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Moon HW, Kim IG, Kim MY, Jung AR, Park K, Lee JY. Erectile Dysfunction Treatment Using Stem Cell Delivery Patch in a Cavernous Nerve Injury Rat Model. Bioengineering (Basel) 2023; 10:635. [PMID: 37370566 DOI: 10.3390/bioengineering10060635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Erectile dysfunction (ED) is a common and feared complication of radical prostatectomy (RP) for prostate cancer. Recently, tissue engineering for post-prostatectomy ED has been attempted in which controlled interactions between cells, growth factors, and the extracellular matrix (ECM) are important for the structural integrity if nerve regeneration. In this study, we evaluated the effects of a biomechanical ECM patch on the morphology and behavior of human bone marrow-derived mesenchymal stem cells (hBMSCs) in a bilateral cavernous nerve injury (BCNI) rat model. The ECM patch, made of decellularized human fibroblast-derived ECM (hFDM) and a biocompatible polyvinyl alcohol (PVA) hydrogel, was tested with human bone marrow-derived mesenchymal stem cells (hBMSCs) on a bilateral cavernous nerve injury (BCNI) rat model. In vitro analysis showed that the hFDM/PVA + hBMSCs patches significantly increased neural development markers. In vivo experiments demonstrated that the rats treated with the hFDM/PVA patch had higher ICP/MAP ratios, higher ratios of smooth muscle to collagen, increased nNOS content, higher levels of eNOS protein expression, and higher cGMP levels compared to the BCNI group. These results indicate that the hFDM/PVA patch is effective in promoting angiogenesis, smooth muscle regeneration, and nitrergic nerve regeneration, which could contribute to improved erectile function in post-prostatectomy ED.
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Affiliation(s)
- Hyong Woo Moon
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - In Gul Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Mee Young Kim
- Catholic Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Ae Ryang Jung
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Kwideok Park
- Center for Biomaterials, Korea Institute of Science and Technology (KIST), Seoul 02792, Republic of Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Catholic Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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2
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Bernal J, Venkatesan K, Martins FE. Erectile Dysfunction in Pelvic Cancer Survivors and Current Management Options. J Clin Med 2023; 12:jcm12072697. [PMID: 37048780 PMCID: PMC10095222 DOI: 10.3390/jcm12072697] [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: 01/17/2023] [Revised: 03/18/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
Pelvic malignancies, including prostate, rectal, and bladder cancers, are among the most frequent malignancies found in the male population. These issues are most effectively and commonly treated with radiotherapy and/or surgery. However, these treatments can cause collateral damage, resulting in significant impacts on quality of life, with erectile dysfunction being one of the most frequent postoperative complications. Currently, there are several treatment options for erectile dysfunction, including oral phosphodiesterase type 5 inhibitors, vacuum erection devices, intracorporeal injections, and penile prosthesis. The latter has shown to be an effective and safe technique, with results comparable to those obtained by patients without pelvic surgery or radiotherapy. The results of early penile rehabilitation programs are promising and they have been incorporated into a greater proportion of treatment plans more recently, with varying degrees of success. In this narrative review, we summarize the literature on erectile dysfunction after pelvic cancer treatments and its management.
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Affiliation(s)
- Jose Bernal
- Department of Urology, Hospital Sotero del Rio/Clinica Indisa, Santiago 13123, Chile
| | - Krishnan Venkatesan
- Department of Urology, MedStar Washington Hospital Center, Washington, DC 20010, USA
| | - Francisco E Martins
- Department of Urology, School of Medicine, University of Lisbon, Hospital Santa Maria, 1649-035 Lisbon, Portugal
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3
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Schmid FA, Poyet C, Rizzi G, Gomolka RS, Donati OF, Hötker AM, Eberli D. Dynamic contrast enhancement in prostate MRI as predictor of erectile function and recovery after radical prostatectomy. Aging Male 2020; 23:1518-1526. [PMID: 33252281 DOI: 10.1080/13685538.2020.1815695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To analyze routine preoperative prostate MRI to predict erectile function (EF) before and after radical prostatectomy (RP). METHODS Patients who underwent RP with an existing preoperative MRI including dynamic contrast-enhanced images and completed International Index of Erectile Function (IIEF-5) questionnaires at baseline and 12 months postoperative. They were divided into four erectile dysfunction (ED) groups according to preoperative IIEF-5 score. The perfusion quality was measured in the peripheral zone of the prostate by the ratio of signal increase 120 s after wash-in of contrast agent (Ratio120) in preoperative MRI and compared between the ED groups. RESULTS Ratio120 showed differences among the preoperative ED groups (p = .020) in 97 patients. According to IIEF-5 at 12 months postoperative, 43 patients were dichotomized into "no to mild" (≥17 points) and "moderate to severe" (≤16) ED groups. Ratio120 revealed differences among the postoperative ED groups (128.84% vs. 101.95%; p = .029) and stayed an independent predictor for ED in the multivariable regression analysis (adjusted for age, nerve-sparing and preoperative IIEF-5). ROC curves demonstrated an additional diagnostic benefit. CONCLUSIONS Preoperative MRI of the prostate may be used for the prediction of EF and postsurgical recovery after RP. This may serve as important tool in preoperative patient counseling and management of expectations.
