- Email: [email protected]
PREDICTING ERECTILE FUNCTION RECOVERY AFTER BILATERAL NERVE SPARING RADICAL PROSTATECTOMY: A PROPOSAL OF A NOVEL RISK STRATIFICATION
THE JOURNAL OF UROLOGY®
Vol. 181, No. 4, Supplement, Monday, April 27, 2009
1030 THE IMPACT OF OAB ON MALE SEXUAL HEALTH: RESULTS FROM EPILUTS Karin S Coyne*, Chris C Sexton, Bethesda, MD; David Weinstein, Paris, France; Zoe S Kopp, New York, NY; Christopher R Chapple, Sheffield, United Kingdom; Caty Ebel-Bitoun, Paris, France; Ian Milsom, Gothenburg, Sweden; Steven A Kaplan, Ithaca, NY INTRODUCTION AND OBJECTIVES: Although lower urinary tract symptoms (LUTS) have been associated with erectile dysfunction (ED), little is know as to the impact of overactive bladder (OAB) on overall male sexual health. Thus, the impact of OAB on male sexual health was evaluated within a large, multi-country epidemiological study of men over 40 in the US, UK, and Sweden. METHODS: This cross-sectional, population representative survey was conducted via the Internet. Participants were asked to rate how often they experienced urinary symptoms during the past 4 weeks on a 5-point Likert scale. Participants were permitted to opt out from the sexual health survey which contained the IIEF for erectile dysfunction (ED) and questions about ejaculation dysfunction (EjD) and premature ejaculation (PE). Those with OAB and/or other LUTS were asked questions about urinary symptom impact on sexual health. Descriptive statistics and logistic regressions were used to assess the impact of OAB on sexual health. RESULTS: Overall survey response rate was 59.2%; 6,331 participated in sexual health survey (16% opted out). Mean age was 56.5; 83% white. Using the q “sometimes” definition, 51% of men had No/ minimal symptoms (NMS), 23% had continent OAB (C-OAB), and 24%, incontinent OAB (I-OAB). 81% of those with NMS reported that they were sexually active, compared to 64% with C-OAB and 55% with I-OAB. Men with OAB were > three times more likely to report their own health reasons prevented them from being sexually active as compared to NMS men (C-OAB, 30%; I-OAB, 33%; NMS 9%). 20% with C-OAB and 26% with I-OAB reported that they had decreased or stopped sexual activity due to their urinary symptoms compared to 2% with NMS. 22% with C-OAB and 28% with I-OAB reported that their urinary symptoms decreased their enjoyment of sexual activity compared to 2% NMS. 18% of NMS reported mild or greater ED (a 21 IIEF) as compared to 32% and 35% of men with C-OAB and I-OAB, respectively. 17% of NMS experienced PE half the time or greater, as compared to 26% and 29% with C-OAB and I-OAB. Significant predictors of ED were older age, hypertension, diabetes, depression, C-OAB, I-OAB, and bladder pain during sex (all p a 0.01). Significant predictors of EjD (q half the time) were older age, prostate cancer, depression, I-OAB, and pain during sex (all p a 0.03). Significant predictors of PE (> half the time) were younger age, depression, C-OAB, I-OAB, and bladder pain during sex (all p a 0.01). CONCLUSIONS: OAB is significantly associated with diminished sexual health and ED, EjD, and PE. Sexual health should be assessed in men presenting with OAB. Source of Funding: Pfizer Inc.
