of-life outcomes influencing patient choice in treatment. Penile rehabilitation has emerged as a therapeutic measure to prevent erectile dysfunction and expedite return of erectile function after radical prostatectomy. Penile rehabilitation involves a program designed to increase the likelihood of return to baseline-level erectile function, as opposed to treatment, which implies the therapeutic treatment of symptoms, a key component of post–radical prostatectomy management. Several pathological theories form the basis for rehabilitation, and a plethora of treatments are currently in widespread use. However, whilst there is some evidence supporting the concept of penile rehabilitation from animal studies, randomised controlled trials are contradictory in outcomes. Similarly, urological guidelines are conflicted in terms of recommendations. Furthermore, it is clear that in spite of the lack of evidence for the role of penile rehabilitation, many urologists continue to employ some form of rehabilitation in their patients after radical prostatectomy. This is a significant burden to health resources in public-funded health economies, and no effective cost-benefit analysis has been undertaken to support this practice. Thus, further research is warranted to provide both scientific and clinical evidence for this contemporary practice and the development of preventative strategies in treating erectile dysfunction after radical prostatectomy.
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Affiliation(s)
- Gideon Blecher
- University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Khaled Almekaty
- University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland Street, London, W1G 8PH, UK.,Urology Department, Tanta University, Tanta, Egypt
| | - Odunayo Kalejaiye
- University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Suks Minhas
- University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland Street, London, W1G 8PH, UK
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Chung E. Management of treatment-related sexual complications in cancer care: evidence for erectile function recovery and penile rehabilitation after radical prostatectomy in prostate cancer survivorship. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/23809000.2017.1403851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Eric Chung
- Department of Urology, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
- AndroUrology Centre, St Andrew’s War Memorial Hospital, Brisbane, Australia
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Miranda-Sousa AJ, Davila HH, Lockhart JL, Ordorica RC, Carrion RE. Sexual Function after Surgery for Prostate or Bladder Cancer. Cancer Control 2017; 13:179-87. [PMID: 16885913 DOI: 10.1177/107327480601300304] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Compromised sexual function is often a side effect for patients following radical surgical procedures for bladder or prostate cancer. Methods The authors review the classification and physiology of sexual function and dysfunction. Moreover, they explain the possible pathophysiology directly resulting from surgery, and they discuss several approaches available to address these problems. Results Options for male sexual dysfunction, primarily erectile dysfunction resulting from radical prostatectomy or surgery for bladder cancer, range from patient education to penile prosthesis implantation. Female sexual dysfunction caused by surgical intervention for bladder cancer includes problems with libido, arousal, orgasm, and dyspareunia. Treatment options for women can include sex therapy, hormonal therapy, and preventive strategies. However, no consensus has been established on the most effective agents and time points to treat male or female sexual dysfunction following radical cystectomies or prostatectomies. The chronic intermittent treatment of erectile dysfunction following radical prostatectomy has been commonly referred to as penile rehabilitation. Conclusions Additional research is needed to obtain further data concerning sexual dysfunction in both men and women following radical pelvic surgeries. Modification of surgical techniques, the use of various treatment modalities for sexual dysfunction, and the development of new agents will help to successfully minimize or prevent damage and restore normal sexual function after local surgical therapy for prostate or bladder cancer in the future.
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Hamm R, Terry TR, Bates AS. Penile rehabilitation after nerve-sparing prostatectomy: Fact or fiction? JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415817701567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 65-year-old man is seen in the clinic two months after a robot-assisted bilateral nerve-sparing radical prostatectomy. He is completely continent and has been since the catheter was removed. The main reason for his referral is erectile dysfunction. Pre-operatively his SHIM score was 25 (maximum score 25). He currently experiences some thickening with stimulation, and an erection hardness score of 2. He has a pleasurable sensation of orgasm during which he remains dry. His sex drive remains normal. He has a long-standing history of hypertension and raised LDL cholesterol, managed with amlodipine and simvastatin respectively. He has no other overt cardiovascular or ischaemic heart disease, and he is not a diabetic, but has an elevated fasting glucose of 6.0 mmol per litre. He stopped smoking five years ago, is 5 feet 11 inches tall, a weight of 95 kg, has a waist measurement of 44 inches (BMI 29 – upper end of overweight) (range <18.50 underweight; 18.50–24.99 healthy weight; 25.00–29.99 overweight; >30.00 obese). He performs no regular exercise. His wife is 60. He is keen to try to regain his erectile function.