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Affiliation(s)
- Florian A Schmid
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Cédric Poyet
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Gianluca Rizzi
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Richard S Gomolka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Olivio F Donati
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas M Hötker
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
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Arousal Incontinence in Men Following Radical Prostatectomy: Prevalence, Impact and Predictors. J Sex Med 2019; 16:1947-1952. [PMID: 31735611 DOI: 10.1016/j.jsxm.2019.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/14/2019] [Accepted: 09/21/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Arousal incontinence (AI) occurs during physical or psychological sexual stimulation in men and has been described after radical prostatectomy (RP). AIM The goals of this study are to describe the characteristics of men experiencing AI, outline the nature of their symptoms, and assess for predictors of this condition. METHODS A survey with questions on AI, stress urinary incontinence (SUI), the International Index of Erectile Function and International Prostate Symptom Score were sent out to men who had undergone an RP within the past 24 months at a single institution. The data were deidentified and analyzed using descriptive statistics. Comparisons between men with and without AI were made using t-tests and χ2 and Fisher exact tests. Logistic regression in univariable and multivariable analyses were used to define predictors of AI. MAIN OUTCOME MEASURES The outcomes of this study included prevalence of AI, symptom severity and timing, patient and patient-perceived partner bother, management strategies used by the patients, and concurrent SUI. RESULTS 226 (32%) men completed the survey. Of these men, almost half (49%) experienced AI at some point during their recovery. Improvement over time was endorsed by 62% of men. 57% of men reported AI in less than half of the sexual encounters, with the amount of urine leakage being equivalent to a tablespoon or less in 88% of men. On univariate analysis, increasing degree of SUI, as measured by pads per day, was associated with AI (P = .01). A lower International Prostate Symptom Score was also associated (P = .05). On multivariate analysis, the absence of hypertension and pads per day were associated with AI (P = .01 for both). CLINICAL IMPLICATIONS AI occurred in almost half of the respondents in our series. Thus, AI should be discussed with patients before surgery to allow for realistic expectations. STRENGTHS & LIMITATIONS Strengths of this study include the largest patient population analyzed to date regarding AI and that it is the only one to address timing and patient experiences with the use of validated instruments for erectile and urinary function. Limitations include single-center data, non-validated AI patient-reported outcomes, and poor survey response rate. CONCLUSION Based on the available data, AI is reported by almost half of men after RP and is associated with SUI. Bach PV, Salter CA, Katz D, et al. Arousal Incontinence in Men Following Radical Prostatectomy: Prevalence, Impact and Predictors. J Sex Med 2020;16:1947-1952.
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Cozzi G, Musi G, Monturano M, Bagnardi V, Frassoni S, Jereczek-Fossa BA, Ferro M, Bianchi R, Mistretta FA, de Cobelli O. Sexual function recovery after robot-assisted radical prostatectomy: Outcomes from an Italian referral centre and predicting nomogram. Andrologia 2019; 51:e13385. [PMID: 31423619 DOI: 10.1111/and.13385] [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] [Received: 05/16/2019] [Revised: 06/20/2019] [Accepted: 07/10/2019] [Indexed: 11/27/2022] Open
Abstract
Aims of this study were to assess sexual recovery after robotic-assisted radical prostatectomy (RARP) and to build a nomogram predicting 1-year sexual function. From May 2015 to July 2016, all patients eligible for RARP at our institution were invited to enter the study. The Expanded Prostate cancer Index Composite (EPIC) questionnaire was administered pre-operatively, then at 45 days, and at 3, 6, 9, and 12 months post-operatively. According to sexual function scores, patients were divided into four classes. Multivariate analysis was used to investigate the influence of patient- and disease-related features on sexual recovery. A total of 643 patients were included. Age was associated with baseline potency (p < .0001). Bioptic Gleason score (GS; p = .0002), American Society of Anesthesiologists (ASA) score ( = .002ASA Physical Status Classification System ) and Charlson Comorbidity Index (CCI; p = .02) were negatively associated with potency. Baseline sexual function was associated with potency recovery. A nomogram resulted from fitting a proportional odds logistic model for ordinal outcomes, with 1-year sexual function as a dependent variable and baseline sexual potency, age, body mass index (BMI), clinical stage, biopsy GS, initial prostate-specific antigen (iPSA), ASA score, and CCI as predictors. After further validation, this nomogram could be a useful tool for the pre-operative counselling.
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Affiliation(s)
- Gabriele Cozzi
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Gennaro Musi
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Massimo Monturano
- Risk Management Service, European Institute of Oncology, IRCCS, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Barbara A Jereczek-Fossa
- Division of Radiotherapy, European Institute of Oncology, IRCCS, Milan, Italy.,Università Degli Studi Di Milano, Milan, Italy
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Roberto Bianchi
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Francesco A Mistretta
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy.,Università Degli Studi Di Milano, Milan, Italy
| | - Ottavio de Cobelli
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy.,Università Degli Studi Di Milano, Milan, Italy
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Bajpai RR, Razdan S, Sanchez MA, Razdan S. A novel intraoperative physician-assigned grading score to predict postoperative return of potency at 1 year after robotic-assisted laparoscopic prostatectomy. INDIAN JOURNAL OF UROLOGY : IJU : JOURNAL OF THE UROLOGICAL SOCIETY OF INDIA 2019; 35:61-66. [PMID: 30692726 PMCID: PMC6334588 DOI: 10.4103/iju.iju_158_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction: We examined a novel method of grading nerve sparing in robotic-assisted laparoscopic radical prostatectomy to better predict the potency outcomes of patients at 1-year after surgery. This grading (scale) was based on the surgeon's criteria of intraoperative findings during completion of nerve sparing. This grading was then analyzed statistically to validate its association with potency outcomes. Methods: We devised a study module based on measurable visual cues intraoperatively where the surgeon risk stratified the surgery into four grades depending on the completeness of nerve sparing, keeping in mind the known parameters influencing potency outcomes. A novel grading scale was then proposed and used in this study for the same. We prospectively collected data and retrospectively analyzed 425 patients undergoing robotic-assisted laparoscopic prostatectomy (RALP) at a high-volume center by a single surgeon. Results: At 1 year of follow-up, it was found that age, laterality of nerve preservation, weight of prostate, and the surgeon-assigned grading were all statistically significant independent predictors of return of potency in terms of satisfactory penetrative intercourse >50% of times and Sexual Health Inventory for Men ≥17. However, prostate-specific antigen was found not to be a predictor of the same. Conclusions: Intraoperative physician-assigned grading was found to be the single most significant predictor of the return of potency at 1-year post-RALP.