1031 AN ANALYSIS OF EXPECTATIONS OF PATIENTS REGARDING SEXUAL FUNCTION FOLLOWING RADICAL PROSTATECTOMY Serkan Deveci, Sr*, Byron Alex, Sr, Keith O’Brien, Sr, John P. Mulhall, Sr, New York, NY INTRODUCTION AND OBJECTIVES: Clinical experience suggests that some patients who have had a radical prostatectomy (RP) have unrealistic expectations with regard to their long-term sexual function. Whether this is related to omission on behalf of the surgeon or failure of the patient to comprehend this information preoperatively is unclear. This study was undertaken to assess the understanding of patients who had previously undergone RP with regard to their postoperative sexual function. METHODS: Patients presenting within 3 months of their RP (open and robotic) were questioned regarding the sexual function information that they had received pre-RP. Patients were questioned about erectile
369
function (expected time to full recovery of erections, requirement for postoperative intracavernosal injections), postoperative ejaculatory status, orgasm (presence, intensity, pain, and climacturia), postoperative Peyronie’s disease, and penile length changes. Statistical comparison was conducted for differences in data for ORP and RRP patients. RESULTS: 336 consecutive patients were enrolled, 216 open (ORP) and 120 robotic (RRP) with a mean age of the group of 64±11 years, with no differences between ORP and RRP groups. The mean duration post-RP at the time of postoperative interview was 3±2 months. 38% of men had an accurate recollection of their nerve sparing status. Results of the sexual function knowledge assessment are listed in the Table. CONCLUSIONS: Patients who have undergone radical prostatectomy have largely unrealistic expectations with regard to their postoperative sexual function. In particular, a significant proportion of patients are unaware of the inability to ejaculate, and almost none understood that there are documented orgasm changes or that RP appears to be associated with Peyronie’s disease. Patients undergoing robotic RP are less likely to be aware of the potential need for injection therapy after surgery or the link between RP and penile length changes, and are more likely to think their erectile function will recover within the first 12 month postoperatively. Mean time to erectile function recovery (months) Potential need for postoperative ICI (Y/N) Knowledge of anejaculatory status (Y/N) Knowledge of change in orgasm (Y/N) Knowledge of orgasmic pain (Y/N) Knowledge of climacturia (Y/N) Knowledge of post-RP Peyronie’s disease (Y/N) Knowledge of penile length changes (Y/N) Table 1
ORP RRP p Value 12m 6m 0.02 20% 4% 0.01 70% 60% NS 10% 12% NS 2% 0% NS 2% 0% NS 0% 0% NS 10% 0% <0.01
Source of Funding: None
1032 PREDICTING ERECTILE FUNCTION RECOVERY AFTER BILATERAL NERVE SPARING RADICAL PROSTATECTOMY: A PROPOSAL OF A NOVEL RISK STRATIFICATION Alberto Briganti*, Andrea Gallina, Andrea Salonia, Nazareno Suardi, Andrea Cestari, Antonino Saccà, Luigi Barbieri, Giorgio Guazzoni, Patrizio Rigatti, Francesco Montorsi, Milan, Italy INTRODUCTION AND OBJECTIVES: The aim of this study was to develop a novel risk stratification of patients aimed at assessing the probability of EF recovery after surgery. METHODS: This study included 435 consecutive patients treated with BNSRP between 2004 to 2008. Complete pre-operative data, including age, International Index of Erectile Function (IIEF) and Charlson comorbidity index (CCI) were available for all patients. Moreover, all patients were assessed post-op every 3 months and were asked to complete the IIEF during each visit. Post-operative EF recovery was defined as an EF domain score of the IIEF (IIEF-EF) q22. Patients were then sub-divided into 3 groups according to the probability of EF recovery after surgery: high (age a65 yrs, IIEF-EFq26, CCIa1), low (age q70 yrs or IIEF-EFa10 or CCIq2) and intermediate (all remaining patients). Kaplan-Meier curves assessed the time to EF recovery according to each category of risk. Cox regression models tested the association between the 3 proposed risk categories and EF recovery. Predictive accuracy (PA) of our proposed classification was quantified using the AUC method and internally validated with 200 boostraps resamples. RESULTS: Overall, 203/435 (46.7%) reached a IIEF-EF domain score q22 after a mean follow-up of 23.2 months (median 20; range: 2-62). The rate of EF recovery was 69.9, 47.8 and 28.8% in patients with high, intermediate and low probability of EF recovery, respectively (figure 1; p<0.001). Univariable and multivariable Cox regression models showed a significant association between all the co-variates included in the analyses (namely, age, IIEF-EF domain score and CCI) and EF recovery (all pa0.03) . Moreover, univariable Cox regression analysis also showed a highly significant association between the risk classification proposed and
370
THE JOURNAL OF UROLOGY®
EF recovery (p<0.001). The stratification showed a 69.1% accuracy. CONCLUSIONS: We report the first risk stratification of patients with regards to the probability of EF recovery after BNSRP. It is based on routinely avalable clinical data such as patient age, pre-operative erectile function and comorbidity profile.
