Factors affecting erectile function after radical retropubic prostatectomy: results from 1620 consecutive patients

Ayyathurai, Rajinikanth; Manoharan, M.; Nieder, Alan M.; Kava, Bruce R.; Soloway, Mark S.

doi:10.1111/j.1464-410x.2007.07409.x

Cited by 73 publications

(82 citation statements)

References 19 publications

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“…23 As shown in several other studies, patients who had undergone nerve-sparing RP have a greater chance to regain sexual function than patients who had undergone non-nerve-sparing RP. 9,10,24 However, even 1 year after nerve-sparing RP, 66% of patients had a severe form of ED, 27% of patients had regained at least some degree of EF and only 7% of patients had regained full EF. Thus, postsurgical improvement of EF does not mean a full convalescence of presurgical EF.…”

Section: Discussionmentioning

confidence: 99%

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Erectile dysfunction after radical prostatectomy: the impact of nerve-sparing status and surgical approach

et al. 2012

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The core question of the study was whether the nerve-sparing status and surgical approach affected the patients' sexual life in the first year after surgery. In addition, determinants of erectile function (EF) and the extent of sexual activity were investigated. We conducted a multicentric, longitudinal study in seven German hospitals before, 3, 6 and 12 months after radical prostatectomy (RP). A total of 329 patients were asked to self-assess the symptoms associated with erectile dysfunction (ED). These symptoms were assessed using the International Index of Erectile Function and EORTC QLQ-PR25 questionnaires. A multiple regression model was used to test the influence of clinical, socio-demographic and quality-of-life-associated variables on the patients' EF 1 year after RP. Before surgery, 39% of patients had a severe ED (complete impotence). At 3, 6 and 12 months after surgery, it was 80, 79 and 71%, respectively. Although the surgical approach had no significant effect on EF, patients who had undergone nerve-sparing surgery had significantly lower ED rates. Nevertheless, 1 year after RP, 66% of these patients had severe ED. Age, nerve-sparing status and the burden of urinary symptoms had the greatest impact on the patients' EF. Regardless of nerve-sparing status and surgical approach, postsurgical improvement of EF does not mean a full convalescence of presurgical EF. Instead, it may rather reduce the degree of postsurgical ED in time. Consequently, urologists should disclose to the patient that ED is a likely side effect of RP. INTRODUCTIONIn many Western countries, prostate cancer has become the most frequently diagnosed cancer in the male population. In Germany, the current incidence is about 60 000 cases per year. 1 Since the introduction of prostate cancer screening, prostate cancer-specific incidence rates have doubled from approx. 50 per 100 000 in 1980 to approx. 100 in 2006. 2 Moreover, there has been a trend towards earlier-stage disease at presentation. 3,4 If detected in a localised state, the most common treatment for prostate cancer is radical prostatectomy (RP). RP can be performed in several ways. The classical approach is open retropubic prostatectomy. Furthermore, RP can be performed in a minimalinvasive laparoscopic way. Both surgical approaches have excellent survival outcomes. In Germany, the 5-year relative survival rate for prostate cancer is between 83 and 94%. 1 However, there are also strong side effects of RP, for example, erectile dysfunction (ED). 5 Depending on the surgical technique, patient age and other sociodemographic and clinical factors, ED rates differ a lot. Even 1 year after RP, ED occurs in about 12--83% of patients. 5--8 The current study is the first prospective multicentre study to compare the functional results of patients who underwent either radical retropubic prostatectomy (RRPE) or endoscopic extraperitoneal radical prostatectomy (EERPE). In this paper, we report data related to the patients' sexual life before (t baseline ), 3 months (t 3m ), 6 months (t 6...

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Section: Discussionmentioning

confidence: 99%

“…9,10 Thus, we expect significantly better sexual functioning in patients who had undergone nerve-sparing vs non-nerve-sparing surgery.…”

Section: Introductionmentioning

confidence: 99%

Erectile dysfunction after radical prostatectomy: the impact of nerve-sparing status and surgical approach

et al. 2012

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“…Several trials have indicated that the best postoperative potency rates are obtained in the younger patient population. [11][12][13][14] Younger patients are more likely to have better preoperative erectile function and to be more interested in sexual recovery after surgery. [11][12][13][14] Patients between ages 40 years and 49 years reported rates of erectile function recovery as high as 92%.…”

Section: Patient and Partner Agementioning

confidence: 99%

“…[11][12][13][14] Younger patients are more likely to have better preoperative erectile function and to be more interested in sexual recovery after surgery. [11][12][13][14] Patients between ages 40 years and 49 years reported rates of erectile function recovery as high as 92%. 13 In addition to patient age, it recently was demonstrated that a difference in age between a patient and their partner is associated linearly with better sexual outcome after RP.…”

Section: Patient and Partner Agementioning

confidence: 99%

“…[11][12][13][14]16 Ideally, patients who are being considered for nerve-sparing RP (NSRP) should be potent before the procedure. 17 This is of major importance, because patients who report some degree of ED and patients who already use a PDE5-I before the procedure are more likely to develop severe ED postoperatively, regardless the surgical technique used.…”