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Affiliation(s)
- Rajesh R Bajpai
- Department of Urology, Larkin Community Hospital, Miami, FL, USA
| | - Shirin Razdan
- Department of Urology, Ichan School of Medicine at Mount Sinai Hospital, New York, USA
| | - Marcos A Sanchez
- Department of Urology, Larkin Community Hospital, Miami, FL, USA
| | - Sanjay Razdan
- Department of Urology, Larkin Community Hospital, Miami, FL, USA
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Clavell-Hernandez J, Ermeç B, Kadıoğlu A, Wang R. Perplexity of penile rehabilitation following radical prostatectomy. Turk J Urol 2019; 45:77-82. [PMID: 30875285 DOI: 10.5152/tud.2019.18488] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/28/2018] [Indexed: 12/15/2022]
Abstract
Radical prostatectomy has significantly improved prostate cancer survival rates but continues to have a negative impact on the patient's erectile function (EF). In attempts to improve erectile dysfunction (ED), clinicians have incorporated different treatment modalities to restore EF. Penile rehabilitation consists of understanding the mechanisms that affect post-prostatectomy EF and utilizing pharmacologic agents, devices, and interventions to promote the male sexual function. This article aims to summarize the available scientific research involving penile rehabilitation. Even though the current literature lacks to prove its irrefutable effectiveness, penile rehabilitation has a positive impact at the molecular and cellular levels, and it is widely adopted in clinic practices.
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Affiliation(s)
| | - Bahadır Ermeç
- Department of Urology İstinye State Hospital, İstanbul, Turkey
| | - Ateş Kadıoğlu
- Department of Urology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Run Wang
- Department of Surgery, Division of Urology, University of Texas Health Science Center- McGovern Medical School at Houston, Houston, Texas, USA.,University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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8
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Predicting erectile function following external beam radiation therapy or brachytherapy for prostate cancer using EPIC-CP. Pract Radiat Oncol 2018; 8:445-451. [DOI: 10.1016/j.prro.2018.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/13/2018] [Accepted: 04/11/2018] [Indexed: 11/24/2022]
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9
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Coman RT, Crisan N, Andras I, Bud G, Matei DV, DE Cobelli O, Coman I, Bocsan IS. Outcomes of robotic-assisted radical prostatectomy for patients in two extreme age-groups (< 50 years vs > 65 years). Med Pharm Rep 2018; 91:92-97. [PMID: 29440957 PMCID: PMC5808275 DOI: 10.15386/cjmed-825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/05/2017] [Indexed: 11/24/2022] Open
Abstract
Background and aims To assess the outcomes of robotic radical prostatectomy in two different age subgroups of pre-operatively potent patients: younger than 50 years and older than 65 years. Methods We included in the present study a number of 202 patients with prostate cancer divided into two groups: 99 patients older than 65 years (group 1) and 103 patients younger than 50 years (group 2). Results More than half of the younger patients were low-risk vs 57% of the older patients who were high-risk. Overall positive surgical margins rate was 21.2% in group 1 vs 12.1% in group 2. The early biochemical recurrence at 6 months after radical prostatectomy was 4% in group 1 vs 11.6% in group 2. The continence rate at 6 months was similar between the two groups and was not correlated with the patients’ age (p=0.72), nerve-sparing (p=0.3 for group 1, p=0.92 for group 2) or pathological staging (overall p=0.81, p=0.89 in group 1 and p=0.63 in group 2). We observed a significantly higher rate of potency for patients in group 2 (91.5% vs 47.2%, p<0.0001). The most important factor associated with the regain of potency at 6 months after the procedure was the age of the patient (p<0.0001), independently of the type of nerve-sparing performed. Conclusions Age seems to be the most important predictor of the regain of potency after robotic radical prostatectomy. Patients should be counseled accordingly in order to have realistic expectations about the functional results after robotic-assisted surgery.
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Affiliation(s)
- Radu-Tudor Coman
- Epidemiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Nicolae Crisan
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Urology Department, Clinical Municipal Hospital Cluj-Napoca, Romania
| | - Iulia Andras
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Urology Department, Clinical Municipal Hospital Cluj-Napoca, Romania
| | - Gabriela Bud
- Urology Department, Clinical Municipal Hospital Cluj-Napoca, Romania
| | | | | | - Ioan Coman
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Urology Department, Clinical Municipal Hospital Cluj-Napoca, Romania
| | - Ioan-Stelian Bocsan
- Epidemiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Yumioka T, Honda M, Kimura Y, Yamaguchi N, Iwamoto H, Morizane S, Hikita K, Takenaka A. Influence of multinerve-sparing, robot-assisted radical prostatectomy on the recovery of erection in Japanese patients. Reprod Med Biol 2017; 17:36-43. [PMID: 29371819 PMCID: PMC5768978 DOI: 10.1002/rmb2.12063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 08/13/2017] [Indexed: 12/20/2022] Open
Abstract
Purpose To evaluate in Japanese patients their sexual function after robot‐assisted radical prostatectomy (RARP) and to investigate the influence of the multinerve‐sparing (NS) grade on their sexual function. Methods In total, 225 patients were reviewed with localized prostate cancer who underwent RARP at the authors' institution. They underwent RARP >3 months ago, without pre‐ and posthormone therapy and salvage radiation. Self‐administered International Index of Erectile Function (IIEF) questionnaires were used for assessment preoperatively and 1–48 months postoperatively. In all, 129 patients were evaluated with the preoperative IIEF‐Question 1 and who achieved a score of ≥2 by being divided into five NS groups. The recovery rates of erection (postoperative IIEF‐Question 1 score of ≥2) were calculated by using the Kaplan–Meier analysis. Results Seventy‐four percent of all the patients had not attempted sexual intercourse, but 60% had felt sexual desire at 24 months postoperatively. In those patients with a preoperative erection, the recovery rate of erection was 58% at 24 months after the RARP. Across the five NS groups, as the procedure was more nerve‐sparing, the recovery rate of erection became significantly higher. The postoperative effects on erection in the bilateral and unilateral NS groups were significantly superior to those in the other NS groups. Conclusion In Japanese patients, erection after a RARP is improved with multiNS grade procedures.
