Patients with detectable prostate specific antigen after radical prostatectomy have a poor biochemical outcome. We identified postoperative prostate specific antigen and prostate specific antigen velocity as independent predictors of progression and failed salvage treatment. In addition to pathological prognostic factors, these factors should be considered early to better stratify patients for adjuvant therapy.
Introduction Patients with erectile dysfunction (ED) after radical prostatectomy (RP) may benefit from penile prosthesis (PP) implantation after failure of less invasive treatments. Aim To assess surgical outcomes and satisfaction after PP implantation in RP patients and compare the results with those in patients with vasculogenic ED (controls). Methods A database of 415 consecutive PPs (January 1996–December 2008) was used to collate data on preimplantation ED treatments, surgical complications, satisfaction, and International Index of Erectile Function (IIEF) scores before and 3 months after implantation. The results for 90 post-RP implants (79 primary, 11 secondary) and 131 implants for vasculogenic ED were compared. Main Outcome Measures The main outcome measures of this study are intra- and postoperative complications and IIEF domain scores. Results Mean follow-up of RP patients was 37.6 ± 26.8 months. Mean interval between RP and PP implantation was 31.5 ± 28.7 months. Nearly all primary implants (96.2%) were inflatable (3-piece, 70.1%; 2-piece, 24.1%). There was no significant difference between groups in terms of rates of infection (1.1%), mechanical failure (3.3%), and other surgical complications requiring revision surgery (migration, auto-inflation) (4.4%). For primary implants, the mean preimplantation IIEF score (all items) was significantly lower in RP patients than in controls (14.7 ± 5.9 vs. 22.6 ± 10.8, P = 0.003), chiefly because of significantly lower scores for erectile function, intercourse satisfaction, and orgasmic function. After PP implantation in RP patients, the scores for all domains improved, but the total score remained significantly lower than in controls (63.1 ± 7.0 vs. 68.5 ± 6.9, P = 0.005). The orgasmic function score was significantly lower (P < 0.001). Overall satisfaction rate was 86.1% in RP patients and 90.7% in controls (P = 0.3). Conclusions PP implantation after RP is associated with low morbidity and high satisfaction. It improves the scores for all IIEF domains and, in particular, erectile function. Fibrosis of the retropubic space may require a second incision for reservoir placement or implantation of a 2-piece PP.
The best surgical option for the management of severe cases of Peyronie's disease is currently a matter of debate. To determine medium-term outcomes and complications after treatment of severe Peyronie's disease by porcine small intestinal submucosa (SIS) grafts, we retrospectively reviewed 33 consecutive plaque incisions followed by 4-ply SIS grafting in 28 patients (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009). Postoperative complications, penile length preservation, de novo ED, penile curvature correction and curvature recurrence rates were recorded. Median patient age was 54 years (38-69 years). Median preoperative curvature was 901 (30-901) (stable for at least 6 months). Six patients (21%) had preoperative ED. There were few postoperative complications (no cases of infection, haematoma (n ¼ 2), penile hypoesthesia (n ¼ 1), patch rejection and migration (n ¼ 1)). Subjective penile shortening and de novo ED were observed in 7 (25%) and 3 (11%) patients, respectively. The success rate for the procedure (straight penis or curvature p201 and ability to have intercourse) was 67% (22/33). Four patients achieved curvature correction after a repeat procedure with a new SIS graft. Eleven patients experienced recurrence within 3 months of surgery. After a median follow-up of 9 months (3-94), 22 patients (79%) had a satisfactory curvature correction.
• The 5-year biochemical-free survival rate and 5-year disease-free survival rate were calculated. RESULTS• In total, 53 patients were included (mean age, 72.5 ± 4.5 years, range 60-79 years; 28 low risk and 25 intermediate risk). None had undergone previous hormonal therapy. Mean ± SD follow-up was 45.4 ± 15.5 months (range 16-71 years). Mean (range) pre-treatment PSA was 8.5 ± 4 (0.29-18) ng/ mL. The median (range) PSA nadir value was 1 (0.01-14) ng/mL and occurred after a mean (range) of 5.09 (3-24) months.• Overall, 36 patients (67.9%) experienced oncological failure.• These included 33 cases (62.2%) of biochemical failure. A PSA nadir of ≤ 0.2, 0.21-1.0 and > 1 ng/mL was reached in 20.8%, 30.2% and 49% of patients, respectively, and was associated with biochemical failure in 9.1%, 30.3% and 60.6%, respectively.• The 5-year biochemical-free survival rate and disease-free survival rate were 21.7% and 13.5%, respectively. In multivariate analysis, a PSA nadir of > 1 ng/mL was significantly associated with a risk of biochemical and oncological failure ( P = 0.002 and P < 0.001).• Oncological failure was not associated with any risk group.• No patient died from prostate cancer.
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