No abstract

The majority of sexual health research has focused on erectile dysfunction following prostate cancer treatment. Ejaculatory and orgasmic dysfunction are significant side effects following the treatment of prostate cancer. Orgasmic dysfunction covers a range of issues including premature ejaculation, anorgasmia, dysorgasmia, and climacturia. This review provides an overview of prevalence and management options to deal with orgasmic dysfunction. A Medline Pubmed search was used to identify articles relating to these problems. We found that orgasmic dysfunction has a very large impact on patients’ lives following prostate cancer treatment and there are ways for physicians to treat it. Management of patients’ sexual health should be focused not only on erectile dysfunction, but on orgasmic dysfunction as well in order to ensure a healthy sexual life for patients and their partners.

HISTORY OF PENILE PROSTHESISThe first documented efforts to create an artificial penile erection came from the 16 th century in France, when Ambroise Pare developed a wooden penis to aid patients with micturition. 12 Throughout the early part of the 20 th century, several attempts to create artificial erections were made, ranging from inserting bones in the 1930s, to acrylic splints extracavernosally in the 1950s, to inserting polyethylene implants intracorporally in the 1960s. 13 However, it was not until the 1970s, when Scott et al. 14 and Small et al. 15 independently published the creation of a semirigid and an inflatable PP, respectively. Since then, penile implants have evolved with the advent of new technologies, especially in the field of implant materials and design. Nowadays, with refinements in surgical technique, penile implantation has improved to become a safe, highly reproducible, and less-invasive procedure. 16 EPIDEMIOLOGY AND HISTORY LEADING TO PENILE PROSTHESISIt is important to recognize the pathologies that ultimately lead to prosthetic surgery. Although PP implantation is not usually considered as a primary therapy for the treatment of ED, its success and satisfaction rates make it an attractive option. Since the introduction of the phosphodiesterase type 5 (PDE5) inhibitors in the 1990s, these medications became the first line of therapy for this condition; 17 however, roughly one-third of patients will fail to respond satisfactorily to oral or medical therapy. 18 In spite of this, Lee et al. 19 showed that only 3% of patients diagnosed with ED between 2001 and 2010 underwent PP surgery. In cases of severe ED, as in nonnerve-sparing prostatic cancer surgery, severe vasculogenic disease, priapism, and Peyronie's disease, the penile implant can also be recommended as the primary therapy, given that medical therapy is likely to yield poor results.

Introduction: Penile prosthesis implantation is a widely used treatment option for erectile dysfunction. Data is limited with regard to patient satisfaction with a penile prosthesis following radical prostatectomy/cystoprostatectomy vs patients with erectile dysfunction of other etiologies. Aim: To examine patient satisfaction with penile prosthesis implantation and determine if a difference in satisfaction exists in post-prostatectomy/cystoprostatectomy patients vs patients with erectile dysfunction of other etiologies. We hypothesize that etiology does not affect satisfaction. Methods: A total of 164 patients underwent penile prosthesis implantation at our institution between August 2017 and December 2019, with 102 patients completing a validated 14 item questionnaire, Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), at 6 months postoperation. Demographics, surgical characteristics, and erectile dysfunction etiology were recorded. Patients were assigned to one of 2 groups: postprostatectomy/ postcystoprostatectomy erectile dysfunction or other etiologies. The study group was further analyzed between radical prostatectomy or radical cystoprostatectomy. Main Outcome Measures: Satisfaction based on key EDITS questions with postradical prostatectomy/cystoprostatectomy vs patients with erectile dysfunction of other etiologies. Results: Responses to 3 questions were analyzed: overall satisfaction, expectations met in the past 4 weeks, and confidence in the ability to participate in sexual activity. Chi-square analysis was performed to determine the difference in responses. No difference was seen in overall satisfaction (P ¼ .96), expectations (P ¼ .78), or confidence (P ¼ .78) between groups. On subgroup analysis, there was no difference in reported overall satisfaction (P ¼ .47) or confidence (P ¼ .080) between postprostatectomy and postcystoprostatectomy patients. Postprostatectomy and postcystoprostatectomy patients differed in whether the penile prosthesis implantation met expectations (P ¼ .033). Postprostatectomy patients reported a mean score of 3.5/4 compared to postcystoprostatectomy patients, who reported a mean of 3.0/4. Conclusions: Our analysis suggests that key erectile function scores are not significantly different between postprostatectomy/postcystoprostatectomy patients compared to other etiologies. The difference in measures between postprostatectomy and postcystoprostatectomy patients is not significant or of unclear significance. Registration # of clinical trial: HSC-MS-19-0320 Howell S, Palasi S, Green T, et al. Comparison of Satisfaction With Penile Prosthesis Implantation in Patients With Radical Prostatectomy or Radical Cystoprostatectomy to the General Population. Sex Med 2020;XX:XXXeXXX.