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Affiliation(s)
- Tetsuya Yumioka
- Department of Urology Tottori University Faculty of Medicine Yonago Japan
| | - Masashi Honda
- Department of Urology Tottori University Faculty of Medicine Yonago Japan
| | - Yusuke Kimura
- Department of Urology Tottori University Faculty of Medicine Yonago Japan
| | - Noriya Yamaguchi
- Department of Urology Tottori University Faculty of Medicine Yonago Japan
| | - Hideto Iwamoto
- Department of Urology Tottori University Faculty of Medicine Yonago Japan
| | - Shuichi Morizane
- Department of Urology Tottori University Faculty of Medicine Yonago Japan
| | - Katsuya Hikita
- Department of Urology Tottori University Faculty of Medicine Yonago Japan
| | - Atsushi Takenaka
- Department of Urology Tottori University Faculty of Medicine Yonago Japan
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Low-intensity shockwave therapy for erectile dysfunction: is the evidence strong enough? Nat Rev Urol 2017; 14:593-606. [DOI: 10.1038/nrurol.2017.119] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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12
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Akinola O, Ginsburg L, Welliver C, Mechlin CW, Fisher HAG, Mian BM, Kaufman RP, McCullough AR. Preoperative PDE5i use is a prognostic metric for poor postoperative erectile function in men undergoing radical prostatectomy: An addition to patient counseling. JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415815612630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: In patients scheduled for radical prostatectomies (RP), preoperative (pre-op) erectile function (EF) characterization may be complicated by social and medical factors. We investigated pre-op use of phosphodiesterase type 5 inhibitor (PDE5i) as a simple metric for predicting long-term postoperative EF. Materials and methods: Electronic medical records (EMRs) for consecutive men who underwent RP between January 2004 and March 2009 at our institution were retrospectively reviewed. Data extracted included demographics, pre-op PDE5i use, cancer treatment details, post-op EF and ED treatment. Predictor variable data were categorical pre-op PDE5i use (pre-op PDE5i use vs. pre-op PDE5i naïve). ANOVA and Chi squared test were used. Results: A total of 250 individuals out of 436 charts met inclusion criteria. Mean follow-up length was 4.2 years (range 2–7). Thirty-seven men (15%) used PDE5i preoperatively. There were no differences in mean age at RP, type of nerve-sparing surgery (NSS), or medical comorbidities between groups. No men with pre-op PDE5i use regained unassisted EF but 37% regained PDE5i-assisted EF after bilateral nerve sparing (BNS). No men with pre-op PDE5i use regained unassisted or PDE5i-assisted EF after unilateral (UNS) or non-nerve-sparing surgery (NNS). Conclusions: Pre-op PDE5i use predicts poor long-term EF outcomes after RP and should be included in pre-op patient counseling.
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13
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Løvvik A, Müller S, Patel HRH. Pharmacological Treatment of Post-Prostatectomy Incontinence: What is the Evidence? Drugs Aging 2016; 33:535-44. [DOI: 10.1007/s40266-016-0388-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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14
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Mulhall JP, Brock G, Oelke M, Fode M, Probst KA, Henneges C, d'Anzeo G, Rossi A, Büttner H. Effects of Tadalafil Once-Daily or On-Demand vs Placebo on Return to Baseline Erectile Function After Bilateral Nerve-Sparing Radical Prostatectomy--Results from a Randomized Controlled Trial (REACTT). J Sex Med 2016; 13:679-83. [PMID: 27045264 DOI: 10.1016/j.jsxm.2016.01.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/27/2016] [Accepted: 01/30/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND AIM The multicenter, randomized, double-blind, double-dummy, placebo-controlled REACTT trial suggested that treatment with tadalafil once daily (OaD) started early after bilateral nerve-sparing radical prostatectomy (nsRP) for prostate cancer may contribute to erectile function (EF)-recovery, which was predefined as achieving an International Index of Erectile Function (IIEF)-EF score ≥22. Here, we report descriptive post-hoc analyses, using the more strict definition for EF-recovery of returning back to the pre-surgery IIEF-EF-level ("back-to-baseline analysis"). METHODS REACTT included 422 men <68 years with adenocarcinoma of the prostate and preoperative IIEF-EF ≥22 who underwent nsRP at 50 centers from 9 European countries and Canada. Patients were randomized post-nsRP 1:1:1 to 9-month double-blind treatment (DBT) with tadalafil 5 mg OaD (n = 139), tadalafil 20 mg on-demand (pro-re-nata, PRN; n = 142), or placebo (n = 141), followed by 6-week drug-free washout (DFW) and 3-month open-label tadalafil OaD treatment (OLT). MAIN OUTCOME MEASURES Proportion of patients returning to their preoperative IIEF-EF category (22-25 or ≥26) at the end of DBT, DFW, and OLT. RESULTS Overall, 92.4% of patients had pre-surgery (baseline) IIEF-EF scores ≥26 (tadalafil OaD 94.2%, PRN 91.6%, placebo 91.5%), 7.4% had IIEF-EF 22-25. At the end of DBT, 22.3% of patients on tadalafil OaD had achieved "back-to-baseline" IIEF-EF, compared with 11.3% on tadalafil PRN and 7.8% on placebo. Of all 58 patients "back-to-baseline" at the end of DBT, only 1 PRN-group patient had started from a baseline IIEF-EF <26. The treatment-group difference at the end of DBT was not maintained after DFW. After 3 months of OLT with tadalafil OaD, the proportion of patients with "back-to-baseline" IIEF-EF had almost doubled in all 3 groups. CONCLUSION Changing the definition for EF-recovery from IIEF-EF ≥22 to the more strict definition of "returning back-to-baseline IIEF-EF" had no major impact. Tadalafil OaD started early after nsRP improved drug-assisted EF, but had no effect on unassisted EF following treatment cessation after 9 months.