Vol. 181, No. 4, Supplement, Monday, April 27, 2009
% of PCa Patients Reporting Utilization and Effectiveness by Type of Medication or Device for ED ED Aid Type Have not Tried but it was Always Sometimes tried it not helpful use it use it pde5 inhibitors intra-urethral suppository penile injection vacuum erection device
40
19
13
20
It helped but I am not using it now 7
90
5
1
2
2
90
2
2
2
4
88
4
2
3
3
Source of Funding: NIH R01 CA95662
1034 INSIGHTS INTO THE IMPACT OF NERVE-SPARING STATUS DURING RADICAL PROSTATECTOMY: VALIDATING OF A NERVE SPARING SCORING SYSTEM. Source of Funding: None
1033 UTILIZATION OF MEDICATIONS AND DEVICES FOR ERECTILE DYSFUNCTION AFTER PROSTATE CANCER TREATMENT: RESULTS FROM THE MULTICENTER PROSTQA CONSORTIUM Martin G Sanda*, Meredith M Regan, Boston, MA; Rodney L Dunn, Ann Arbor, MI; Jeff Michalski, Adam S Kibel, St. Louis, MO; Howard M Sandler, Christopher S Saigal, Los Angeles, CA; Larry Hembroff, East Lansing, CA; Eric A Klein, Jay P Ciezki, Arul Mahadevan, Cleveland, OH; Louis L Pisters, Deborah Kuban, Houston, TX; David P Wood, Ann Arbor, MI; Irving Kaplan, Boston, MA; John T Wei, Ann Arbor, MI INTRODUCTION AND OBJECTIVES: Data regarding utilization of medications and devices for erectile dysfunction (ED aids) among patients treated for localized prostate cancer (PCa) have been limited to either single institution series or cross-sectional multicenter studies. We sought to determine use of medications or devices for ED and their effectiveness in a prospective, longitudinal multicenter study of PCa treatment outcomes. METHODS: The PROSTQA consortium is a prospective cohort of 1,201 patients who underwent radical prostatectomy (RP, 603), external radiotherapy (XRT, 298) or brachytherapy (BT, 302) for PCa at 9 hospitals (N Engl J Med 2008; 358:1250). Information regarding ED aid use (measured by the EPIC-ED Supplement, that queries use of phosphodiesterase 5 - PDE5 - inhibitors, intraurethral suppositories, penile injections, or vaccuum erection devices) and health-related quality of life data (measured by EPIC-26) were collected by phone interview before and 2, 6, 12, and 24 months after treatment. Medical, demographic, and cancer-severity data were collected during clinical visits. Univariate and multivariable analyses were used to evaluate ED aid use 2 years after treatment. RESULTS: 1027 men (86%) completed 2-years on study; among these, 14 had a penile prosthesis and 12 chose not to respond to questions at 2 yrs about ED aid use, leaving 1001 men for detailed analysis. 531 (53%) reported having used any ED aids at 2 yrs; use varied by treatment (66% RP, 32% XRT, 47% BT; P<0.001). Patient factors associated with ED aid use included marital status, age, education level, baseline ED, and presence of comorbidities; treatment factors included nerve-sparing status with RP and use of hormone therapy or radiation boost with BT (p <0.02 for each). Tabulated are ED aid use and effectiveness among men who had no ED before PCa treatment. CONCLUSIONS: ED aid use was more common after RP than ERT or BT. PDE-5 inhibitors were tried most commonly yet were the least effective; other medications or devices appear to be underutilized after PCa treatment.