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Affiliation(s)
- Rebecca Hamm
- Royal Liverpool and Broadgreen University Hospitals, UK
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Ye Z, Lu H, Guo W, Dai W, Li H, Yang H, Li L. The effect of alprostadil on preventing contrast-induced nephropathy for percutaneous coronary intervention in diabetic patients: A systematic review and meta-analysis. Medicine (Baltimore) 2016; 95:e5306. [PMID: 27861357 PMCID: PMC5120914 DOI: 10.1097/md.0000000000005306] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/07/2016] [Accepted: 10/09/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND At present, there are a lot of research about the effect of Alprostadil on preventing contrast-induced nephropathy for percutaneous coronary intervention (PCI) in diabetic patients, but the clinical efficacy is not consistent, so we conduct this study and therefore determine the dominant strategy for the treatment of PCI in diabetic patients based on the best evidence currently. METHODS An electronic database search was conducted in MEDLINE, Embase, Cochrane library, CBM, CNKI, VIP, and WanFang to retrieve randomized controlled trial (RCT) comparing Alprostadil versus hydration on preventing CIN for PCI in diabetic patients. Reference lists of relevant articles were also screened manually to retrieve additional ones. Two investigators independently assessed the eligibility of retrieved articles using predefined inclusion and exclusion criteria. All characteristics as well as outcome variables including incidence of CIN, blood urea nitrogen (BUN), cystatin C (CysC), glomerular filtration rate (GFR), serum creatinine (Scr), serum beta 2-microspheres (β2-MG) presented in each included study were extracted. Heterogeneity was thought to be significant when I > 50%. All of the meta-analytic procedures were performed by using Review Manager software, version 5.3. RESULTS Finally, data from 8 articles including 969 patients were included into this meta-analysis, among them, 487 patients in the experience group, and 482 patients in the control group. Meta analysis showed that the incidence of CIN in the experimental group was significantly lower than that in the control group (OR = 0.28,95%CI[0.18,0.42]). The incidence of adverse reactions in the experimental group was significantly lower than that in the control group (OR = 0.46,95%CI[0.24,0.85]). The BUN of 24 hours, 48 hours, and 72 hours in the experimental group were significantly lower than that of control group (MD = -0.77, 95%CI [-1.22, -0.32]; MD = -1.38, 95%CI [-1.83,-0.92]; MD = -2.43, 95%CI [-2.68,-2.19], respectively). The CysC of 24 hours, 48 hours, and 72 hours in the experimental group were significantly lower than that of control group (MD = -0.30, 95%CI [-0.40, -0.21]; MD = -0.54, 95%CI [-0.68,-0.41]; MD = -0.49, 95%CI [-0.63, -0.35], respectively). The GFR of 24 hours, 48 hours, and 72 hours in the experimental group were significantly higher than that of control group (MD = 7.86, 95%CI [4.44, 11.29], MD = 18.23, 95%CI [13.76,22.69], MD = 12.81, 95%CI [8.51,17.11], respectively). The Scr of 24 hours, 48 hours, and 72 hours in the experimental group were significantly lower than that of control group (MD = -9.09, 95%CI [-12.67, -5.51], MD = -19.14, 95%CI [-23.61, -14.66], MD = -6.50, 95%CI [-8.29, -4.71], respectively). The β2-MG of 24 hours, 48 hours, and 72 hours in the experimental group were significantly lower than that of control group (MD = -0.12, 95%CI [-0.27, 0.03], MD = -0.55, 95%CI [-0.71, -0.39], MD = -0.50, 95%CI [-0.60, -0.39], respectively). CONCLUSION Our result suggested that comparing with conventional Hydration, Alprostadil can significantly reduce the incidence of CIN, adverse reaction, and protect renal function in PCI in diabetic patients. Due to the limitations of the quality and quantity of the articles, this conclusion still needs further research to confirm.