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Affiliation(s)
- John P Mulhall
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Gerald Brock
- Division of Urology, Department of Surgery, University of Western Ontario, London, Ontario, Canada.
| | - Matthias Oelke
- Department of Urology and Urological Oncology, Hannover Medical School, Hannover, Germany
| | - Mikkel Fode
- Department of Urology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Kai A Probst
- Department of Urology, Saarland University Medical Center, Homburg, Saar, Germany
| | - Carsten Henneges
- Global Statistical Sciences, EU Statistics, Lilly Deutschland GmbH, Bad Homburg, Germany
| | | | - Andrea Rossi
- Medical Department, Eli Lilly S.p.A., Florence, Italy
| | - Hartwig Büttner
- Biomedicines BU, Lilly Deutschland GmbH, Bad Homburg, Germany
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Miyake H, Miyazaki A, Yao A, Hinata N, Fujisawa M. Significance of erection hardness score as a diagnostic tool to assess erectile function recovery in Japanese men after robot-assisted radical prostatectomy. J Robot Surg 2016; 10:221-6. [DOI: 10.1007/s11701-016-0571-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/06/2016] [Indexed: 11/28/2022]
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Montorsi F, Oelke M, Henneges C, Brock G, Salonia A, d'Anzeo G, Rossi A, Mulhall JP, Büttner H. Exploratory Decision-Tree Modeling of Data from the Randomized REACTT Trial of Tadalafil Versus Placebo to Predict Recovery of Erectile Function After Bilateral Nerve-Sparing Radical Prostatectomy. Eur Urol 2016; 70:529-37. [PMID: 26947602 DOI: 10.1016/j.eururo.2016.02.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 02/11/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Understanding predictors for the recovery of erectile function (EF) after nerve-sparing radical prostatectomy (nsRP) might help clinicians and patients in preoperative counseling and expectation management of EF rehabilitation strategies. OBJECTIVE To describe the effect of potential predictors on EF recovery after nsRP by post hoc decision-tree modeling of data from A Study of Tadalafil After Radical Prostatectomy (REACTT). DESIGN, SETTING, AND PARTICIPANTS Randomized double-blind double-dummy placebo-controlled trial in 423 men aged <68 yr with adenocarcinoma of the prostate (Gleason ≤7, normal preoperative EF) who underwent nsRP at 50 centers from nine European countries and Canada. INTERVENTION Postsurgery 1:1:1 randomization to 9-mo double-blind treatment with tadalafil 5mg once a day (OaD), tadalafil 20mg on demand, or placebo, followed by a 6-wk drug-free-washout, and a 3-mo open-label tadalafil OaD treatment. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Three decision-tree models, using the International Index of Erectile Function-Erectile Function (IIEF-EF) domain score at the end of double-blind treatment, washout, and open-label treatment as response variable. Each model evaluated the association between potential predictors: presurgery IIEF domain and IIEF single-item scores, surgical approach, nerve-sparing score (NSS), and postsurgery randomized treatment group. RESULTS AND LIMITATIONS The first decision-tree model (n=422, intention-to-treat population) identified high presurgery sexual desire (IIEF item 12: ≥3.5 and <3.5) as the key predictor for IIEF-EF at the end of double-blind treatment (mean IIEF-EF: 14.9 and 11.1), followed by high confidence to get and maintain an erection (IIEF item 15: ≥3.5 and <3.5; IIEF-EF: 15.4 and 7.1). For patients meeting these criteria, additional non-IIEF-related predictors included robot-assisted laparoscopic surgery (yes or no; IIEF-EF: 19.3 and 12.6), quality of nerve sparing (NSS: <2.5 and ≥2.5; IIEF-EF: 14.3 and 10.5), and treatment with tadalafil OaD (yes and no; IIEF-EF: 17.6 and 14.3). Additional analyses after washout and open-label treatment identified high presurgery intercourse satisfaction as the key predictor. CONCLUSIONS Exploratory decision-tree analyses identified high presurgery sexual desire, confidence, and intercourse satisfaction as key predictors for EF recovery. Patients meeting these criteria might benefit the most from conserving surgery and early postsurgery EF rehabilitation. Strategies for improving EF after surgery should be discussed preoperatively with all patients; this information may support expectation management for functional recovery on an individual patient level. PATIENT SUMMARY Understanding how patient characteristics and different treatment options affect the recovery of erectile function (EF) after radical surgery for prostate cancer might help physicians select the optimal treatment for their patients. This analysis of data from a clinical trial suggested that high presurgery sexual desire, sexual confidence, and intercourse satisfaction are key factors predicting EF recovery. Patients meeting these criteria might benefit the most from conserving surgery (robot-assisted surgery, perfect nerve sparing) and postsurgery medical rehabilitation of EF. TRIAL REGISTRATION ClinicalTrials.gov, NCT01026818.
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Affiliation(s)
- Francesco Montorsi
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy.
| | - Matthias Oelke
- Department of Urology and Urological Oncology, Hanover Medical School, Hanover, Germany
| | - Carsten Henneges
- Global Statistical Sciences, EU Statistics, Lilly Deutschland GmbH, Bad Homburg, Germany
| | - Gerald Brock
- Department of Surgery, Division of Urology, University of Western Ontario, London, Ontario, Canada
| | - Andrea Salonia
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy
| | | | - Andrea Rossi
- Therapeutic Area Men's Health, Eli Lilly SpA, Florence, Italy
| | - John P Mulhall
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hartwig Büttner
- Biomedicines BU, Lilly Deutschland GmbH, Bad Homburg, Germany
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Kadıoğlu A, Ortaç M, Brock G. Pharmacologic and surgical therapies for sexual dysfunction in male cancer survivors. Transl Androl Urol 2016; 4:148-59. [PMID: 26816821 PMCID: PMC4708121 DOI: 10.3978/j.issn.2223-4683.2014.12.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The recent recognition that many men experience sexual dysfunction following their diagnosis and treatment of genitourinary cancers, has led to the development multiple varied strategies that attempt to restore or preserve that function. In this manuscript we review the understanding of why it happens, highlight novel management strategies and discuss the concept of penile rehabilitation (PR) following prostate cancer (PCa) treatment, glans preserving strategies among men diagnosed with penile cancer and address the controversial issue of testosterone therapy in men with PCa.