Christian Nelson, Hannah H Alphs*, Farhang Rabbani, James A Eastham, Karim A Touijer, Bertrand Guillonneau, Peter T Scardino, John P Mulhall, New York, NY INTRODUCTION AND OBJECTIVES: It is well established that nerve sparing is integral to erectile function (EFR) after radical prostatectomy (RP). We attempted to analyze a novel system of nerve sparing grading and its impact on EF recovery at 12 and 24 months post-RP. METHODS: We analyzed data from an ongoing post-RP QOL study assessing among other factors, EFR. We assessed patients with preoperative and 24m postoperative IIEF erectile domain (EFD) score data. Demographic, pathologic, and nerve sparing data were also recorded. We have been using a nerve sparing scoring (NSS) system: 1=perfect nerve sparing, 2=minor damage, 3=moderate damage, 4=complete resection. Each nerve was assigned a grade by the surgeon at the end of the RP and a total score (right + left sides) was calculated (range 2-8; 2 representing perfect nerve sparing and 8 complete non-nerve sparing). Correlations and multiple regression analysis were used to test convergent validity between the NSS and EFD scores. An ANOVA analysis and Chi-Squared analysis were used to provide descriptive data and determine if there were differences in EFR between the different NSS. RESULTS: Mean age of the 244 patients was 60±7 years. Comorbidities included: hypertension 29%, dyslipidemia 35%, cigarette smoking 24%. Baseline and 24m mean EFD scores were 24±8 and 17±10. NSS were associated with 12m EFD scores (r=-0.26, p <0.01), 24m EFD scores (r=-0.33, p <0.01), and change in EFD score from baseline to 24m (r=-0.18, p < .01). In multivariate analysis, NSS remained a significant predictor of 24m EFD scores (beta=-0.15, p<0.01). As the NSS increased, the mean 24m EFD declined: NSS 2: EFD=19; NSS 3: EFD=16; NSS 4: EFD=13; NSS 5: EFD=15; NSS 6-8: EFD=7. ANOVA showed significant differences between NSS groups (F = 3.03, p <0.01). There was a significant difference in EFD score between NSS 2 and 4 but not between 2 and 3 or between 3 and 4. In support of this analysis, almost all of the men with pre-RP EFDq20 who returned to baseline EFD score at 24m (n=37, 15%) were in NSS groups 2 or 3. CONCLUSIONS: There were significant correlations between the NSS and EFD scores. NSS was a significant predictor on multivariate analysis. This supports the concept that it is the volume of remaining nerve tissue that is critical for EFR. The clear gradation in EFD score between the different NSS validates the use of this system for nerve sparing assessment. Source of Funding: None
Vol. 181, No. 4, Supplement, Monday, April 27, 2009
1030 THE IMPACT OF OAB ON MALE SEXUAL HEALTH: RESULTS FROM EPILUTS Karin S Coyne*, Chris C Sexton, Bethesda, MD; David Weinstein, Paris, France; Zoe S Kopp, New York, NY; Christopher R Chapple, Sheffield, United Kingdom; Caty Ebel-Bitoun, Paris, France; Ian Milsom, Gothenburg, Sweden; Steven A Kaplan, Ithaca, NY INTRODUCTION AND OBJECTIVES: Although lower urinary tract symptoms (LUTS) have been associated with erectile dysfunction (ED), little is know as to the impact of overactive bladder (OAB) on overall male sexual health. Thus, the impact of OAB on male sexual health was evaluated within a large, multi-country epidemiological study of men over 40 in the US, UK, and Sweden. METHODS: This cross-sectional, population representative survey was conducted via the Internet. Participants were asked to rate how often they experienced urinary symptoms during the past 4 weeks on a 5-point Likert scale. Participants were permitted to opt out from the sexual health survey which contained the IIEF for erectile dysfunction (ED) and questions about ejaculation dysfunction (EjD) and premature ejaculation (PE). Those with OAB and/or other LUTS were asked questions about urinary symptom impact on sexual health. Descriptive statistics and logistic regressions were used to assess the impact of OAB on sexual health. RESULTS: Overall survey response rate was 59.2%; 6,331 participated in sexual health survey (16% opted out). Mean age was 56.5; 83% white. Using the q “sometimes” definition, 51% of men had No/ minimal symptoms (NMS), 23% had continent OAB (C-OAB), and 24%, incontinent OAB (I-OAB). 81% of those with NMS reported that they were sexually active, compared to 64% with C-OAB and 55% with I-OAB. Men with OAB were > three times more likely to report their own health reasons prevented them from being sexually active as compared to NMS men (C-OAB, 30%; I-OAB, 33%; NMS 9%). 20% with C-OAB and 26% with I-OAB reported that they had decreased or stopped sexual activity due to their urinary symptoms compared to 2% with NMS. 22% with C-OAB and 28% with I-OAB reported that their urinary symptoms decreased their enjoyment of sexual activity compared to 2% NMS. 18% of NMS reported mild or greater ED (a 21 IIEF) as compared to 32% and 35% of men with C-OAB and I-OAB, respectively. 17% of NMS experienced PE half the time or greater, as compared to 26% and 29% with C-OAB and I-OAB. Significant predictors of ED were older age, hypertension, diabetes, depression, C-OAB, I-OAB, and bladder pain during sex (all p a 0.01). Significant predictors of EjD (q half the time) were older age, prostate cancer, depression, I-OAB, and pain during sex (all p a 0.03). Significant predictors of PE (> half the time) were younger age, depression, C-OAB, I-OAB, and bladder pain during sex (all p a 0.01). CONCLUSIONS: OAB is significantly associated with diminished sexual health and ED, EjD, and PE. Sexual health should be assessed in men presenting with OAB. Source of Funding: Pfizer Inc.
