Prediction of erectile dysfunction in patients with localized prostate cancer undergoing radical prostatectomy

Мұқаба

Дәйексөз келтіру

Толық мәтін

Ашық рұқсат Ашық рұқсат
Рұқсат жабық Рұқсат берілді
Рұқсат жабық Рұқсат ақылы немесе тек жазылушылар үшін

Аннотация

Introduction. Penile rehabilitation strategies have been developed to accelerate and improve the recovery of erectile function after radical prostatectomy. However, the differential efficacy and the best penile rehabilitation strategy are still unclear. Therefore, the search for factors influencing the prognosis of erectile dysfunction (ED) one year after radical prostatectomy and the formulation of algorithms for patient management is highly relevant.

Aim. To analyze pre- and postoperative factors that affect erectile function after radical prostatectomy with the development of an algorithm for calculating the risk of developing ED.

Materials and methods. A total of 104 patients with localized prostate cancer who underwent nerve-sparing prostatectomy were retrospectively examined. A year after surgery, regardless of whether medicinal penile rehabilitation was used or not, patients were divided into two groups depending on the possibility of having sexual intercourse.

Results. The following indicators were identified as predictors of an unfavorable prognosis using multiple regression analysis with a stepwise inclusion method: age, erectile function assessed using the International Index of Erectile Dysfunction-5 (IIEF-5) before surgery, the presence of type 2 diabetes mellitus, use of phosphodiesterase type 5 (PDE-5) inhibitors in the postoperative period, type of radical prostatectomy (unilateral or bilateral nerve sparing). It was found that the presence of factors such as the older age, type 2 diabetes mellitus and a lower preoperative IIEF-5 score were associated with lower IIEF-5 score after a year. Taking PDE-5 inhibitors for a year and bilateral nerve-sparing RP increased IIEF-5 score.

Of the five factors presented in the model, four (patient’s age, presence/absence of diabetes mellitus, IIEF-5 level before surgery) were not controlling factors, since they could not influence the choice of rehabilitation method. The indicator reflecting the fact of taking PDE-5 inhibitors during the year was a controlling factor, since its inclusion in the model allowed to choose the appropriate method of rehabilitation for the patient. The multiple correlation coefficient is 0.898, which characterizes the high predictive level of this model.

The data obtained were converted into an algorithm that allowed to calculate the risk of developing ED, taking into account modern methods of treatment and rehabilitation, and make the right decision in choosing the optimal strategy for further rehabilitation interventions.

Conclusions. From the presented data we can conclude that the prognosis for the development of ED after radical prostatectomy can be determined with high reliability based on the following risk factors: the type of surgical treatment, namely bilateral nerve sparing, affects the preservation of innervation, which affects the postoperative restoration of erectile function. The use of PDE-5 inhibitors helps restore erectile function only in a certain category of patients. The older age, type 2 diabetes mellitus and erectile dysfunction at baseline (IIEF-5 value) aggravate ED in the postoperative period.

Thus, taking into account these risk factors, it is possible to determine an individual management strategy for the patient and provide optimal and timely treatment, which will preserve the quality of life and effectively use medical resources.

Толық мәтін

Рұқсат жабық

Авторлар туралы

Evgeny Pomeshkin

OOO «Medsi Saint-Peterburg»; FGBOU VO «Kemerovo State University»

Email: pomeshkin@mail.ru
ORCID iD: 0000-0002-5612-1878

Ph.D., Deputy Chief Physician for Urology

 

Ресей, 191025, St. Petersburg, st. Marat, d. 6; 191025, St. Petersburg, st. Marat, d. 6, lit. A

Mikhail Shamin

OOO «Medsi Saint-Peterburg»; FGBOU VO «Kemerovo State University»

Хат алмасуға жауапты Автор.
Email: mshamin@inbox.ru
ORCID iD: 0000-0001-7809-5722

urologist at the Urological Department No.1

Ресей, 191025, St. Petersburg, st. Marat, d. 6; 191025, St. Petersburg, st. Marat, d. 6, lit. A