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Affiliation(s)
- Ateş Kadıoğlu
- 1 Department of Urology, Istanbul Faculty of Medicine, Istanbul, Turkey ; 2 University of Western Ontario, London, Ontario, Canada
| | - Mazhar Ortaç
- 1 Department of Urology, Istanbul Faculty of Medicine, Istanbul, Turkey ; 2 University of Western Ontario, London, Ontario, Canada
| | - Gerald Brock
- 1 Department of Urology, Istanbul Faculty of Medicine, Istanbul, Turkey ; 2 University of Western Ontario, London, Ontario, Canada
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Stolzenburg JU, Graefen M, Kriegel C, Michl U, Martin Morales A, Pommerville PJ, Manning M, Büttner H, Henneges C, Schostak M. Effect of surgical approach on erectile function recovery following bilateral nerve-sparing radical prostatectomy: an evaluation utilising data from a randomised, double-blind, double-dummy multicentre trial of tadalafil vs placebo. BJU Int 2015; 116:241-51. [DOI: 10.1111/bju.13030] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | | | | | - Uwe Michl
- Martini Hospital, UKE GmbH; Hamburg Germany
| | | | - Peter J. Pommerville
- Department of Urological Sciences; University of British Columbia; Victoria BC Canada
| | | | | | | | - Martin Schostak
- Department of Urology and Paediatric Urology; Magdeburg University Medical Centre; Magdeburg Germany
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Patel HR, Ilo D, Shah N, Cuzin B, Chadwick D, Andrianne R, Henneges C, Barry J, Hell-Momeni K, Branicka J, Büttner H. Effects of tadalafil treatment after bilateral nerve-sparing radical prostatectomy: quality of life, psychosocial outcomes, and treatment satisfaction results from a randomized, placebo-controlled phase IV study. BMC Urol 2015; 15:31. [PMID: 25879460 PMCID: PMC4419565 DOI: 10.1186/s12894-015-0022-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 03/24/2015] [Indexed: 11/16/2022] Open
Abstract
Background This multicenter, randomized, double-blind, double-dummy, placebo-controlled trial primarily evaluated the efficacy of tadalafil once-daily (OaD) or on-demand (“pro-re-nata”; PRN) treatment, started early post-nsRP. Secondary outcome-measures on quality-of-life (QoL) and treatment satisfaction are reported. Methods Patients, aged <68 yrs, with adenocarcinoma of the prostate (Gleason ≤ 7, normal preoperative erectile function [EF]) were randomized post-nsRP 1:1:1 to 9-month treatment with tadalafil 5 mg OaD, tadalafil 20 mg PRN, or placebo, followed by 6-week drug-free washout and 3-month open-label tadalafil OaD treatment (OLT). The main outcome measures were Changes in Expanded Prostate Cancer Index Composite (EPIC-26), Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), and Self-Esteem and Relationship (SEAR) questionnaires (mixed-model-for-repeated-measures, including terms for treatment, visit, treatment-by-visit interaction, age-group, country, baseline-score). LS means with 95% confidence interval (CI) are reported. Results 423 patients were randomized to 3 treatment-groups: tadalafil OaD (N = 139), PRN (N = 143), or placebo (N = 141). In each group, 57 (41.0%), 58 (40.6%), and 50 (35.5%) patients were aged 61-68 yrs. At the end of double-blind treatment (DBT), patients’ EPIC sexual domain-scores improved significantly with tadalafil OaD versus placebo (treatment effect [95% CI]: 9.6 [3.1,16.0]; p = 0.004); comparisons of PRN versus placebo at end of DBT, and comparisons of tadalafil OaD and PRN versus placebo after OLT were not significant. Only in older patients (61-68 yrs; age-by-treatment p ≤ 0.1), EPIC urinary incontinence domain-scores also improved significantly with tadalafil OaD versus placebo (overall treatment effect across all visits, 8.3 [0.4,16.1]; p = 0.040). Treatment satisfaction increased significantly in both tadalafil groups, EDITS total-scores increased significantly with OaD and PRN versus placebo during DBT (p = 0.005 and p = 0.041, respectively). At the end of OLT, improvement was significant for tadalafil OaD versus placebo only (p = 0.035). No significant differences were observed for SEAR. Conclusions These results suggest that chronic dosing of tadalafil improves QoL of patients post-nsRP. The improvement of urinary incontinence in elderly patients randomized to tadalafil OaD may contribute to this effect. Trial registration www.clinicaltrials.gov, NCT01026818. Electronic supplementary material The online version of this article (doi:10.1186/s12894-015-0022-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hitendra R Patel
- Department of Urology, University Hospital North Norway, Sykehusvegen 38, 9038, Tromsø, Norway.
| | | | | | - Béatrice Cuzin
- Department of Urology, Edouard Herriot University Hospital, Lyon, France.
| | - David Chadwick
- South Tees Hospitals NHS Foundation Trust, Stockton-on-Tees, UK.
| | - Robert Andrianne
- Centre Hospitalier Universitaire de Liège, Service d'Urologie, Belgium.
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Salz T, Baxi SS, Raghunathan N, Onstad EE, Freedman AN, Moskowitz CS, Dalton SO, Goodman KA, Johansen C, Matasar MJ, de Nully Brown P, Oeffinger KC, Vickers AJ. Are we ready to predict late effects? A systematic review of clinically useful prediction models. Eur J Cancer 2015; 51:758-66. [PMID: 25736818 DOI: 10.1016/j.ejca.2015.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 02/02/2015] [Accepted: 02/03/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND After completing treatment for cancer, survivors may experience late effects: consequences of treatment that persist or arise after a latent period. PURPOSE To identify and describe all models that predict the risk of late effects and could be used in clinical practice. DATA SOURCES We searched Medline through April 2014. STUDY SELECTION Studies describing models that (1) predicted the absolute risk of a late effect present at least 1 year post-treatment, and (2) could be used in a clinical setting. DATA EXTRACTION Three authors independently extracted data pertaining to patient characteristics, late effects, the prediction model and model evaluation. DATA SYNTHESIS Across 14 studies identified for review, nine late effects were predicted: erectile dysfunction and urinary incontinence after prostate cancer; arm lymphoedema, psychological morbidity, cardiomyopathy or heart failure and cardiac event after breast cancer; swallowing dysfunction after head and neck cancer; breast cancer after Hodgkin lymphoma and thyroid cancer after childhood cancer. Of these, four late effects are persistent effects of treatment and five appear after a latent period. Two studies were externally validated. Six studies were designed to inform decisions about treatment rather than survivorship care. Nomograms were the most common clinical output. CONCLUSION Despite the call among survivorship experts for risk stratification, few published models are useful for risk-stratifying prevention, early detection or management of late effects. Few models address serious, modifiable late effects, limiting their utility. Cancer survivors would benefit from models focused on long-term, modifiable and serious late effects to inform the management of survivorship care.
