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Our group has shown that intracavernous injection test (ICI) have a better accuracy in predicting short-term response to therapy with sildenafil citrate versus penile doppler ultrasound (PDU). Our objective was to compare the prognostic value of PDU parameters with erection rigidity assessed by the Erection Hardness Score (EHS) during ICI in predicting refractory ED after 5-years. Patients referred for ED were evaluated and had a PDU with, at least, 15 ug of intracavernous alprostadil. Refractory ED was defined as having a penile prosthesis implanted, failed non-surgical treatments but refused penile prosthesis (PP) implantation or discontinuation of non-surgical treatments due to loss of efficacy. Receiver operating characteristic curves were drawn and the area under the curve (AUC) was calculated. At 5 years, 69 men were still in follow-up with a mean age of 58.47 years and 13 (18.8%) were classified as having refractory ED. The AUC for EHS, peak systolic velocity, end diastolic flow and resistive index to discriminate refractory ED were 0.820, 0.613, 0.730 and 0.714, respectively. Our data suggest that an abnormal EHS during an ICI could be non-inferior than an abnormal PDU in predicting response to non-surgical treatments and that will need a PP in long-term.

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Kaplan-Meier analysis was conducted to compare graft times of anephric VHL patients to those with transplanted kidneys.RESULTS: A total of 23 VHLD patients were identified as either anephric or candidates for transplant. Out of this cohort, 11 total VHLD received 12 total kidney grafts. Median wait time from nephrectomy to transplant was 22.6 months (IQR: 1.02-40.25 months). Median age at transplant was 32 years (IQR: 23-54 years). Overall survival (OS) at 5 and 10 years of anephric patients who did not receive a transplant was 33% and 16.7%, respectively. OS rates of the transplant cohort at 10, 15, and 20 years were 91%, 78%, and 58% years, respectively. Median graft time was 161 months (IQR: 56-214 months). Graft survival at 10, 15, and 20 years was 69.8%, 69.8%, and 26.2%, respectively.CONCLUSIONS: We demonstrate that transplant recipients have decreased mortality with no difference in cancer recurrence compared to those who do not receive renal transplant for RRT. This data can aid in informing providers of the optimal window for early RRT planning in VHL, while also improving patient counseling.