On-demand use of erectile aids in men with preoperative erectile dysfunction treated by whole gland prostate cryoablation

Abstract

Prostate cryoablation is an established minimally invasive treatment for localized prostate cancer (PCa). However, the impairment of erectile function (EF) is considered a serious complication of the procedure. To investigate the efficacy of erectile aids following cryotherapy, 93 patients who underwent whole gland prostate cryoablation with required complete medical records were analyzed. The changes in postoperative EF were evaluated using the International Index of Erectile Function (IIEF-5) questionnaire. Additionally, independent factors that could have a correlation to the postoperative IIEF-5 score or postoperative Expanded Prostate Cancer Index Composite (EPIC) score were assessed. In the entire cohort, the mean preoperative IIEF-5 score was 7.0 ± 6.2. A total of 72 (77.4%) patients had moderate-to-severe preoperative erectile dysfunction. In longitudinal investigation, the patients using erectile aids showed the ability to recover to baseline after 24 months from cryoablation compared with the patients not using erectile aids. There were significant differences of IIEF-5 scores between these groups at 24 months (7.5 vs 3.0; P ¼ 0.025) and 36 months (8.5 vs 3.5; P ¼ 0.010). In multivariate analysis, the use of erectile aids correlated with restoration of IIEF-5 scores (odds ratio, 5.11; confidence interval (CI), 1.87-13.96; Po0.001) and lower EPIC sexual bother (coef, 19.61; CI,; P ¼ 0.046). Our data indicate that on-demand use of erectile aids could help restore EF and reduce sexual bother after whole gland prostate cryoablation. Although, erectile aids could not play a role as an adequate treatment for ED after whole gland prostate cryoablation, these results may aid in the decision-making process for PCa patients with preoperative and postoperative ED who have concern about sexual health-related quality of life.

Targeted prostate cancer ablation

“…The visualized leading edge of the ice at the periphery of the ice ball is just below freezing (08C), and the isotherms for temperature change in tissues show that lethal temperatures (À408C) exist at least 5 or more millimetres inside the leading edge of the ice. Several groups of investigators have reported profound loss of sexual function in patients after whole-gland prostate cryoablation, due to collateral neurovascular damage [10][11][12]. At this distance, collateral damage to the rectal wall and neurovascular structures is a serious concern during prostate cryoablation, despite major efforts to minimize the risk.…”