Predictors of corporo-venocclusive dysfunction in men with bilateral nerve-sparing radical prostatectomy Journal Article
| Authors: | Flores, J. M.; Novaes, L. F.; Vertosick, E.; Salter, C.; Liso, N.; Vickers, A. J.; Mulhall, J. P. |
| Article Title: | Predictors of corporo-venocclusive dysfunction in men with bilateral nerve-sparing radical prostatectomy |
| Abstract: | Background: Erectile dysfunction (ED) is seen in some men who have undergone bilateral nerve-sparing surgery. Corporo-venocclusive dysfunction (CVOD) is the major pathway to permanent ED after radical prostatectomy (RP). Aim: To identify comorbidity factors that are associated with the presence of CVOD in men who had undergone bilateral nerve-sparing RP. Methods: We included patients who had no ED before RP, underwent bilateral nerve-sparing RP, were unresponsive to pharmacotherapy, and had a penile Duplex Doppler Ultrasound (PDDU) with a diagnosis of CVOD. PDDU was performed with a redosing vasoactive agent protocol. A logistic regression model was created to define predictors of CVOD, defined as end-diastolic velocity (EDV) ≥ 5 cm/s bilaterally. Outcomes: CVOD diagnosis. Results: 135 patients with a median age of 60 (IQR 54, 64) years were included. 45% reported ≥2 comorbidities, 10% diabetes, 28% obstructive sleep apnea (OSA), and 44% were current or former smokers. At PDDU, 34% had less than penetration hardness erections, and 43% received 100 units of vasoactive agent. 44% were diagnosed with CVOD. Increased age at RP (OR 2.12 per 10 years, 95% CI 2.35, 3.73, P =. 007) and OSA (OR 2.44, 95% CI 1.07, 5.73, P =. 036) were associated with a diagnosis of CVOD. Clinical implications: Comorbidities, especially OSA, have a role in erection recovery after surgery. Strengths and limitations: The study used a well-established institutional RP nerve-sparing score, a strict PDDU vasoactive agent redosing protocol, validated cut-offs for CVOD diagnosis, and a validated erectile function questionnaire both pre- and post-operatively. The major limitation is that this is a cohort of men seeking treatment at a sexual medicine clinic for post-operative ED, which limits the generalizability of the results to patients without ED symptoms or who decided not to seek treatment. The dichotomous definition of comorbidities is also a limitation since patients can have differing degrees of comorbidities' severity. Conclusion: Older patients and the presence of OSA were associated with the presence of CVOD. © 2024 The Author(s). Published by Oxford University Press on behalf of The International Society for Sexual Medicine. All rights reserved. |
| Keywords: | adult; middle aged; major clinical study; hypertension; prostate specific antigen; cohort analysis; risk factors; anticoagulant therapy; vascularization; prediction; risk factor; prostate cancer; postoperative complication; postoperative complications; prostatic neoplasms; questionnaire; conservative treatment; prostatectomy; prostate tumor; echography; diabetes mellitus; comorbidity; papaverine; surgery; radical prostatectomy; cholesterol; dyslipidemia; logistic regression analysis; erectile dysfunction; innervation; coronary artery disease; testosterone; phosphodiesterase v inhibitor; prostaglandin e1; impotence, vasculogenic; penis; ultrasonography, doppler, duplex; phentolamine; etiology; adverse event; obstructive sleep apnea; liquid chromatography-mass spectrometry; procedures; vasoactive agent; organic impotence; peak systolic velocity; end-diastolic velocity; organ sparing treatments; humans; human; male; article; sleep apnea, obstructive; duplex doppler ultrasonography; sleep apnea; robot-assisted prostatectomy; sleep apnea syndromes; penile duplex doppler ultrasound; corporo venocclusive dysfunction; nerve-sparing robotic prostatectomy |
| Journal Title: | Journal of Sexual Medicine |
| Volume: | 22 |
| Issue: | 1 |
| ISSN: | 1743-6095 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2025-01-01 |
| Start Page: | 93 |
| End Page: | 97 |
| Language: | English |
| DOI: | 10.1093/jsxmed/qdae157 |
| PUBMED: | 39528243 |
| PROVIDER: | scopus |
| PMCID: | PMC11697056 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding author is Jose Flores -- Source: Scopus |
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