Persistent Erectile Dysfunction Following Radical Prostatectomy: The Association between Nerve-Sparing Status and the Prevalence and Chronology of Venous Leak

Tal, Raanan; Valenzuela, Rolando; Aviv, Nadid; Parker, Marilyn; Waters, W. Bedford; Flanigan, Robert C.; Mulhall, John P.

doi:10.1111/j.1743-6109.2009.01437.x

Cited by 51 publications

(30 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The vascular status of erectile tissue is one of the most important factors relating to ED, which was reported by several studies in both animals and humans [8,[36][37][38]. Our perfusion results imply that the time-dependent loss of blood flow is associated with radiation-induced ED.…”

Section: Figuresupporting

confidence: 74%

Radiation-Induced Erectile Dysfunction Using Prostate-Confined Modern Radiotherapy in a Rat Model

Kimura

Yan

Rabbani

et al. 2011

The Journal of Sexual Medicine

View full text Add to dashboard Cite

Introduction The mechanisms of radiation-induced erectile dysfunction (ED) are unclear, as clinical studies are limited, and previous animal models were based on wide-field irradiation, which does not model current radiotherapy (RT) techniques. Aims To perform functional and morphological analyses of erectile function (EF) utilizing image-guided stereotactic prostate-confined RT in a rat model. Methods Sixty young adult male rats aged 10–12 weeks old were divided into age-matched sham and RT groups. A single 20-Gy fraction to the prostate was delivered to RT animals. Penile bulb, shaft, and testes were excluded from treatment fields. Main Outcome Measures Bioassay and intracavernous pressure (ICP) measurements were conducted at 2, 4, and 9 weeks following RT. Perfusion analysis of the corpora cavernosa (CC) was conducted using Hoechst injected prior to sacrifice. Penile shaft and cavernous nerve (CN) were evaluated by immunohistochemistry. Plasma testosterone level was analyzed using a testosterone enzyme-linked immunosorbent assay (ELISA) assay kit. Results Irradiated animals demonstrated statistically significant time-dependent functional impairment of EF by bioassay and ICP measurement from 4 weeks. Neuronal nitric oxide synthase (NOS) expression was decreased in CN by 4 weeks. In CC, expression levels of anti-alpha smooth muscle actin and endothelial NOS were significantly decreased at 9 weeks. In penile dorsal vessels, smooth muscle/collagen ratio was significantly decreased at 4 and 9 weeks. Additionally, Hoechst perfusion showed time-dependent decrease in CC of RT animals, whereas CD31 expression was not affected. No toxicities were noted; testosterone levels were similar in both groups. Conclusion We demonstrated time-dependent ED following image-guided stereotactic RT. Our results imply that reduction of neuronal NOS expression in cavernous nerve could trigger consecutive reduction of smooth muscle content as well as blood perfusion in CC that resulted in corporal veno-occlusive dysfunction. Present study could be a cornerstone to future research that may bring comprehensive scientific understanding of radiation-induced ED.

show abstract

Section: Figuresupporting

confidence: 74%

Radiation-Induced Erectile Dysfunction Using Prostate-Confined Modern Radiotherapy in a Rat Model

Kimura

Yan

Rabbani

et al. 2011

The Journal of Sexual Medicine

View full text Add to dashboard Cite

show abstract

“…The evaluation of erectile function recovery is critical, considering the numerous methodological issues related to the assessment of erectile function [1,11–14]. The incidence of reported erectile dysfunction after RP is extremely discrepant, probably as an effect of the great variation in study population characteristics, means of data acquisition, questionnaires used, definitions of adequate erectile function, baseline erectile function status, and follow‐up duration.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Criteria to Select Patients for Bilateral Nerve-sparing Robotic-assisted Radical Prostatectomy