Section: Preoperative Erectile Functionmentioning

confidence: 99%

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Prediction of sexual function after radical prostatectomy

Briganti

Capitanio

Chun

et al. 2009

Cancer

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Radical prostatectomy (RP) is a commonly used procedure in the treatment of clinically localized prostate cancer. For this report, the authors critically analyzed the factors associated with recovery of erectile function after surgery. A systematic review of the literature using the Medline and CancerLit databases was conducted. Keywords for the literature search included prostate cancer, radical prostatectomy, erectile dysfunction, impotence, treatment, and prophylaxis. Accurate patient selection (based on patient age, preoperative erectile function, and comorbidity profile) and adequate surgical technique (ie, the preservation of neurovascular bundles) were the major determinants of postoperative erectile function. Moreover, better results were achieved when an appropriate pharmacologic treatment using either oral or local approaches was given. Therefore, the authors concluded that, if patients are stratified correctly according to preoperative, intraoperative, and postoperative factors, then a satisfactory functional recovery may be expected after surgery. For these reasons, an ideal multivariate model predicting the restoration of erectile function after surgery should include patient, surgeon, and postsurgical treatment variables. The authors also concluded that the stratification of patients with regard to their risk of developing erectile dysfunction after surgery was feasible based on several parameters, which should be taken into account for correct patient treatment and counseling. To address this objective, accurate tools for predicting the likelihood of complete functional recovery after surgery are needed. Radical prostatectomy (RP) is used increasingly as a therapeutic option for patients who have clinically localized prostate cancer and a life expectancy 10 years. The pioneering work by Walsh and Donker 1 contributed significantly to our understanding of the surgical anatomy of the prostate and represented the basis for the subsequent development of the anatomic RP technique. The objective of this surgical approach is complete excision of the prostate to provide optimal cancer control while maintaining the integrity of the anatomic structures devoted to the functions of urinary continence and sexual potency. [2][3][4] Since the initial reports on this technique, increasing numbers of studies have reported satisfactory *Predictive Modeling in Prostate Cancer, Supplement to Cancer

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Prediction of Erectile Function Following Treatment for Prostate Cancer

Alemozaffar¹,

Regan²,

Cooperberg³

et al. 2011

JAMA

267

188

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Context Sexual function is the health-related quality of life (HRQOL) domain most commonly impaired after prostate cancer treatment; however, validated tools to enable personalized prediction of erectile dysfunction after prostate cancer treatment are lacking. Objective To predict long-term erectile function following prostate cancer treatment based on individual patient and treatment characteristics. Design Pretreatment patient characteristics, sexual HRQOL, and treatment details measured in a longitudinal academic multicenter cohort (Prostate Cancer Outcomes and Satisfaction With Treatment Quality Assessment; enrolled from 2003 through 2006), were used to develop models predicting erectile function 2 years after treatment. A community-based cohort (community-based Cancer of the Prostate Strategic Urologic Research Endeavor [CaPSURE]; enrolled 1995 through 2007) externally validated model performance. Patients in US academic and community-based practices whose HRQOL was measured pretreatment (N = 1201) underwent follow-up after prostatectomy, external radiotherapy, or brachytherapy for prostate cancer. Sexual outcomes among men completing 2 years’ follow-up (n = 1027) were used to develop models predicting erectile function that were externally validated among 1913 patients in a community-based cohort. Main Outcome Measures Patient-reported functional erections suitable for intercourse 2 years following prostate cancer treatment. Results Two years after prostate cancer treatment, 368 (37% [95% CI, 34%–40%]) of all patients and 335 (48% [95% CI, 45%–52%]) of those with functional erections prior to treatment reported functional erections; 531 (53% [95% CI, 50%–56%]) of patients without penile prostheses reported use of medications or other devices for erectile dysfunction. Pretreatment sexual HRQOL score, age, serum prostate-specific antigen level, race/ethnicity, body mass index, and intended treatment details were associated with functional erections 2 years after treatment. Multivariable logistic regression models predicting erectile function estimated 2-year function probabilities from as low as 10% or less to as high as 70% or greater depending on the individual’s pretreatment patient characteristics and treatment details. The models performed well in predicting erections in external validation among CaPSURE cohort patients (areas under the receiver operating characteristic curve, 0.77 [95% CI, 0.74–0.80] for prostatectomy; 0.87 [95% CI, 0.80–0.94] for external radiotherapy; and 0.90 [95% CI, 0.85–0.95] for brachytherapy). Conclusion Stratification by pretreatment patient characteristics and treatment details enables prediction of erectile function 2 years after prostatectomy, external radiotherapy, or brachytherapy for prostate cancer.

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Factors affecting erectile function after radical retropubic prostatectomy: results from 1620 consecutive patients

Cited by 73 publications

References 19 publications

Erectile dysfunction after radical prostatectomy: the impact of nerve-sparing status and surgical approach

Erectile dysfunction after radical prostatectomy: the impact of nerve-sparing status and surgical approach

Prediction of sexual function after radical prostatectomy

Prediction of Erectile Function Following Treatment for Prostate Cancer

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