Local steroid application during nerve‐sparing radical retropubic prostatectomy

Deliveliotis, Charalambos; Delis, Alex; Papatsoris, Athanasios; Antoniou, Nikos; Varkarakis, Ioannis

doi:10.1111/j.1464-410x.2005.05679.x

Cited by 9 publications

(3 citation statements)

References 10 publications

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“…Initial search of the PubMED/MEDLINE and EMBASE databases retrieved 1,326 publications, 796 from the PubMED/MEDLINE database and 1,156 from the EMBASE database. Initial exclusion of publications reporting on a study group of less than 50 subjects and/or presenting EF data collected after less than 12‐month follow‐up after RP yielded 212 publications, eligible for further full review and 22 studies (10%) met full inclusion criteria (Figures 1 and 2) [12–33]. Of the 9,965 total subjects, appropriate ED data were available for 4,983.…”

Section: Resultsmentioning

confidence: 99%

Erectile Function Recovery Rate after Radical Prostatectomy: A Meta-Analysis

Tal¹,

Alphs²,

Krebs³

et al. 2009

The Journal of Sexual Medicine

191

139

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Introduction Erectile function recovery (EFR) rates after radical prostatectomy (RP) vary greatly based on a number of factors, such as erectile dysfunction (ED) definition, data acquisition means, time-point postsurgery, and population studied. Aim To conduct a meta-analysis of carefully selected reports from the available literature to define the EFR rate post-RP. Main Outcome Measures EFR rate after RP. Methods An EMBASE and MEDLINE search was conducted for the time range 1985–2007. Articles were assessed blindly by strict inclusion criteria: report of EFR data post-RP, study population ≥50 patients, ≥1 year follow-up, nerve-sparing status declared, no presurgery ED, and no other prostate cancer therapy. Meta-analysis was conducted to determine the EFR rate and relative risks (RR) for dichotomous subgroups. Results A total of 212 relevant studies were identified; only 22 (10%) met the inclusion criteria and were analyzed (9,965 RPs, EFR data: 4,983 subjects). Mean study population size: 226.5, standard deviation = 384.1 (range: 17–1,834). Overall EFR rate was 58%. Single center series publications (k = 19) reported a higher EFR rate compared with multicenter series publications (k = 3): 60% vs. 33%, RR = 1.82, P = 0.001. Studies reporting ≥18-month follow-up (k = 10) reported higher EFR rate vs. studies with <18-month follow-up (k = 12), 60% vs. 56%, RR = 1.07, P = 0.02. Open RP (k = 16) and laparoscopic RP (k = 4) had similar EFR (57% vs. 58%), while robot-assisted RP resulted in a higher EFR rate (k = 2), 73% compared with these other approaches, P = 0.001. Patients <60 years old had a higher EFR rate vs. patients ≥60 years, 77% vs. 61%, RR = 1.26, P = 0.001. Conclusions These data indicate that most of the published literature does not meet strict criteria for reporting post-RP EFR. Single and multiple surgeon series have comparable EFR rates, but single center studies have a higher EFR. Younger men have higher EFR and no significant difference in EFR between ORP and LRP is evident.

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Section: Resultsmentioning

confidence: 99%

Erectile Function Recovery Rate after Radical Prostatectomy: A Meta-Analysis

Tal¹,

Alphs²,

Krebs³

et al. 2009

The Journal of Sexual Medicine

191

139

View full text Add to dashboard Cite

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“…The anatomical techniques used in RRP results in decreased blood loss and thus better visualization and safer dissection of the neurovascular bundles [2,3]. Many studies on erectile dysfunction (ED) following nerve-sparing RRP have been published, revealing widely disparate potency rates (30-86%) among various groups in different studies [4][5][6][7][8][9][10][11]. This variation in potency rates may be due to patient selection, surgeon and hospital volume, and the proportion of nerve-sparing procedures [5,[12][13][14].…”

Section: Introductionmentioning

confidence: 99%

The Use of IIEF-5 for Reporting Erectile Dysfunction Following Nerve-Sparing Radical Retropubic Prostatectomy