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Affiliation(s)
- Ziliang Ye
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, Guangxi, China
| | - Haili Lu
- Department of Orthodontic, The Affiliated Dental Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Wenqin Guo
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, Guangxi, China
| | - Weiran Dai
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, Guangxi, China
| | - Hongqing Li
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, Guangxi, China
| | - Huafeng Yang
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, Guangxi, China
| | - Lang Li
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, Guangxi, China
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Emanu JC, Avildsen IK, Nelson CJ. Erectile dysfunction after radical prostatectomy: prevalence, medical treatments, and psychosocial interventions. Curr Opin Support Palliat Care 2016; 10:102-7. [PMID: 26808052 DOI: 10.1097/spc.0000000000000195] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW This review will discuss erectile dysfunction in prostate cancer patients following radical prostatectomy . It will focus on the prevalence and current treatments for erectile dysfunction as well as the emotional impact of erectile dysfunction and the current psychosocial interventions designed to help patients cope with this side effect. RECENT FINDINGS Although there is a large discrepancy in prevalence rates of erectile dysfunction after radical prostatectomy, several recent studies have cited rates as high as 85%. The concept of 'penile rehabilitation' is now the standard of practice to treat erectile dysfunction following radical prostatectomy. However, many men avoid seeking help or utilizing erectile dysfunction treatments. This avoidance is related to the shame, frustration, and distress many men with erectile dysfunction and their partners experience. Recent psychosocial interventions have been developed to facilitate the use of treatments and help men cope with erectile dysfunction. These interventions have shown initial promise, however, continued intervention development is needed to reduce distress and improve long-term erectile function outcomes. SUMMARY Erectile dysfunction is a significant problem following prostate cancer surgery. Although there are effective medical treatments, the development of psychosocial interventions should continue to evolve to maximize the assistance we can give to men and their partners.
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Affiliation(s)
- Jessica C Emanu
- Department of Psychiatry and Behavioral Sciences Memorial Sloan Kettering Cancer Center, New York, USA
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Valero-Rosa J, Campos-Hernández JP, Carrasco-Valiente J, Gómez-Gómez E, Márquez-López FJ, Ruiz-García J, García-Rubio JH, Requena-Tapia MJ, Prieto-Castro R. Prognostic value of penile colour doppler ultrasonography for recovering erectile function after radical prostatectomy. Actas Urol Esp 2016; 40:507-12. [PMID: 27207597 DOI: 10.1016/j.acuro.2016.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To analyse the predictive utility of penile colour Doppler ultrasonography after the injection of vasoactive agents for recovering erectile function after radical prostatectomy. MATERIAL AND METHODS A retrospective study was conducted on patients with erectile dysfunction after radical prostatectomy who were treated with intracavernous injections of prostaglandins E1 between January 1, 2006 and December 31, 2012. The study included patients with no history of erectile dysfunction prior to the surgery and who did not respond to medical treatment. Colour Doppler was performed on all patients after the intracavernous injection. A peak systolic velocity ≥30cm/sec and an end diastolic velocity ≤5cm/sec were considered normal haemodynamic values. We assessed the result of the treatment during the follow-up using the International Index of Erectile Function-5. RESULTS We included 197 patients. The mean age was 60.8 (±6.3). The pathological diagnosis for all patients was adenocarcinoma, 74.1% of which were confined to the organ (T1-T2/Nx-N0). Treatment with injections after the surgery was started after a mean duration of 6.8 months (+3.5). The Doppler ultrasonography results were normal for 53 patients (26.9%). During the follow-up, 113 patients (57.4%) maintained functional erections; 55 of these patients (28%) did not require injections. Normal Doppler ultrasonography results were associated with a favourable response to treatment (p<.01). CONCLUSIONS The prostaglandin E1 test will help provide a diagnosis in erectile dysfunction for patients who have undergone prostatectomies. The test helps provide information on the vascular condition of the penis and useful prognostic information for the follow-up of these patients.
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Affiliation(s)
- J Valero-Rosa
- Departamento de Urología, Hospital Universitario Reina Sofía, Córdoba, España.