Novara

Ficarra

D’Elia

et al. 2010

The Journal of Sexual Medicine

View full text Add to dashboard Cite

Introduction To date, no study has analyzed the predictors of potency recovery in a robot-assisted laparoscopic radical prostatectomy (RALP) series. A novel risk stratification for erectile function recovery after retropubic radical prostatectomy (RRP) has been proposed recently by Briganti et al. from the University Vita-Salute San Raffaele in Milan, Italy. Aim To evaluate the potency rate in a series of consecutive patients who underwent bilateral nerve-sparing RALP, to identify the preoperative predictors of erectile function recovery, and to validate the risk-group stratification of Briganti et al. Methods The clinical records of all patients who underwent RALP for clinically localized prostate cancer between April 2005 and April 2009 were prospectively collected in the Prostate Cancer Padua Database. For the present study, we extracted all consecutive cases receiving a bilateral nerve-sparing technique with a minimum follow-up ≥12 months. Main Outcome Measures Twelve-month potency rate after RALP, defined as an International Index of Erectile Function 6 (IIEF-6) score ≥18. Results Data showed that 129 out of 208 enrolled patients (62%) were potent 12 months after surgery. Age (hazard ratio [HR]: 2.8; P <0.001), Charlson score (HR: 2.9; P = 0.007), and baseline IIEF-6 score (HR: 0.8; P <0.001) were independent predictors of potency recovery at multivariate analysis. According to Briganti et al.’s risk-group stratification, the 12-month potency rate following RALP was 81.9% in the low-risk group, 56.7% in the intermediate-risk group, and 28.6% in the high-risk group (P <0.001). Conclusions In the era of robotic surgery, the key point for the success of the nerve-sparing technique remains the accurate selection of patients. Age ≤65 years, absence of associated comorbidities, and good preoperative erectile function are the most important preoperative factors to select those patients for whom bilateral nerve-sparing RALP can achieve the best results.

show abstract

“…Generally, the damage that occurs during these procedures is primarily neurogenic in nature (cavernous nerve injury) but accessory pudendal artery injury can also contribute 46 . Pelvic fractures can also cause erectile dysfunction in a similar manner, owing to nerve distraction injury and arterial trauma.…”

Section: Mechanisms/pathophysiologymentioning

confidence: 99%

Erectile dysfunction

Yafi

Jenkins

Albersen

et al. 2016

Nat Rev Dis Primers

Self Cite

602

500

View full text Add to dashboard Cite

Erectile dysfunction is a multidimensional but common male sexual dysfunction that involves an alteration in any of the components of the erectile response, including organic, relational and psychological. Roles for nonendocrine (neurogenic, vasculogenic and iatrogenic) and endocrine pathways have been proposed. Owing to its strong association with metabolic syndrome and cardiovascular disease, cardiac assessment may be warranted in men with symptoms of erectile dysfunction. Minimally invasive interventions to relieve the symptoms of erectile dysfunction include lifestyle modifications, oral drugs, injected vasodilator agents and vacuum erection devices. Surgical therapies are reserved for the subset of patients who have contraindications to these nonsurgical interventions, those who experience adverse effects from (or are refractory to) medical therapy and those who also have penile fibrosis or penile vascular insufficiency. Erectile dysfunction can have deleterious effects on a man’s quality of life; most patients have symptoms of depression and anxiety related to sexual performance. These symptoms, in turn, affect his partner’s sexual experience and the couple’s quality of life. This Primer highlights numerous aspects of erectile dysfunction, summarizes new treatment targets and ongoing preclinical studies that evaluate new pharmacotherapies, and covers the topic of regenerative medicine, which represents the future of sexual medicine.

show abstract

Persistent Erectile Dysfunction Following Radical Prostatectomy: The Association between Nerve-Sparing Status and the Prevalence and Chronology of Venous Leak

Cited by 51 publications

References 26 publications

Radiation-Induced Erectile Dysfunction Using Prostate-Confined Modern Radiotherapy in a Rat Model

Radiation-Induced Erectile Dysfunction Using Prostate-Confined Modern Radiotherapy in a Rat Model

Preoperative Criteria to Select Patients for Bilateral Nerve-sparing Robotic-assisted Radical Prostatectomy

Erectile dysfunction

Contact Info

Product

Resources

About