Serkan Deveci

Outcomes of the management of post-chemotherapy retroperitoneal lymph node dissection-associated anejaculation

Study Type – Outcomes (cohort)

Ejaculation Profiles of Men Following Radiation Therapy for Prostate Cancer

OBJECTIVESnRadical prostatectomy (RP) is associated with anejaculation, which for some men is a source of bother and sexual dissatisfaction. Clinical experience has shown us some men after pelvic radiation therapy (RT) also experience anejaculation. This analysis was conducted to define the ejaculation profiles of men after RT for prostate cancer (PCa).nnnMETHODSnAs a routine part of the sexual health evaluation for post-RT patients, men provided information regarding their ejaculatory function and orgasm. Analysis was conducted of a sexual medicine database reviewing demographic data, PCa factors, erectile, ejaculatory, and orgasmic function. Men with prior history of RP, cryotherapy, focal therapies, and androgen deprivation therapy (ADT) were excluded. Patients completed the International Index of Erectile Function (IIEF) questionnaire at follow-up visits commencing with the first posttreatment visit and specific attention was paid to the IIEF orgasm domain.nnnRESULTSnThree hundred and sixty-four consecutive patients were included. Two hundred and fifty-two patients had external beam, and 112 patients had brachytherapy (BT). Mean age was 64u2009±u200911 (42-78) years and mean follow-up after RT was 6u2009±u20094.5 years. Mean prostate size at time of RT was 42u2009±u200921u2009g. Of the entire population, 72% lost the ability to ejaculate in an antegrade fashion after prostate RT by their last visit. The proportion experiencing anejaculation at 1, 3, and 5 years after RT was 16%, 69%, and 89%, respectively. For men with at least two IIEF questionnaires completed, the orgasm domain scores decreased dramatically over the follow-up period; orgasm domain scores (0-10): <12 months post-RT 7.4, 13-24 months 5.4, 25-36 months 3.2, >36 months 2.8 (Pu2009<u20090.01). Multivariable analysis identified several factors predictive of failure to ejaculate: older age, ADT, RT doseu2009>u2009100u2009Gy, and smaller prostates at the time of RT.nnnCONCLUSIONSnThe vast majority of men after prostate RT will experience anejaculation and should be counseled accordingly prior to undergoing therapy. We have identified predictive factors.

Efficacy of a penile variable tension loop for improving climacturia after radical prostatectomy.

Climacturia is present in ∼20–40% of men after radical prostatectomy, and adversely affects sexual satisfaction. Although several strategies have been proposed for the treatment of climacturia, none have been systematically studied to date. This observational study shows that use of a penile variable tension loop can significantly reduce the degree and frequency of orgasm‐associated incontinence, and the associated distress experienced by patients and partners. Climacturia resolves completely in half the patients, and occurs occasionally or rarely in the remainder.

Androgen deprivation therapy before radical prostatectomy is associated with poorer postoperative erectile function outcomes

Study Type – Therapy (case series)

A survey of patient expectations regarding sexual function following radical prostatectomy.

To assess the understanding of patients, who had previously undergone radical prostatectomy (RP), about their postoperative sexual function, as clinical experience suggests that some RP patients have unrealistic expectations about their long‐term sexual function.

Exploring the Association Between Erectile Rigidity and Treatment Adherence With Sildenafil

INTRODUCTIONnErection hardness has been shown to correlate with increased self-confidence, sexual satisfaction, and improvement in psychosocial factors such as sexual and overall relationship. It is estimated that one-third of men using phosphodiesterase type 5 inhibitors (PDE5) cease use of medication after one prescription and one-half cease use by 6 months.nnnAIMnThis study was undertaken to explore the link between erection hardness and treatment adherence.nnnMETHODSnMen presenting with erectile dysfunction (ED) who were candidates for PDE5 therapy constituted the study population. They were assessed at the baseline regarding their erectile function (EF) and rigidity using autoquestionnaires. Patients then received regular follow-up using the same assessment tools and were also asked about continued use of PDE5. The final patient assessment was conducted at a time point no sooner than 12 months after commencing PDE5. Multivariable analysis was conducted to define predictors of continued PDE5 use.nnnMAIN OUTCOME MEASURESnPatients were assessed using the International Index of Erectile Function (IIEF) questionnaire and the Erection Hardness Score (EHS). Adherence was defined as continued use of PDE5 at least once per month.nnnRESULTSnOne hundred eighty-six men were analyzed. The mean age and the duration of ED were 61 ± 22 and 2.2 ± 2.9 years, respectively. Sixty-three percent were married or partnered. The mean partner age was 52 ± 8 years. Of the 186 patients, 32% had one vascular comorbidity, 34% had two vascular comorbidities, 26% had three vascular comorbidities, and 6% had ≥ 4 vascular comorbidities. All patients were treated with sildenafil and were sexually active. The mean time to end-of-treatment (EOT) interview and repeat completion of questionnaires was 17 ± 4 months. At the baseline, 26% were EHS 3 (mild ED), 42% were EHS 2 (moderate ED), and 32% were EHS 1 (severe ED). The mean baseline EF domain score was 14 ± 10, and at the EOT, it was 22 ± 5 (P < 0.01). At the follow-up interview, 4% were EHS 1, 12% were EHS 2, 28% were EHS 3, and 56% were EHS 4. Overall, 67% of the men continued to use PDE5 at follow-up. The distribution of patients continuing to use PDE5 after commencement was 15% of those achieving EHS 1, 30% for EHS 2, 66% for EHS 3, and 82% for EHS 4. Based on logistic regression analysis, the factors predictive of continued PDE5 use were being partnered, partner age, frequency of sexual activity, a shift of ≥ 2 points on the EHS, and reaching level 4 on the EHS scale.nnnCONCLUSIONnThere is an excellent relationship between erection hardness and adherence to PDE5 treatment. Driving men to greater erectile rigidity appears to translate into lower dropout rates.

Male Sexual Dysfunction

Publisher Summary This chapter focuses on the pathophysiology of erectile dysfunction (ED) and its various treatments. Erectile dysfunction is defined as the consistent inability to obtain and maintain an erection for satisfactory sexual relations. ED is clinically classified in three groups: psychogenic, organic, and mixed. Previously psychogenic ED was believed to be the most common cause of ED. Recently, mixed organic and psychogenic are accepted as the most common. Psychogenic ED is the persistent inability to obtain and/or maintain adequate erection for sufficient sexual intercourse due primarily to psychological or relationship factors. A lot of psychological conditions such as performance anxiety, lack of sexual arousal, major life stress, or depression, can cause or aggravate ED. Diseases involving the brain, spinal cord, and cavernous or pudendal nerves are associated with ED. Hormonal disorders such as hypogonadism may suppress sexual interest and nocturnal erections. The major risk factors of ED are diabetes mellitus, heart disease, hypertension, dyslipidemia, lower urinary tract symptoms (LUTS), and cigarette smoking. Various tests to evaluate ED include physical examination, laboratory tests, vascular testing, and a special test called Nocturnal Penile Tumescence Test. The most commonly used surgical technique for penile revascularization is a bypass from the inferior epigastric artery to the dorsal artery or deep dorsal vein of the penis.