| | | | - J Carrasco-Valiente
- Departamento de Urología, Hospital Universitario Reina Sofía, Córdoba, España
| | - E Gómez-Gómez
- Departamento de Urología, Hospital Universitario Reina Sofía, Córdoba, España
| | - F J Márquez-López
- Departamento de Urología, Hospital Universitario Reina Sofía, Córdoba, España
| | - J Ruiz-García
- Departamento de Urología, Hospital Universitario Reina Sofía, Córdoba, España
| | - J H García-Rubio
- Departamento de Urología, Hospital Universitario Reina Sofía, Córdoba, España
| | - M J Requena-Tapia
- Departamento de Urología, Hospital Universitario Reina Sofía, Córdoba, España
| | - R Prieto-Castro
- Departamento de Urología, Hospital Universitario Reina Sofía, Córdoba, España
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Salomon L, Droupy S, Yiou R, Soulié M. [Functional results and treatment of functional dysfunctions after radical prostatectomy]. Prog Urol 2016; 25:1028-66. [PMID: 26519966 DOI: 10.1016/j.purol.2015.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 07/30/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To describe the functional results and treatment of functional dysfunctions after radical prostatectomy for localized prostate cancer. MATERIAL AND METHOD Bibliography search was performed from the database Medline (National Library of Medicine, Pubmed) selected according to the scientific relevance. The research was focused on continence, potency, les dyserections, couple sexuality, incontinence, treatments of postoperative incontinence, dysrection and trifecta. RESULTS Radical prostatectomy is an elaborate and challenging procedure when carcinological risk balances with functional results. Despite recent developments in surgical techniques, post-radical prostatectomy urinary incontinence (pRP-UI) continues to be one of the most devastating complications, which affects 9-16% of patients. Sphincter injury and bladder dysfunction are the most common causes or pRP-UI. The assessment of severity of pRP-UI that affects the choice of treatment is still not well standardized but should include at least a pad test and self-administered questionnaires. The implantation of an artificial urinary sphincter AMS800 remains the gold standard treatment for patients with moderate to severe pRP-UI. The development of less invasive techniques such as the male sling of Pro-ACT balloons has provided alternative therapeutic options for moderate and slight forms of pRP-UI. Most groups now consider the bulbo-urethral compressive sling as the treatment of choice for patients with non-severe pRP-UI. The most appropriate second-line therapeutic strategy is not clearly determined. Recent therapies such as adjustable artificial urinary sphincters and sling and stem cells injections have been investigated. Maintenance of a satisfying sex life is a major concern of a majority of men facing prostate cancer and its treatments. It is essential to assess the couple's sexuality before treating prostate cancer in order to deliver comprehensive information and consider early therapeutic solutions adapted to the couple's expectations. Active pharmacological erectile rehabilitation (intracavernous injections or phosphodiesterase type 5 inhibitors [PDE5i] on demand, during in the month following surgery) or passive (daily PDE5i after surgery) might improve the quality of erections especially in response to PDE5i. Unimpaired aspects of sexual response (orgasm) may, when the erection is not yet recovered, represent an alternative allowing the couple to preserve intimacy and complicity. Androgen blockade is a major barrier to maintain or return to a satisfying sex. Trifecta is a simple tool to present in one way the results of radical prostatectomy: in case of bilateral neurovascular preservation, Trifecta is 60% whatever the surgical approach. CONCLUSION Radical prostatectomy is an elaborate and challenging procedure when carcinological risk balances with functional results. Various treatments of postoperative incontinence and dysrections exist. Functional disorders after surgery have to be treated to ameliorate quality of life of patients.
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Affiliation(s)
- L Salomon
- Service d'urologie et de transplantation rénale et pancréatique, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France.
| | - S Droupy
- Service d'urologie et d'andrologie, CHU de Nîmes, place du Professeur-Robert-Debré, 30029 Nîmes cedex 09, France
| | - R Yiou
- Service d'urologie et de transplantation rénale et pancréatique, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - M Soulié
- Département d'urologie-andrologie-transplantation rénale, CHU Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse cedex 9, France
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Facio FN, Facio MF, Spessoto LF, Pessutti D, Reis LO, Campos SG, Taboga S. Anti-inflammatory and anti-fibrotic effects of annexin1 on erectile function after cavernous nerve injury in rats. Int J Impot Res 2016; 28:221-227. [PMID: 27557611 DOI: 10.1038/ijir.2016.32] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 05/14/2016] [Accepted: 07/23/2016] [Indexed: 01/22/2023]
Abstract
The aim of this study was to investigate the effect of the anti-inflammatory and anti-fibrotic actions of ANX1 on erectile function (EF). Forty-eight male Wistar rats were randomly distributed into four equal groups: one group (sham operation-control) and three groups (bilateral cavernous nerve (CN) crush injury). Crush injury groups were treated prior to injury with an intravascular injection of either ANX1 (50 or 100 μg kg-1) or vehicle. EF was assessed by CN electrical stimulation at 2 and 7 days after CN injury with histomorphometric and immunohistochemical analysis. ANX1 demonstrated functional preservation as the increase in intracavernous pressure (ICP). A dose-response relationship regarding the effect on penile tissue was confirmed, and preservation of the penile dorsal nerves and anti-apoptotic effects in the corpus cavernosum (real P-value vs injured control). ANX1 treatment prevented collagen deposition and smooth muscle loss in the penis. ANX1 normalized the expression of vascular endothelial growth factor and decreased tumor necrosis factor-α in the lumen of the blood vessels of the organ. ANX1 proved effective in preserving EF in a rat model of neurogenic erectile dysfunction. ANX1 treatment before CN injury in rats improved erectile recovery, enhanced vascular regeneration and preserved the micro-architecture of the corpus cavernosum. The clinical availability of this compound merits application in penile rehabilitation studies following radical prostatectomy.
