Recovery of Baseline Erectile Function in Men Following Radical Prostatectomy for High-Risk Prostate Cancer: A Prospective Analysis Using Validated Measures.

Published on Mar 1, 2016in The Journal of Sexual Medicine3.802
· DOI :10.1016/J.JSXM.2016.01.005
J.D. Kelly44
Estimated H-index: 44
(UCL: University College London)
Abstract Introduction Recovery of baseline erectile function (EF) after robotic radical prostatectomy in men with high-risk prostate cancer is under-reported. Published studies have selectively reported on low-risk disease using non-validated and poorly defined thresholds for EF recovery. Aim To assess return to baseline EF in men after robotic radical prostatectomy for high-risk prostate cancer. Materials Five hundred thirty-one men underwent robotic radical prostatectomy for high-risk prostate cancer from February 2010 through July 2014. Pre- and postoperative EF was prospectively assessed using the International Index of Erectile Dysfunction (IIEF-5) questionnaire. Multivariate logistic regression analysis determined the effect of age, preoperative function, comorbidities, body mass index, prostate-specific antigen level, cancer stage or grade, nerve-sparing status, adjuvant therapy, and continence on EF return (defined as postoperative return to baseline EF with or without use of phosphodiesterase type 5 inhibitors). Kaplan-Meier analysis and log-rank test were used to analyze return over time. Mann-Whitney U-test was used to compare IIEF-5 scores. Main Outcome Measures Pre- and postoperative EF was assessed using the IIEF-5 Sexual Health Inventory for Men at 3 months, 6 months, 1 year, 2 years, 3 years, and 4 years postoperatively. Results Overall, return of EF was seen in 23.5% of patients at 18 months. This was significantly increased in men no older than 60 years ( P  = .024), with a preoperative IIEF-5 score of at least 22 ( P  = .042), and after undergoing neurovascular bundle preservation (34.9% of patients, P P  = .87), although there was significant improvement in those receiving second- or third-line therapies ( P  = .042). Other than preoperative hypertension ( P  = .03), none of the other comorbidities predicted return of EF. Conclusion In this study, 23.5% of men recovered to baseline EF. Of those who underwent bilateral neurovascular bundle preservation robotic radical prostatectomy, 70% recovered baseline EF; however, this accounted for only 9.6% of all patients. Only 4% of men who underwent non-neurovascular bundle preservation had baseline recovery with phosphodiesterase type 5 inhibitors up to 36 months. There was significant improvement after use of second- or third-line therapies, indicating the need for earlier institution of these treatment modalities.
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