Erectile Dysfunction is a Transient Complication of Prostate Biopsy: A Systematic Review and Meta-Analysis

Fainberg, Jonathan; Gaffney, Christopher; Pierce, Hudson; Aboukhshaba, Ahmad; Chughtai, Bilal; Christos, Paul J.; Kashanian, James A.

doi:10.1097/ju.0000000000001398

Cited by 12 publications

(15 citation statements)

References 10 publications

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“…Our results also demonstrated no statistically significant reduction in erectile function. This is incongruent with current literature, where prostate biopsies, regardless of route, are believed to reduce erectile function 11,18,19 . In studies with longer follow up durations, erectile function is seen to recover 11 .…”

Section: Discussioncontrasting

confidence: 54%

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Outpatient transperineal prostate biopsy under local anaesthesia is safe, well tolerated and feasible

Hong

Hemmingway

Wetherell

et al. 2022

ANZ Journal of Surgery

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Background Transperineal biopsy (TPB) of the prostate has been increasingly utilized as it has reduced infection risks. Traditionally however, it is performed under general anaesthesia, thus it carries a differing set of risks. Recently, new studies have performed TPB under local anaesthesia with success. In the present study, we explored our experience of performing TPB under local anaesthesia in an Australian cohort. Methods In this prospective study based at a metropolitan outpatient clinic, patients were provided with TPB under local anaesthesia. We assessed prostate cancer detection rates, complication rates and patient tolerability. Pain tolerability was assess using patient reported pain score on the visual analogue scale. Follow up data was collected at days 7 and 30 post‐biopsy via telephone interview. Results A total of 48 patients were enrolled in this study between June 2020 and March 2021. Median age was 65.5 years and median PSA was 6.95 ng/mL. Clinically significant prostate cancer was detected in 58% of patients. During the procedure, pain scores were rated the highest during infiltration of local anaesthetic agent with a median score of 5. By the conclusion of the procedure, median pain score was 1. Vast majority of patients (85.4%) would opt for a repeat TPB under local anaesthesia should the need for prostate biopsy arise again. Two of our patients experienced infectious complications, and one experienced urinary retention. Conclusion Our data is in line with currently available data and confirms that TPB under local anaesthesia can be achieved in a safe and tolerable manner.

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Section: Discussioncontrasting

confidence: 54%

“…This is incongruent with current literature, where prostate biopsies, regardless of route, are believed to reduce erectile function. 11,18,19 In studies with longer follow up durations, erectile function is seen to recover. 11 Our results differ possibly due to our small sample size.…”

Section: Discussionmentioning

confidence: 99%

Outpatient transperineal prostate biopsy under local anaesthesia is safe, well tolerated and feasible

Hong

Hemmingway

Wetherell

et al. 2022

ANZ Journal of Surgery

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“…Currently, screening of PCa mainly relies on PSA and imaging examinations, and prostate puncture and pathology test are still the "gold standard" for PCa diagnosis. However, prostate puncture, as an invasive procedure, has been associated with a number of complications, such as hematuria, rectal bleeding, hemospermia, infection, pain, lower urinary tract syndrome, erectile dysfunction, urinary retention and even death [ 11 ]. Therefore, reducing unnecessary prostate puncture is of great significance in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

A preliminary study on the diagnostic value of PSADR, DPC and TSRP in the distinction of prostatitis and prostate cancer