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Affiliation(s)
- F N Facio
- Division of Urology, Medical School of São José do Rio Preto (FAMERP), Sao Paulo, Brazil
| | - M F Facio
- Department of Medicine, Undergraduate Student, Ceres School of Medicine, Faceres, Brazil
| | - L F Spessoto
- Division of Urology, Medical School of São José do Rio Preto (FAMERP), Sao Paulo, Brazil
| | - D Pessutti
- Division of Urology, Medical School of São José do Rio Preto (FAMERP), Sao Paulo, Brazil
| | - L O Reis
- Department of Urology, Faculty of Medicine, Division of Urology, Center for Life Sciences, Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, Brazil
| | - S G Campos
- Department of Biology, São Paulo State University, UNESP/IBILCE, São José Rio Preto, Brazil
| | - S Taboga
- Department of Biology, São Paulo State University, UNESP/IBILCE, São José Rio Preto, Brazil
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Capogrosso P, Salonia A, Briganti A, Montorsi F. Postprostatectomy Erectile Dysfunction: A Review. World J Mens Health 2016; 34:73-88. [PMID: 27574591 PMCID: PMC4999493 DOI: 10.5534/wjmh.2016.34.2.73] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 06/20/2016] [Indexed: 11/16/2022] Open
Abstract
In the current era of the early diagnosis of prostate cancer (PCa) and the development of minimally invasive surgical techniques, erectile dysfunction (ED) represents an important issue, with up to 68% of patients who undergo radical prostatectomy (RP) complaining of postoperative erectile function (EF) impairment. In this context, it is crucial to comprehensively consider all factors possibly associated with the prevention of post-RP ED throughout the entire clinical management of PCa patients. A careful assessment of both oncological and functional baseline characteristics should be carried out for each patient preoperatively. Baseline EF, together with age and the overall burden of comorbidities, has been strongly associated with the chance of post-RP EF recovery. With this goal in mind, internationally validated psychometric instruments are preferable for ensuring proper baseline EF evaluations, and questionnaires should be administered at the proper time before surgery. Careful preoperative counselling is also required, both to respect the patient's wishes and to avoid false expectations regarding eventual recovery of baseline EF. The advent of robotic surgery has led to improvements in the knowledge of prostate surgical anatomy, as reflected by the formal redefinition of nerve-sparing techniques. Overall, comparative studies have shown significantly better EF outcomes for robotic RP than for open techniques, although data from prospective trials have not always been consistent. Preclinical data and several prospective randomized trials have demonstrated the value of treating patients with oral phosphodiesterase 5 inhibitors (PDE5is) after surgery, with the concomitant potential benefit of early re-oxygenation of the erectile tissue, which appears to be crucial for avoiding the eventual penile structural changes that are associated with postoperative neuropraxia and ultimately result in severe ED. For patients who do not properly respond to PDE5is, proper counselling regarding intracavernous treatment should be considered, along with the further possibility of surgical treatment for ED involving the implantation of a penile prosthesis.