Andrei Bragin-Maltsev

GAUZ Kuzbass Clinical Emergency Hospital named after M.A. Podgorbunsky

Email: bragin_maltsev@mail.ru
SPIN-код: 9130-7130

urologist at the Urological Department No.1

 

Ресей, 191025, St. Petersburg, st. Marat, d. 6, lit. A

Elena Kagan

FGBOU VO «Kemerovo State University»

Email: kaganes@mail.ru
ORCID iD: 0000-0002-8470-961X

Ph.D. in Technical Sciences, associate professor, Head of Head of the Department of Applied Mathematics of the Institute of Fundamental Sciences

Ресей, 650000, Kemerovo, st. Krasnaya, d. 6

Әдебиет тізімі

  1. Bratu O., Oprea I., Marcu D., Spinu D., Niculae A., Geavlete B., Mischianu D. Erectile dysfunction post-radical prostatectomy - a challenge for both patient and physician. J Med Life. 2017;10(1):13–18.
  2. Whalen M. Preventing erectile dysfunction after radical prostatectomy: nerve-sparing techniques, penile rehabilitation, and novel regenerative therapies. In: Prostatectomy. Ed. by T. Genadiev. London: IntechOpen, 2019. Pp. 129–174. doi: 10.5772/intechopen.79398.
  3. Walsh P.C., Donker P.J. Impotence following radical prostatectomy: insight into etiology and prevention. J. Urol. 1982;128:492–497. doi: 10.1016/s0022-5347(17)53012-8.
  4. Philippou Y.A., Jung J.H., Steggall M.J., O’Driscoll S.T., Bakker C.J., Bodie J.A., Dahm P. Penile rehabilitation for postprostatectomy erectile dysfunction. Cochrane Database Syst. Rev. 2018;10(10):CD012414. doi: 10.1002/14651858.CD012414.pub2.
  5. Albaugh J., Adamic B., Chang C., Kirwen N., Aizen J. Adherence and barriers to penile rehabilitation over 2 years following radical prostatectomy. BMC Urol. 2019;19(1):89. doi: 10.1186/s12894-019-0516-y.
  6. Carrier J., Edwards D., Harden J. Men’s perceptions of the impact of the physical consequences of a radical prostatectomy on their quality of life: a qualitative systematic review. JBI Database System Rev Implement Rep. 2018;16(4):892–972. doi: 10.1097/xeb.0000000000000192
  7. Gabrielsen J.S. Penile rehabilitation: The «Up»-date. Curr Sex Health Rep. 2018 Dec;10(4):287-292. doi: 10.1007/s11930-018-0174-1.
  8. Sari Motlagh R., Abufaraj M., Yang L., Mori K., Pradere B., Laukhtina E., Mostafaei H., Schuettfort V.M., Quhal F., Montorsi F., Amjadi M., Gratzke C., Shariat S.F. Penile rehabilitation strategy after nerve sparing radical prostatectomy: A systematic review and network Meta-Analysis of randomized trials. J. Urol. 2021;205(4):1018–1030. doi: 10.1097/JU.0000000000001584.
  9. Feng D. et al. Current management strategy of treating patients with erectile dysfunction after radical prostatectomy: a systematic review and meta-analysis //International Journal of Impotence Research. 2022;34(1):18–36. doi: 10.1038/s41443-020-00364-w.
  10. Castellucci R. et al. Penile Rehabilitation after Prostate Cancer Treatment: Which Is the Right Program? Uro. 2023;3(1):61–73. doi: 10.3390/uro3010009.
  11. Jo J.K., Jeong S.J., Oh J.J., Lee S.W., Lee S., Hong S.K., Byun S-S., Lee S.E. Effect of Starting Penile Rehabilitation with Sildenafil Immediately after Robot-Assisted Laparoscopic Radical Prostatectomy on Erectile Function Recovery: A Prospective Randomized Trial. J. Urol. 2018;199:1600–1606. doi: 10.1016/j.juro.2017.12.060.