Wang

et al. 2022

BMC Cancer

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Background The purpose of this study was to investigate the ability of differential diagnosis of prostate specific antigen decline rate (PSADR) per week, degree of prostatic collapse (DPC) and tissue signal rate of prostate (TSRP) between prostatitis and prostate cancer. Methods The clinical data of 92 patients [prostate specific antigen (PSA) > 10 ng/mL] who underwent prostate biopsy in the Department of Urology, the Second Affiliated Hospital of Xi ’an Jiaotong University from May 2017 to April 2020 were reviewed retrospectively. They were divided into two groups, prostatitis group (n = 42) and prostate cancer (PCa) group (n = 50), according to pathological results. Parameters, like patient characteristics, PSADR, DPC, TSRP and infectious indicators, were compared and analyzed by t test or non-parametric test to identify if there were significant differences. The thresholds of parameters were determined by the receiver operating characteristic curve (ROC), and the data were analyzed to investigate the diagnostic value in distinguishing of prostatitis and prostate cancer. Results There were statistical differences in age, PSADR, DPC, TSRP, neutrophil percentage in serum, white blood cell (WBC) in urine and prostate volume between prostatitis group and PCa group (P < 0.001, < 0.001, = 0.001, 0.001, 0.024, 0.014, < 0.001 respectively). There was no statistical difference in serum WBC count, serum neutrophil count, monocyte percentage and urine bacterial count between two groups (P = 0.089, 0.087, 0.248, 0.119, respectively). Determined by ROC curve, when the thresholds of PSADR per week as 3.175 ng/mL/week, DPC as 1.113, TSRP as 2.708 were cutoffs of distinguishing prostatitis and prostate cancer. When combining these three indexes to diagnose, the accuracy rate of diagnosis of prostatitis was 78.85%, the accuracy rate of diagnosis of prostate cancer was 97.50%. Univariate analysis suggested that PSADR, DPC and TSRP played an important role in differentiating prostate cancer from prostatitis (P < 0.05), multivariate analysis suggested PSADR > 3.175 might be good indicators when distinguishing prostate disease with prostatitis (OR = 14.305, 95%CI = 3.779 ~ 54.147), while DPC > 1.113 and TSRP > 2.708 might be associated with a higher risk of prostate cancer (OR = 0.151, 95%CI = 0.039 ~ 0.588; OR = 0.012, 95%CI = 0.005 ~ 0.524, respectively). Conclusion The combination of PSADR per week, DPC, and TSRP might be helpful to distinguish prostate cancer and prostatitis, and can reduce unnecessary invasive and histological procedure.

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“…These observations suggest that in addition to direct CN injury (CNI), there are other mechanisms by which pelvic surgeries result in ED. This suggestion is strengthened by reports that patients undergoing pelvic surgeries that do not involve direct CN damage, such as surgical repair of abdominal aortic aneurysm and prostate biopsies, are also at increased risk for development of ED (Fainberg et al., 2020; Regnier et al., 2018).…”

Section: Introductionmentioning

confidence: 98%

“…This suggestion is strengthened by reports that patients undergoing pelvic surgeries that do not involve direct CN damage, such as surgical repair of abdominal aortic aneurysm and prostate biopsies, are also at increased risk for development of ED (Fainberg et al, 2020;Regnier et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Erectile dysfunction resulting from pelvic surgery is associated with changes in cavernosal gene expression indicative of cavernous nerve injury

2021

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Pelvic surgery, even without direct cavernous nerve injury, carries a high risk of post-operative erectile dysfunction. The present studies were aimed at identifying molecular mechanisms by which pelvic surgery results in erectile dysfunction. As a model of pelvic surgery, male Sprague-Dawley rats underwent pelvic laparotomy, avoiding direct cavernous nerve injury. A second group of animals, serving as a model of direct cavernous nerve injury, underwent bilateral transection of the cavernous nerve. Cavernosometry demonstrated, that even in the absence of direct nerve injury, the pelvic surgery model exhibited significant erectile dysfunction 3 days postoperatively. Gene expression profiling also demonstrated that even in this animal model of nerve-sparing pelvic surgery, the profile of differentially expressed genes in cavernosal tissue was indicative of cavernous nerve injury. In addition, although 6 hr after surgery there were significant changes in circulating cytokine/chemokine levels, an inflammatory response in the major pelvic ganglion, cavernous nerve and cavernosal tissue was only observed 3 days post-surgery. Our results validate a rat model of pelvic surgery exhibiting erectile dysfunction and suggest systemic release of cytokines/chemokines following surgical trauma might mediate a pathological inflammatory response in tissues distal to the site of surgical trauma, indirectly resulting in cavernous nerve injury and erectile dysfunction.

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Erectile Dysfunction is a Transient Complication of Prostate Biopsy: A Systematic Review and Meta-Analysis

Cited by 12 publications

References 10 publications

Outpatient transperineal prostate biopsy under local anaesthesia is safe, well tolerated and feasible

Outpatient transperineal prostate biopsy under local anaesthesia is safe, well tolerated and feasible

A preliminary study on the diagnostic value of PSADR, DPC and TSRP in the distinction of prostatitis and prostate cancer

Erectile dysfunction resulting from pelvic surgery is associated with changes in cavernosal gene expression indicative of cavernous nerve injury

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