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Affiliation(s)
- Paolo Capogrosso
- Università Vita-Salute San Raffaele; Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- Università Vita-Salute San Raffaele; Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Università Vita-Salute San Raffaele; Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Università Vita-Salute San Raffaele; Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
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38
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[Rehabilitation of prostate cancer patients : A multidisciplinary consensus]. Urologe A 2016; 55:933-9. [PMID: 27246473 DOI: 10.1007/s00120-016-0122-5] [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: 10/21/2022]
Abstract
BACKGROUND Even though several specialist groups, including the German Pension Insurance (Deutsche Rentenversicherung) and health insurance funds, participate in the rehabilitation of patients with prostate carcinoma, there is no standardized rehabilitation program available for these patients. Consequently, there is no transparency regarding the services provided within the scope of rehabilitation for the referring physicians to uro-oncological rehabilitation, in particular, neither for physicians at urological acute-care clinics, nor for the patients concerned. Rehabilitation clinics are rather left to their own devices as to which services they provide in the treatment of the respective disease and in social situations, but also with regard to the consulting services offered. PROBLEM Development of a standard for the rehabilitation of patients with prostate carcinoma, taking into account both specialist circles and self-help groups relevant to this matter. METHODS Specialist groups, including self-help groups participating in the rehabilitation of patients with prostate cancer, have formed an expert group and developed the present standard. To this end, a thematic unsystematic literature review was carried out in advance to provide an evidence-based foundation. RESULTS Views were given with regard to rehabilitation diagnostics, the therapy of urinary incontinence and erectile dysfunction, sport and physical exercise therapy, psycho-oncology, and social- and disease-related consulting. In this context, the focus was set on classification as well as on the consensus strength of the respective recommendations. CONCLUSION All parties involved in the rehabilitation of prostate cancer patients, as well as the patients and the responsible cost bearers, can now use the standard as an orientation guide.
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Nason GJ, McNamara F, Twyford M, O'Kelly F, White S, Dunne E, Durkan GC, Giri SK, Smyth GP, Power RE. Efficacy of vacuum erectile devices (VEDs) after radical prostatectomy: the initial Irish experience of a dedicated VED clinic. Int J Impot Res 2016; 28:205-208. [PMID: 27225711 DOI: 10.1038/ijir.2016.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 03/15/2016] [Accepted: 04/24/2016] [Indexed: 01/07/2023]
Abstract
Controversy exists regarding optimal penile rehabilitation program following radical prostatectomy (RP). Vacuum erectile devices (VEDs) have become an important component of penile rehabilitation protocols. The aim of this study was to assess the efficacy and patient satisfaction of a dedicated VED clinic. A voluntary telephone questionnaire was performed of all patients who attended a VED clinic to date in two university teaching hospitals. Patient demographics, histopathological characteristics and functional status (International Index of Erectile Function (IIEF) scores) were obtained from a retrospective review of a prospectively maintained database. Sixty-five men attended the dedicated VED clinic in the two university teaching hospitals. Forty-men (76.3%) men purchased a VED following the dedicated clinic. There was significant differences noted between the mean preoperative and the 3-month postoperative IIEF scores (22.08±3.16 vs 11.3±3.08, P=0.0001) and between the 3-month postoperative IIEF score and the post-VED use IIEF score (11.3±3.08 vs 16.74±2.62, P=0.0001). Despite VED use, there was a significant reduction in erectile function from presurgery status (22.08±3.16 vs 16.74±2.62, P=0.0001). All patients reported that the dedicated VED was helpful and would recommend it to other patients. Our study demonstrates that, despite a reduction in erectile function after RP, successful erections are attainable with a VED. There is potential and need for the development of a standard penile rehabilitation program and treatment of ED after RP internationally.
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Affiliation(s)
- G J Nason
- Department of Urology, Beaumont Hospital, Dublin, Ireland
| | - F McNamara
- Department of Urology, Beaumont Hospital, Dublin, Ireland.,Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - M Twyford
- Department of Urology, Beaumont Hospital, Dublin, Ireland
| | - F O'Kelly
- Department of Urology, Beaumont Hospital, Dublin, Ireland
| | - S White
