Clinical Outcomes of Intracavernosal Injection in Postprostatectomy Patients: A Single-center Experience

Domes, Trustin; Chung, Eric; DeYoung, Ling; MacLean, Natalie; Al-Shaiji, Tariq F.; Brock, Gerald

doi:10.1016/j.urology.2011.09.009

Cited by 15 publications

(16 citation statements)

References 27 publications

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“…Only two studies have examined four year outcomes of ICI among men with PPED. 10,22 To our knowledge, our report represents the longest follow-up experience with ICI, independent of the etiology for ED.…”

Section: Discussionmentioning

confidence: 70%

“…8,10,13–22,25–27 This variability may be attributed to differences in: duration of follow-up, etiology for ED, timing of initiating treatment for PPED, physician comfort administering ICI, the degree of counseling or education received prior to initiating therapy, and number and structure of follow-up visits. While it has been suggested that high dropout rates associated with ICI may be improved with comprehensive training and education as well as regular follow-up, 8,10 the results of a recent randomized trial evaluating the use of extra counseling suggest otherwise.…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies have assessed experience with ICI in men with ED 8,13–21 and specifically PPED, 10,22 but none have reported outcomes beyond a mean of four years. Additionally, no study to date has examined preoperative factors associated with the characteristics of those men undergoing RP who elect a trial of ICI.…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Satisfaction and Predictors of Use of Intracorporeal Injections for Post-Prostatectomy Erectile Dysfunction

et al. 2013

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Purpose ICI has low utilization and high discontinuation rates. We examined factors associated with ICI use, long-term satisfaction with ICI, and reasons for discontinuation in men having undergone radical prostatectomy. Materials and Methods Between October 2000 and September 2003, 731 men undergoing open radical retropubic prostatectomy were enrolled in a prospective outcomes study. The eight-year follow-up evaluation included the UCLA-PCI and a survey capturing ICI use, satisfaction, and reasons for discontinuation. Logistic regression was utilized to determine associations between ICI use and pre-operative variables. Results Eight-year self-assessment was completed by 368 (50.4%) men; 140 (38%) of these indicated prior or current ICI use, with only 34 using ICI at eight years. Forty four percent of men were satisfied with ICI. Discontinuation reasons included: dislike (47%), pain (33%), return of erection (19%), inefficacy (14%), and no partner (6%). Men trying ICI had greater pre-operative UCLA-PCI sexual function scores (75.2 vs. 65.62, p = 0.00005) and greater declines in this score at three months (p = 0.0002) and two years (p = 0.003). Higher pre-operative sexual function scores were independently associated with utilization of ICI in a model adjusted for age, marital status, nerve sparing status, and BMI (OR =1.021, 95% CI 1.008–1.035). Conclusions Men pursuing ICI have better baseline erectile function and experience greater deterioration in erectile function during the early post-operative period. Despite high efficacy, many discontinue ICI due to dislike or discomfort. Satisfaction rates with ICI indicate its long-term role in restoring sexual function in men with PPED.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

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Long-Term Satisfaction and Predictors of Use of Intracorporeal Injections for Post-Prostatectomy Erectile Dysfunction

et al. 2013

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“…Of men who seek help to treat their ED, compliance is poor. It is estimated that 50 to 80% of men discontinue their use of ED treatments within a year of starting them [4, 27–29]. This applies to men with and without PC.…”

Section: Avoidance and Difficulty Sustaining Ed Treatmentsmentioning

confidence: 99%

Erectile dysfunction after radical prostatectomy

Emanu

Avildsen²,

Nelson³

2016

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of review This review will discuss erectile dysfunction (ED) in prostate cancer patients following radical prostatectomy (RP). It will focus on the prevalence and current treatments for ED as well as the emotional impact of ED and the current psychosocial interventions designed to help patients cope with this side effect. Recent findings While there is a large discrepancy in prevalence rates of ED after RP, several recent studies have cited rates as high as 85%. The concept of “penile rehabilitation” is now the standard of practice to treat ED following RP. However, many men avoid seeking help or utilizing ED treatments. This avoidance is related to the shame, frustration, and distress many men with ED and their partners experience. Recent psychosocial interventions have been developed to facilitate the use of treatments and help men cope with ED. These interventions have shown initial promise, however, continued intervention development is needed to reduce distress and improve long-term erectile function (EF) outcomes. Summary ED is a significant problem following prostate cancer surgery. While 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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“…Other studies have cited response rates as high as 90% 44. A moderately large questionnaire study examined 117 patients with post-prostatectomy erectile dysfunction who had failed a trial of PDE5 inhibitors and were provided with intracorporeal injections 45. In sexually active patients, intracorporeal injections were associated with significantly improved erectile function.…”

Section: Intracavernosal Injectionmentioning

confidence: 99%

Post-prostatectomy erectile dysfunction: contemporary approaches from a US perspective

Hamilton

Mirza²

2014

RRU

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Success of cancer surgery often leads to life-changing side effects, and surgical treatment for malignant urologic disease often results in erectile dysfunction (ED). Patients that undergo surgical prostatectomy or cystoprostatectomy will often experience impairment of erections due to disruption of blood and nerve supply. Surgical technique, nerve sparing status, patient age, comorbid conditions, and pretreatment potency status all have an effect on post-surgical ED. Regardless of surgical technique, prostatectomy results in disruption of normal anatomy and nerve supply to the penis, which governs the functional aspects of erection. A variety of different treatment options are available for men who develop ED after prostatectomy, including vacuum erection device, oral phosphodiesterase 5 inhibitors (PDE5I), intracorporal injections, and penile prosthesis. The vacuum erection device creates an artificial erection by forming a vacuum via suction of air to draw blood into the penis. The majority of men using the vacuum erection device daily after prostatectomy, regardless of nerve-sparing status, have erections sufficient for intercourse. Phosphodiesterase 5 inhibitors remain a common treatment option for post-surgical ED and are the mainstay of therapy. They work through cyclic adenosine monophosphate and cyclic guanine monophosphate pathways and are recommended in all forms of ED. Intracorporal injections or intraurethral use of vasoactive substances may be a good second-line therapy in men who do not experience improvement with oral medications. Surgical placement of a penile prosthesis is typically the treatment strategy of choice after other options have failed. Semi-rigid and inflatable devices are available with high satisfaction rates. With careful patient counseling and proper treatment selection, patient satisfaction and improved erectile function can be achieved. We advise that patients use a vacuum erection device daily in the early postoperative period in combination with an oral PDE5I. For patients who do not respond to a vacuum erection device or PDE5I, consideration should be given to intraurethral alprostadil, intracorporal injections, or a penile prosthesis.

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Clinical Outcomes of Intracavernosal Injection in Postprostatectomy Patients: A Single-center Experience

Cited by 15 publications

References 27 publications

Long-Term Satisfaction and Predictors of Use of Intracorporeal Injections for Post-Prostatectomy Erectile Dysfunction

Long-Term Satisfaction and Predictors of Use of Intracorporeal Injections for Post-Prostatectomy Erectile Dysfunction

Erectile dysfunction after radical prostatectomy

Post-prostatectomy erectile dysfunction: contemporary approaches from a US perspective

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