1031 AN ANALYSIS OF EXPECTATIONS OF PATIENTS REGARDING SEXUAL FUNCTION FOLLOWING RADICAL PROSTATECTOMY Serkan Deveci, Sr*, Byron Alex, Sr, Keith O’Brien, Sr, John P. Mulhall, Sr, New York, NY INTRODUCTION AND OBJECTIVES: Clinical experience suggests that some patients who have had a radical prostatectomy (RP) have unrealistic expectations with regard to their long-term sexual function. Whether this is related to omission on behalf of the surgeon or failure of the patient to comprehend this information preoperatively is unclear. This study was undertaken to assess the understanding of patients who had previously undergone RP with regard to their postoperative sexual function. METHODS: Patients presenting within 3 months of their RP (open and robotic) were questioned regarding the sexual function information that they had received pre-RP. Patients were questioned about erectile
369
function (expected time to full recovery of erections, requirement for postoperative intracavernosal injections), postoperative ejaculatory status, orgasm (presence, intensity, pain, and climacturia), postoperative Peyronie’s disease, and penile length changes. Statistical comparison was conducted for differences in data for ORP and RRP patients. RESULTS: 336 consecutive patients were enrolled, 216 open (ORP) and 120 robotic (RRP) with a mean age of the group of 64±11 years, with no differences between ORP and RRP groups. The mean duration post-RP at the time of postoperative interview was 3±2 months. 38% of men had an accurate recollection of their nerve sparing status. Results of the sexual function knowledge assessment are listed in the Table. CONCLUSIONS: Patients who have undergone radical prostatectomy have largely unrealistic expectations with regard to their postoperative sexual function. In particular, a significant proportion of patients are unaware of the inability to ejaculate, and almost none understood that there are documented orgasm changes or that RP appears to be associated with Peyronie’s disease. Patients undergoing robotic RP are less likely to be aware of the potential need for injection therapy after surgery or the link between RP and penile length changes, and are more likely to think their erectile function will recover within the first 12 month postoperatively. Mean time to erectile function recovery (months) Potential need for postoperative ICI (Y/N) Knowledge of anejaculatory status (Y/N) Knowledge of change in orgasm (Y/N) Knowledge of orgasmic pain (Y/N) Knowledge of climacturia (Y/N) Knowledge of post-RP Peyronie’s disease (Y/N) Knowledge of penile length changes (Y/N) Table 1
ORP RRP p Value 12m 6m 0.02 20% 4% 0.01 70% 60% NS 10% 12% NS 2% 0% NS 2% 0% NS 0% 0% NS 10% 0% <0.01
Source of Funding: None
1032 PREDICTING ERECTILE FUNCTION RECOVERY AFTER BILATERAL NERVE SPARING RADICAL PROSTATECTOMY: A PROPOSAL OF A NOVEL RISK STRATIFICATION Alberto Briganti*, Andrea Gallina, Andrea Salonia, Nazareno Suardi, Andrea Cestari, Antonino Saccà, Luigi Barbieri, Giorgio Guazzoni, Patrizio Rigatti, Francesco Montorsi, Milan, Italy INTRODUCTION AND OBJECTIVES: The aim of this study was to develop a novel risk stratification of patients aimed at assessing the probability of EF recovery after surgery. METHODS: This study included 435 consecutive patients treated with BNSRP between 2004 to 2008. Complete pre-operative data, including age, International Index of Erectile Function (IIEF) and Charlson comorbidity index (CCI) were available for all patients. Moreover, all patients were assessed post-op every 3 months and were asked to complete the IIEF during each visit. Post-operative EF recovery was defined as an EF domain score of the IIEF (IIEF-EF) q22. Patients were then sub-divided into 3 groups according to the probability of EF recovery after surgery: high (age a65 yrs, IIEF-EFq26, CCIa1), low (age q70 yrs or IIEF-EFa10 or CCIq2) and intermediate (all remaining patients). Kaplan-Meier curves assessed the time to EF recovery according to each category of risk. Cox regression models tested the association between the 3 proposed risk categories and EF recovery. Predictive accuracy (PA) of our proposed classification was quantified using the AUC method and internally validated with 200 boostraps resamples. RESULTS: Overall, 203/435 (46.7%) reached a IIEF-EF domain score q22 after a mean follow-up of 23.2 months (median 20; range: 2-62). The rate of EF recovery was 69.9, 47.8 and 28.8% in patients with high, intermediate and low probability of EF recovery, respectively (figure 1; p<0.001). Univariable and multivariable Cox regression models showed a significant association between all the co-variates included in the analyses (namely, age, IIEF-EF domain score and CCI) and EF recovery (all pa0.03) . Moreover, univariable Cox regression analysis also showed a highly significant association between the risk classification proposed and
370
THE JOURNAL OF UROLOGY®
EF recovery (p<0.001). The stratification showed a 69.1% accuracy. CONCLUSIONS: We report the first risk stratification of patients with regards to the probability of EF recovery after BNSRP. It is based on routinely avalable clinical data such as patient age, pre-operative erectile function and comorbidity profile.
Vol. 181, No. 4, Supplement, Monday, April 27, 2009
% of PCa Patients Reporting Utilization and Effectiveness by Type of Medication or Device for ED ED Aid Type Have not Tried but it was Always Sometimes tried it not helpful use it use it pde5 inhibitors intra-urethral suppository penile injection vacuum erection device
40
19
13
20
It helped but I am not using it now 7
90
5
1
2
2
90
2
2
2
4
88
4
2
3
3
Source of Funding: NIH R01 CA95662
1034 INSIGHTS INTO THE IMPACT OF NERVE-SPARING STATUS DURING RADICAL PROSTATECTOMY: VALIDATING OF A NERVE SPARING SCORING SYSTEM. Source of Funding: None
1033 UTILIZATION OF MEDICATIONS AND DEVICES FOR ERECTILE DYSFUNCTION AFTER PROSTATE CANCER TREATMENT: RESULTS FROM THE MULTICENTER PROSTQA CONSORTIUM Martin G Sanda*, Meredith M Regan, Boston, MA; Rodney L Dunn, Ann Arbor, MI; Jeff Michalski, Adam S Kibel, St. Louis, MO; Howard M Sandler, Christopher S Saigal, Los Angeles, CA; Larry Hembroff, East Lansing, CA; Eric A Klein, Jay P Ciezki, Arul Mahadevan, Cleveland, OH; Louis L Pisters, Deborah Kuban, Houston, TX; David P Wood, Ann Arbor, MI; Irving Kaplan, Boston, MA; John T Wei, Ann Arbor, MI INTRODUCTION AND OBJECTIVES: Data regarding utilization of medications and devices for erectile dysfunction (ED aids) among patients treated for localized prostate cancer (PCa) have been limited to either single institution series or cross-sectional multicenter studies. We sought to determine use of medications or devices for ED and their effectiveness in a prospective, longitudinal multicenter study of PCa treatment outcomes. METHODS: The PROSTQA consortium is a prospective cohort of 1,201 patients who underwent radical prostatectomy (RP, 603), external radiotherapy (XRT, 298) or brachytherapy (BT, 302) for PCa at 9 hospitals (N Engl J Med 2008; 358:1250). Information regarding ED aid use (measured by the EPIC-ED Supplement, that queries use of phosphodiesterase 5 - PDE5 - inhibitors, intraurethral suppositories, penile injections, or vaccuum erection devices) and health-related quality of life data (measured by EPIC-26) were collected by phone interview before and 2, 6, 12, and 24 months after treatment. Medical, demographic, and cancer-severity data were collected during clinical visits. Univariate and multivariable analyses were used to evaluate ED aid use 2 years after treatment. RESULTS: 1027 men (86%) completed 2-years on study; among these, 14 had a penile prosthesis and 12 chose not to respond to questions at 2 yrs about ED aid use, leaving 1001 men for detailed analysis. 