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Affiliation(s)
- Talya Salz
- Memorial Sloan-Kettering Cancer Center, New York, NY, United States.
| | - Shrujal S Baxi
- Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | | | - Erin E Onstad
- Harvard School of Public Health, Boston, MA, United States
| | | | | | | | - Karyn A Goodman
- Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | | | | | | | | | - Andrew J Vickers
- Memorial Sloan-Kettering Cancer Center, New York, NY, United States
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Müller S, Grønning LE, Nilsen FS, Mygland V, Patel HRH. Robotic and minimal access surgery: technology and surgical outcomes of radical prostatectomy for prostate cancer. Expert Rev Anticancer Ther 2014; 14:1317-21. [PMID: 25266367 DOI: 10.1586/14737140.2014.965689] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Since the 1990s, minimal access surgery has been utilized in urology. In the past 15 years, robotic surgery has evolved and become a natural part of minimal access surgery. The dissemination has been fast and the opportunity of prospective trials has been missed. Nevertheless, robotic surgery has obvious benefits for the surgeon and patient. Even though the scientific evidence is not strong, robotic surgery is here to stay. However, there are lessons to learn from the implementation of the da Vinci system with regards to patient safety and prospective evaluation of the new technology. The future of surgery will include technologies derived from robotic surgery.
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Affiliation(s)
- Stig Müller
- Department of Urology, Akershus University Hospital, Sykehusveien 23, Lørenskog 1478, Norway
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Effects of tadalafil once daily or on demand versus placebo on time to recovery of erectile function in patients after bilateral nerve-sparing radical prostatectomy. World J Urol 2014; 33:1031-8. [PMID: 25155034 PMCID: PMC4480825 DOI: 10.1007/s00345-014-1377-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 08/05/2014] [Indexed: 11/21/2022] Open
Abstract
Purpose We report time to erectile function (EF)-recovery data from a multicenter, randomized, double-blind, double-dummy, placebo-controlled trial evaluating tadalafil started after bilateral nerve-sparing radical prostatectomy (nsRP). Methods Patients ≤68 years were randomized post-nsRP 1:1:1 to 9-month double-blind treatment (DBT) with tadalafil 5 mg once daily (OaD), 20 mg tadalafil on demand (“pro-re-nata”; PRN), or placebo, followed by 6-week drug-free washout (DFW) and 3-month open-label OaD treatment. Secondary outcome measures included Kaplan–Meier estimates of time to EF-recovery (IIEF-EF ≥ 22) during DBT (Cox proportional hazard model adjusting for treatment, age, and country). Results A total of 423 patients were randomized to tadalafil OaD (N = 139), PRN (N = 143), and placebo (N = 141); 114/122/155 completed DBT. The proportion of patients achieving IIEF-EF ≥22 at some point during DBT with OaD, PRN, and placebo was 29.5, 23.9, and 18.4 %, respectively. DBT was too short to achieve EF-recovery (IIEF-EF ≥ 22) in >50 % of patients; median time to EF-recovery was non-estimable. Time for 25 % of patients to achieve EF-recovery (95 % CI) was 5.8 (4.9, 9.2) months for OaD versus 9.0 (5.5, 9.2) and 9.3 (9.0, 9.9) months for PRN and placebo, respectively. Showing a significant overall treatment effect (p = 0.038), the probability for EF-recovery was significantly higher for OaD versus placebo [hazard ratio (HR); 95 % CI 1.9; 1.2, 3.1; p = 0.011], but not for PRN versus placebo (p = 0.140). Of 57 OaD patients (41.0 %) with ED improved (by ≥1 IIEF-EF severity grade) at the end of DBT, 16 (28.1 % of 57) maintained this improvement through DFW and 27 (47.4 %) declined but maintained improvement from baseline after DFW. Conclusions Data suggest that the use of tadalafil OaD can significantly shorten the time to EF-recovery post-nsRP compared with placebo. Electronic supplementary material The online version of this article (doi:10.1007/s00345-014-1377-3) contains supplementary material, which is available to authorized users.
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Predictive factors for return of erectile function in robotic radical prostatectomy: case series from a single centre. Int J Impot Res 2014; 27:29-32. [DOI: 10.1038/ijir.2014.20] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/23/2014] [Accepted: 06/06/2014] [Indexed: 11/08/2022]
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Haskins AE, Han PKJ, Lucas FL, Bristol I, Hansen M. Development of clinical models for predicting erectile function after localized prostate cancer treatment. Int J Urol 2014; 21:1227-33. [DOI: 10.1111/iju.12566] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 06/15/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Amy E Haskins
- Center for Outcomes Research and Evaluation; Maine Medical Center; Portland Maine USA
| | - Paul KJ Han
- Center for Outcomes Research and Evaluation; Maine Medical Center; Portland Maine USA
| | - Frances L Lucas
- Center for Outcomes Research and Evaluation; Maine Medical Center; Portland Maine USA
| | - Ian Bristol
- Department of Radiation Oncology; Maine Medical Center; Portland Maine USA
| | - Moritz Hansen
- Division of Urology; Maine Medical Center; Portland Maine USA
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Nicolaisen M, Müller S, Patel HRH, Hanssen TA. Quality of life and satisfaction with information after radical prostatectomy, radical external beam radiotherapy and postoperative radiotherapy: a long-term follow-up study. J Clin Nurs 2014; 23:3403-14. [DOI: 10.1111/jocn.12586] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Marianne Nicolaisen
- National Continence and Pelvic Floor Center of Norway; University Hospital of North Norway; Tromsø Norway
| | - Stig Müller
- Department of Urology; Akershus University Hospital; Lørenskog Norway
- Institute of Clinical Medicine; University of Oslo; Lørenskog Norway
| | - Hitendra RH Patel
- National Continence and Pelvic Floor Center of Norway; University Hospital of North Norway; Tromsø Norway
- Faculty of Health Sciences; University of Tromsø; Tromsø Norway
| | - Tove Aminda Hanssen
- Faculty of Health Sciences; University of Tromsø; Tromsø Norway
- Division of Cardiothoracic and Respiratory Medicine; University Hospital North Norway; Tromsø Norway
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Counseling the post-radical prostatectomy patients about functional recovery: high predictiveness of current status. Urology 2014; 84:158-63. [PMID: 24824411 DOI: 10.1016/j.urology.2014.02.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 02/11/2014] [Accepted: 02/13/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To develop prediction models to help counsel post-radical prostatectomy patients about functional recovery. METHODS The study included 2162 patients undergoing radical prostatectomy at a major cancer center, who reported urinary and erectile function at 1 year or at 2 years and at least 1 prior follow-up at 3, 6, 9, or 12 months. We created logistic regression models predicting function at one or 2 years on the basis of function at 3, 6, 9, and 12 months (2 years only), with the additional predictors of age, stage, grade, prostate-specific antigen levels, nerve-sparing status and baseline functional score. RESULTS No variable other than current functional score had a consistent statistically significant relationship with outcome. The area under the curves for predicting function at 2 years based on current function alone at 3, 6, 9, and 12 months were respectively 0.796, 0.831, 0.882, and 0.885 for erectile function and 0.789, 0.862, 0.869, and 0.876 for urinary function. Patients using 1 pad at 6 months had only a 50% probability of being pad free at 2 years; this dropped to 36% for patients using 2 pads. This suggests that there is an opportunity for early identification and possible referral of patients likely to have long-term urinary dysfunction. CONCLUSION Assessment of urinary and erectile function in the first postoperative year is strongly predictive of long-term outcome and can guide patient counseling and decisions about rehabilitative treatments.