- Department of Urology, Beaumont Hospital, Dublin, Ireland
| | - E Dunne
- Department of Urology, Beaumont Hospital, Dublin, Ireland
| | - G C Durkan
- Department of Urology, University Hospital Limerick, Limerick, Ireland.,Department of Urology, University College Hospital Galway, Galway, Ireland
| | - S K Giri
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - G P Smyth
- Department of Urology, Beaumont Hospital, Dublin, Ireland
| | - R E Power
- Department of Urology, Beaumont Hospital, Dublin, Ireland
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Schauer I, Keller E, Müller A, Madersbacher S. Have rates of erectile dysfunction improved within the past 17 years after radical prostatectomy? A systematic analysis of the control arms of prospective randomized trials on penile rehabilitation. Andrology 2016. [PMID: 26198796 DOI: 10.1111/andr.12060] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Based on case series, potency rates after radical prostatectomy (RPE) differ substantially and - furthermore - it remains unclear whether they have improved in more recent surgical series. The purpose of this study was to investigate whether potency rates after RPE have improved over the years. A systematic analysis of the control arms of all randomized controlled trials (RCT; n = 11) on penile rehabilitation after RPE was carried out. In total, 2009 patients were included in these RCTs, 685 thereof in the respective control arms, who were either observed or received placebo. Assessment of erectile function in these studies was carried out by the Sexual Encounter Profile (SEP) or the International Index of Erectile Function (IIEF). Eight trials used SEP3 as study endpoint. The rate of positive response to SEP3 (=erectile function sufficient for successful intercourse) in the control arms was 20% in 1997 (year of publication), 10% in 2003, 19% in 2004, 25% in 2008, 21% in 2010, 67% in 2011, 10% in 2013, and 22% in 2014. Eight RCTs assessed the IIEF-EF, yet results were not reported uniformly. In the control arms the IIEF-EF was 9.2 (year of publication 2003), 13.3 (2004), 8.8 (2008), 25% ≥22.0 (2008), 17.4 (2010), 58% ≥26.0 (2011), 9.3 (2013), and 11.6 (2014). Limitations of this analysis are a positive selection bias regarding patient recruitment, surgical approach, and the non-uniform inclusion and outcome criteria. This systematic analysis of the control arms of all RCTs on penile rehabilitation after nerve-sparing RPE shows (i) that the rate of undisturbed erectile function is in the range 20-25% in most studies and (ii) that these rates have not substantially improved or changed over the past 17 years.
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Affiliation(s)
- I Schauer
- Department of Urology, Kaiser-Franz-Josef Hospital, Vienna, Austria
| | - E Keller
- Department of Urology, University Hospital Zürich, Zürich, Switzerland
| | - A Müller
- Department of Urology, University Hospital Zürich, Zürich, Switzerland
| | - S Madersbacher
- Department of Urology, Kaiser-Franz-Josef Hospital, Vienna, Austria
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Hotta Y, Ieda N, Fukamoto A, Kataoka T, Kawade Y, Maeda Y, Nakagawa H, Kimura K. Light-controlled relaxation of the rat penile corpus cavernosum using NOBL-1, a novel nitric oxide releaser. Investig Clin Urol 2016; 57:215-20. [PMID: 27195321 PMCID: PMC4869565 DOI: 10.4111/icu.2016.57.3.215] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 03/23/2016] [Indexed: 11/29/2022] Open
Abstract
Purpose To investigate whether relaxation of the rat penile corpus cavernosum could be controlled with NOBL-1, a novel, light-controllable nitric oxide (NO) releaser. Materials and Methods Fifteen-week-old male Wistar-ST rats were used. The penile corpus cavernosum was prepared and used in an isometric tension study. After noradrenaline (10-5 M) achieved precontraction, the penile corpus cavernosum was irradiated by light (470–500 nm) with and without NOBL-1 (10-6 M). In addition, we noted rats' responses to light with vardenafil (10-6 M), a phosphodiesterase-5 (PDE-5) inhibitor. Next, responses to light in the presence of a guanylate cyclase inhibitor, ODQ (1H-[1,2,4] oxadiazolo[4,3-a]quinoxalin-1-one) (10-5 M), were measured. All measurements were performed in pretreated L-NAME (10-4 M) conditions to inhibit endogenous NO production. Results Corpus cavernosal smooth muscle, precontracted with noradrenaline, was unchanged by light irradiation in the absence of NOBL-1. However, in the presence of NOBL-1, corpus cavernosal smooth muscle, precontracted with noradrenaline, relaxed in response to light irradiation. After blue light irradiation ceased, tension returned. In addition, the light response was obviously enhanced in the presence of a PDE-5 inhibitor. Conclusions This study showed that rat corpus cavernosal smooth muscle relaxation can be light-controlled using NOBL-1, a novel, light sensitive NO releaser. Though further in vivo studies are needed to investigate possible usefulness, NOBL-1 may be prove to be a useful tool for erectile dysfunction therapy, specifically in the field of penile rehabilitation.