531 (53%) reported having used any ED aids at 2 yrs; use varied by treatment (66% RP, 32% XRT, 47% BT; P<0.001). Patient factors associated with ED aid use included marital status, age, education level, baseline ED, and presence of comorbidities; treatment factors included nerve-sparing status with RP and use of hormone therapy or radiation boost with BT (p <0.02 for each). Tabulated are ED aid use and effectiveness among men who had no ED before PCa treatment. CONCLUSIONS: ED aid use was more common after RP than ERT or BT. PDE-5 inhibitors were tried most commonly yet were the least effective; other medications or devices appear to be underutilized after PCa treatment.
Christian Nelson, Hannah H Alphs*, Farhang Rabbani, James A Eastham, Karim A Touijer, Bertrand Guillonneau, Peter T Scardino, John P Mulhall, New York, NY INTRODUCTION AND OBJECTIVES: It is well established that nerve sparing is integral to erectile function (EFR) after radical prostatectomy (RP). We attempted to analyze a novel system of nerve sparing grading and its impact on EF recovery at 12 and 24 months post-RP. METHODS: We analyzed data from an ongoing post-RP QOL study assessing among other factors, EFR. We assessed patients with preoperative and 24m postoperative IIEF erectile domain (EFD) score data. Demographic, pathologic, and nerve sparing data were also recorded. We have been using a nerve sparing scoring (NSS) system: 1=perfect nerve sparing, 2=minor damage, 3=moderate damage, 4=complete resection. Each nerve was assigned a grade by the surgeon at the end of the RP and a total score (right + left sides) was calculated (range 2-8; 2 representing perfect nerve sparing and 8 complete non-nerve sparing). Correlations and multiple regression analysis were used to test convergent validity between the NSS and EFD scores. An ANOVA analysis and Chi-Squared analysis were used to provide descriptive data and determine if there were differences in EFR between the different NSS. RESULTS: Mean age of the 244 patients was 60±7 years. Comorbidities included: hypertension 29%, dyslipidemia 35%, cigarette smoking 24%. Baseline and 24m mean EFD scores were 24±8 and 17±10. NSS were associated with 12m EFD scores (r=-0.26, p <0.01), 24m EFD scores (r=-0.33, p <0.01), and change in EFD score from baseline to 24m (r=-0.18, p < .01). In multivariate analysis, NSS remained a significant predictor of 24m EFD scores (beta=-0.15, p<0.01). As the NSS increased, the mean 24m EFD declined: NSS 2: EFD=19; NSS 3: EFD=16; NSS 4: EFD=13; NSS 5: EFD=15; NSS 6-8: EFD=7. ANOVA showed significant differences between NSS groups (F = 3.03, p <0.01). There was a significant difference in EFD score between NSS 2 and 4 but not between 2 and 3 or between 3 and 4. In support of this analysis, almost all of the men with pre-RP EFDq20 who returned to baseline EFD score at 24m (n=37, 15%) were in NSS groups 2 or 3. CONCLUSIONS: There were significant correlations between the NSS and EFD scores. NSS was a significant predictor on multivariate analysis. This supports the concept that it is the volume of remaining nerve tissue that is critical for EFR. The clear gradation in EFD score between the different NSS validates the use of this system for nerve sparing assessment. Source of Funding: None