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Brock G, Montorsi F, Büttner H, Henneges C, Mulhall J. Reply from Authors re: Arthur L. Burnett. Erection Rehabilitation After Radical Prostatectomy: Definite Purpose, Indefinite Strategy. Eur Urol 2014;65:597–8. Eur Urol 2014; 65:598-9. [DOI: 10.1016/j.eururo.2013.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 11/08/2013] [Indexed: 10/26/2022]
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Isgoren AE, Saitz TR, Serefoglu EC. Erectile Function Outcomes after Robot‐Assisted Radical Prostatectomy: Is It Superior to Open Retropubic or Laparoscopic Approach? Sex Med Rev 2014; 2:10-23. [DOI: 10.1002/smrj.21] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Droupy S, Al Said B, Lechevallier É, Colson MH, Giuliano F. Sexualité et cancer de la prostate. Prog Urol 2013; 23:696-711. [DOI: 10.1016/j.purol.2013.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 03/18/2013] [Indexed: 01/09/2023]
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Teloken PE, Mulhall JP. Erectile Function Following Prostate Cancer Treatment: Factors Predicting Recovery. Sex Med Rev 2013; 1:91-103. [PMID: 27784588 DOI: 10.1002/smrj.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Prostate cancer represents the most common nonskin malignancy encountered in men, and the excellent long-term survival achieved in the majority of patients has allowed more attention to be given to the side effects associated with its treatment. Erectile function is one of the main concerns of patients when considering treatment options for prostate cancer. Not surprisingly, post-treatment sexual function is closely related to outcome satisfaction and has long-lasting effects on quality of life. Radical prostatectomy is currently the most commonly employed therapy for prostate cancer. Conflicting rates of erectile dysfunction have been reported after surgery, owing not only to different surgical techniques but also because of dissimilar patient populations and definitions. Providing accurate information to individual patients in regards to their chances of recuperating the ability to have intercourse after treatment is important not only because it allows patients to make informed decisions but also because it has the potential to reduce treatment dissatisfaction. This article mainly focuses on discussing predictors of erectile function after radical prostatectomy. Patient factors, surgical aspects, including comparisons between open, laparoscopic, and robotic approaches, and postoperative management issues that impact sexual outcomes are evaluated. Prediction models combining multiple factors are described. The definition and chronology of erectile function recovery and impact of sexual function on quality of life after surgery are also discussed. Teloken PE and Mulhall JP. Erectile function following prostate cancer treatment: Factors predicting recovery. Sex Med Rev 2013;1:91-103.
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Affiliation(s)
- Patrick E Teloken
- Department of Urology, Sir Charles Gaidner Hospital, Perth, Australia
| | - John P Mulhall
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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A Pilot Study of Laparoscopic Doppler Ultrasound Probe to Map Arterial Vascular Flow within the Neurovascular Bundle during Robot-Assisted Radical Prostatectomy. Prostate Cancer 2013; 2013:810715. [PMID: 23862066 PMCID: PMC3703796 DOI: 10.1155/2013/810715] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 05/22/2013] [Accepted: 06/05/2013] [Indexed: 11/20/2022] Open
Abstract
Purpose. To report on the feasibility of a new Laparoscopic Doppler ultrasound (LDU) technology to aid in identifying and preserving arterial blood flow within the neurovascular bundle (NVB) during robotic prostatectomy (RARP). Materials and Methods. Nine patients with normal preoperative potency and scheduled for a bilateral nerve-sparing procedure were prospectively enrolled. LDU was used to measure arterial flow at 6 anatomic locations alongside the prostate, and signal intensity was evaluated by 4 independent reviewers. Measurements were made before and after NVB dissection. Modifications in nerve-sparing procedure due to LDU use were recorded. Postoperative erectile function was assessed. Fleiss Kappa statistic was used to evaluate inter-rater agreement for each of the 12 measurements. Results. Analysis of Doppler signal intensity showed maintenance of flow in 80% of points assessed, a decrease in 16%, and an increase in 4%. Plane of NVB dissection was altered in 5 patients (56%) on the left and in 4 patients (44%) on the right. There was good inter-rater reliability for the 4 reviewers. Use of the probe did not significantly increase operative time or result in any complications. Seven (78%) patients had recovery of erections at time of the 8-month follow-up visit. Conclusions. LDU is a safe, easy to use, and effective method to identify local vasculature and anatomic landmarks during RARP, and can potentially be used to achieve greater nerve preservation.
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Davis JW, Dasgupta P. A case-mix-adjusted comparison of early oncological outcomes of open and robotic prostatectomy performed by experienced high volume surgeons. BJU Int 2013; 111:184-5. [PMID: 23356744 DOI: 10.1111/j.1464-410x.2012.11643.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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