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Affiliation(s)
- Yuji Hotta
- Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan
| | - Naoya Ieda
- Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan
| | - Ayako Fukamoto
- Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan
| | - Tomoya Kataoka
- Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Yoshihiro Kawade
- Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan
| | - Yasuhiro Maeda
- Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan
| | - Hidehiko Nakagawa
- Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan
| | - Kazunori Kimura
- Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan.; Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
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42
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El-Sakka AI. What is the current role of intracavernosal injection in management of erectile dysfunction? Int J Impot Res 2016; 28:88-95. [DOI: 10.1038/ijir.2016.14] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 11/14/2015] [Accepted: 03/14/2016] [Indexed: 12/15/2022]
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43
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Erection rehabilitation following prostatectomy — current strategies and future directions. Nat Rev Urol 2016; 13:216-25. [DOI: 10.1038/nrurol.2016.47] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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44
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Core principles of sexual health treatments in cancer for men. Curr Opin Support Palliat Care 2016; 10:38-43. [PMID: 26814146 DOI: 10.1097/spc.0000000000000183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The considerable prevalence of sexual health problems in men after cancer treatment coupled with the severity of impact and challenges to successful intervention make sexual dysfunction one of the most substantial health-related quality of life burdens in all of cancer survivorship. Surgeries, radiation therapies, and nontreatment (e.g., active surveillance) variously result in physical disfigurement, pain, and disruptions in physiological, psychological, and relational functioning. Although biomedical and psychological interventions have independently shown benefit, long-term, effective treatment for sexual dysfunction remains elusive. RECENT FINDINGS Recognizing the complex nature of men's sexual health in an oncology setting, there is a trend toward the adoption of a biopsychosocial orientation that emphasizes the active participation of the partner, and a broad-spectrum medical, psychological, and social approach. Intervention research to date provides good insight into the potential active ingredients of successful sexual rehabilitation programming. SUMMARY Combining a biopsychosocial approach with these active intervention elements forecasts an optimistic future for men's sexual rehabilitation programming within oncology. However, significant gaps remain in our understanding of patient experience and appropriate sexual health intervention for gay men and men of diverse race and culture.
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45
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Jenkins LC, Mulhall JP. Impact of Prostate Cancer Treatments on Sexual Health. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00062-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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46
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Kim DJ, Hawksworth DJ, Hurwitz LM, Cullen J, Rosner IL, Lue TF, Dean RC. A prospective, randomized, placebo-controlled trial of on-Demand vs. nightly sildenafil citrate as assessed by Rigiscan and the international index of erectile function. Andrology 2015; 4:27-32. [DOI: 10.1111/andr.12118] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 08/15/2015] [Accepted: 09/06/2015] [Indexed: 01/01/2023]
Affiliation(s)
- D. J. Kim
- Department of Urology; Walter Reed National Military Medical Center; Bethesda MD USA
| | - D. J. Hawksworth
- Department of Urology; Fort Belvoir Community Hospital; Fort Belvoir VA USA
| | - L. M. Hurwitz
- Center for Prostate Cancer Disease Research; Rockville MD USA
| | - J. Cullen
- Center for Prostate Cancer Disease Research; Rockville MD USA
- Department of Surgery; Uniformed Services University; Bethesda MD USA
| | - I. L. Rosner
- Department of Urology; Walter Reed National Military Medical Center; Bethesda MD USA
- Center for Prostate Cancer Disease Research; Rockville MD USA
- Department of Surgery; Uniformed Services University; Bethesda MD USA
| | - T. F. Lue
- Department of Urology; UCSF Medical Center; San Francisco CA USA
| | - R. C. Dean
- Department of Urology; Walter Reed National Military Medical Center; Bethesda MD USA
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47
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48
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Culha MG, Pastuszak A, Serefoglu EC. Re: Effect of Tadalafil Once Daily on Penile Length Loss and Morning Erections in Patients After Bilateral Nerve-sparing Radical Prostatectomy: Results From a Randomized Controlled Trial (Urology 2015;85:1090-1096). Urology 2015; 86:1242-3. [PMID: 26404057 DOI: 10.1016/j.urology.2015.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 08/02/2015] [Accepted: 08/03/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Mehmet Gokhan Culha
- Department of Urology Istanbul Training and Research Hospital Istanbul, Turkey
| | - Alexander Pastuszak
- Department of Urology Bağcilar Training and Research Hospital Istanbul, Turkey
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49
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Survey of the Literature for September 2015 Issue of Sexual Medicine Journal. Sex Med 2015. [PMCID: PMC4599550 DOI: 10.1002/sm2.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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50
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Goncalves P, Groninger H. Sexual Dysfunction in Cancer Patients and Survivors #293. J Palliat Med 2015; 18:714-5. [DOI: 10.1089/jpm.2015.0207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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