Predictors of worsening erectile function in men with functional erections early after radical prostatectomy Journal Article
| Authors: | Salter, C. A.; Tin, A. L.; Bernie, H. L.; Nascimento, B.; Katz, D. J.; Benfante, N. E.; Carlsson, S. V.; Mulhall, J. P. |
| Article Title: | Predictors of worsening erectile function in men with functional erections early after radical prostatectomy |
| Abstract: | Background: Prior studies suggest that men with good erectile function shortly after radical prostatectomy (RP) can subsequently have worsened erectile function. Aim: To determine the prevalence and predictors of early erectile function recovery post-RP and of worsening erectile function after initial erectile function recovery. Methods: We retrospectively queried our institutional database. Men who underwent RP during 2008–2017 and who completed the International Index of Erectile Function erectile function domain both pre-RP and serially post-RP, constituted the population. Functional erections were defined as International Index of Erectile Function (IIEF)-6 erectile function domain scores ≥24. We analyzed factors predicting functional erections at 3 months post-RP as well as factors predicting a decrease in functional erections between 3 and 6 months, defined as ≥2-point drop in the erectile function domain. Multivariable logistic regression models were used to identify predictors of early erectile function recovery and also of subsequent decline. Outcomes: Erectile function recovery rates at 3 months post-RP and predictive factors; rates of erectile function decline between 3-6 months and associated predictors. Results: Eligible patients comprised 1,655 men with median age of 62 (IQR 57, 67) years. Bilateral nerve-sparing (NS) surgery was performed in 71% of men, unilateral NS in 19%, and no NS in 10%. Of this population, 224 men (14%; 95% CI 12%, 15%) had functional erections at 3 months post-RP. On multivariable analysis, significant predictors of early erectile function recovery included: younger age (OR 0.93, P <.001), higher baseline erectile function domain score (OR 1.14, P <.001) and bilateral NS (OR 3.81, P =.002). The presence of diabetes (OR 0.43, P =.028) and a former smoking history (OR 0.63, P =.008; reference group: never smoker) was associated with the erectile dysfunction at 3 months post-RP. Of the men with early functional erections, 41% (95% CI 33%, 48%) had a ≥ 2-point decline in erectile function between 3 and 6 months. No factors were identified as predictors for this decline. Clinical Implications: Only a small proportion of men have functional erections at 3 months post-RP and a notable number of them will experience a decline in erectile function between 3 and 6 months. Strengths and Limitations: Strengths: large patient population and the use of validated questionnaire. Limitations: single-center retrospective study. Conclusion: A minority of men had functional erections 3 months post-RP, about half of whom had a decline in erectile function by month 6. We recommend appropriately counseling post-RP patients on the risk of such a decline in erectile function. Salter CA, Tin AL, Bernie HL, et al. Predictors of Worsening Erectile Function in Men with Functional Erections Early After Radical Prostatectomy. J Sex Med 2022;19:1790–1796. © 2022 International Society for Sexual Medicine |
| Keywords: | recovery of function; retrospective studies; psychology; retrospective study; prostate cancer; prostate; prostatectomy; radical prostatectomy; erectile dysfunction; convalescence; penile erection; penis erection; erectile function; adverse event; humans; human; male; erection recovery |
| Journal Title: | Journal of Sexual Medicine |
| Volume: | 19 |
| Issue: | 12 |
| ISSN: | 1743-6095 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2022-12-01 |
| Start Page: | 1790 |
| End Page: | 1796 |
| Language: | English |
| DOI: | 10.1016/j.jsxm.2022.08.193 |
| PUBMED: | 36192298 |
| PROVIDER: | scopus |
| PMCID: | PMC10168542 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 December 2022 -- Source: Scopus |
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