Albersen¹,

Joniau²,

Poppel³

2009

TOPCANJ

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Abstract:Introduction: Increased detection of organ-confined prostate cancer has led to an increased demand for nervesparing surgery. Most studies of erectile dysfunction (ED) following nerve-sparing radical prostatectomy (RRP) use single-item assessment, and potency rates differ widely among various groups. We aimed to investigate the use of the IIEF-5, a validated questionnaire, for reporting ED following RRP. Aims: To study the use of the IIEF-5 questionnaire in the evaluation of post-RRP ED, and to find possible variations in ED reporting when comparing IIEF-5 to single-item assessment. Methods: At a minimum of 18 months post-surgery, patients completed a questionnaire on erectile function that included both single-item assessment and the IIEF-5. The study included sexually active patients who reported no pre-operative ED and who did not receive adjuvant or salvage therapy. Main Outcome Measures: For the single-item assessment, potency was defined as "the ability to achieve erections firm enough for intercourse". For the IIEF-5 questionnaire, potency was defined as a score >22 (out of 25) points. Results: Ninety-one patients were included in the study. The procedures consisted of bilateral nerve-sparing (55%) or unilateral or partial bilateral nerve-sparing surgery (45%). We found a striking difference in potency rates when using either IIEF-5 score or single-item assessment for reporting of potency after RRP. The results when using the IIEF-5 questionnaire indicated that 25.5% of all patients were potent. In contrast, single-item assessment indicated a potency rate of 53.8%. Conclusions: Using the IIEF-5 questionnaire to evaluate ED following RRP results in a remarkably lower percentage of men being classified as having no ED. This might be the main reason IIEF-5 is not frequently used in the reporting of ED following radical prostatectomy. Literature search reveals that the IIEF-5 questionnaire is expected to have a higher level of validity, accuracy, and reliability, and may be more stable than single-item assessment. We think that the use of IIEF-5 in the reporting of ED following RRP enhances comparison of different series and of different treatment modalities. However, a prospective comparison between IIEF-5 and single-item assessment is needed to confirm this finding.

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“…The medication was started 16-22 h after surgery. A similar study was done with the intraoperative local administration of betamethasone cream 0.1% on the area of the CN in 60 men [49]. Neither study demonstrated appreciable improvement in erection recovery after 12 months follow-up.…”

Section: Corticosteroidsmentioning

confidence: 87%

Penile Rehabilitation and Neuromodulation

Junior

Burnett²

2009

The Scientific World JOURNAL

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Erectile dysfunction (ED) following treatment for clinically localized prostate cancer, particularly radical prostatectomy (RP), is a major quality of life issue that remains unsatisfactorily addressed. With the introduction and use of cavernous nerve–sparing procedures over the past 25 years, many men recover erections postoperatively that enable sexual intercourse unlike in the prior surgical era, when permanent ED postoperatively was certain. Despite this advance, 26–100% of these patients may never recover normal erectile function (EF). Recent advances in the understanding of ED after RP have stimulated great attention to develop penile rehabilitation programs and neuromodulation. The purpose of penile rehabilitation is to prevent adverse corpus cavernosal tissue structural alterations and thereby maximize the chances of recovering functional erections. Rehabilitation programs are common in clinical practice, but there is no definitive evidence to support their efficacy. Neuromodulation represents another strategy for promoting erection recovery postoperatively. This therapy involves the application of neuroprotective interventions, conceivably targeting biological elements involved in the erection response that are affected by neuropathic injury. Well-conducted, controlled trials with adequate follow-up are required in order to determine the erection preservative benefits of these therapeutic strategies. The purpose of this essay is to describe the mechanisms related to post-RP ED, assess the need for penile rehabilitation and neuromodulation following surgery, and analyze the basic science and clinical trial evidence associated with these applications for preserving EF following prostate cancer treatment.

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Local steroid application during nerve‐sparing radical retropubic prostatectomy

Cited by 9 publications

References 10 publications

Erectile Function Recovery Rate after Radical Prostatectomy: A Meta-Analysis

Erectile Function Recovery Rate after Radical Prostatectomy: A Meta-Analysis

The Use of IIEF-5 for Reporting Erectile Dysfunction Following Nerve-Sparing Radical Retropubic Prostatectomy

Penile Rehabilitation and Neuromodulation

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