  12. Karnauh P.A., Jajcev S.V., Vazhenin A.V., Zolotyh M.A., Peretruhin A.A. Profilaktika i lechenie jerektil’noj disfunkcii u pacientov posle radikal’noj nervosberegajushhej prostatjektomii. Vestnik urologii. 2015;4:50–64. Russian (Карнаух П.А., Яйцев С.В., Важенин А.В., Золотых М.А., Перетрухин А.А. Профилактика и лечение эректильной дисфункции у пациентов после радикальной нервосберегающей простатэктомии. Вестник урологии. 2015; 4:50–64). doi: 10.21886/2308-6424-2015-0-4-50-64.
  13. Wang X., Wang X., Liu T., He Q., Wang Y., Zhang X. Systematic review and meta-analysis of the use of phosphodiesterase type 5 inhibitors for treatment of erectile dysfunction following bilateral nerve-sparing radical prostatectomy. PLoS One. 2014;9:91327. doi: 10.1371/journal.pone.0091327.
  14. Mondaini N., Cai T., Sarti E., Polloni G., Gavazzi A., Conti D., Cocci A., Albersen M., Cito G., Bartoletti R. A Case Series of Patients Who Underwent Laparoscopic Extraperitoneal Radical Prostatectomy with the Simultaneous Implant of a Penile Prosthesis: Focus on Penile Length Preservation. World J Mens Health. 2018;36(2):132–138. doi: 10.5534/wjmh.17043.
  15. Polito M., d’Anzeo G., Conti A., Muzzonigro G. Erectile rehabilitation with intracavernous alprostadil after radical prostatectomy: refusal and dropout rates. BJU Int. 2012;110:E954–E957. doi: 10.1111/j.1464-410X.2012.11484.x.
  16. Rosen R.C., Cappelleri J.C., Smith M.D. et al. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11(6):319–26. PMID: 10637462 doi: 10.1038/sj.ijir.3900472.
  17. John P. Mulhall, Irwin Goldstein, Andrew G. Bushmakin, MS, Joseph C. Cappelleri, MPH, Kyle Hvidsten, MPH, Validation of the Erection Hardness Score. The Journal of Sexual Medicine. 2007;4(6):1626–1634, https://doi.org/10.1111/j.1743-6109.2007.00600.x.
  18. Davison B.J., So A.I., Goldenberg S.L. Quality of life, sexual function and decisional regret at 1 year after surgical treatment for localized prostate cancer. BJU Int. 2007;100(4):780–85. PMID: 17578466. doi: 10.1111/j.1464-410x.2007.07043.x)
  19. Schoentgen N., Califano G., Manfredi C., Romero-Otero J., Chun F. K., Ouzaid I. Is it worth starting sexual rehabilitation before radical prostatectomy? Results from a systematic review of the literature. Frontiers in Surgery, 8, 648345. doi: 10.3389/fsurg.2021.648345.
  20. Checherita I.A., Manda G., Hinescu M.E., Peride I., Niculae A., Bilha S., Gramaticu A., Voroneanu L., Covic A. New molecular insights in diabetic nephropathy. Int Urol Nephrol. 2016;48(3):373–387. doi: 10.1007/s11255-015-1203-x.
  21. Geavlete B., Bulai C., Ene C., Checherita I., Geavlete P. Bipolar vaporization, resection, and enucleation versus open prostatectomy: optimal treatment alternatives in large prostate cases? J. Endourol. 2015;29(3):323–331. doi: 10.1089/end.2014.0493.
  22. Mulhall J.P., Kattan M.W., Bennett N.E., Stasi J., Nascimento B., Eastham J. et al. Development of nomograms to predict the recovery of erectile function following radical prostatectomy. J Sex Med. 2019;16:1796–802. doi: 10.1016/j.jsxm.2019.08.003.
  23. Walz J., Epstein J.I., Ganzer R., Graefen M., Guazzoni G., Kaouk J. et al. A Critical Analysis of the current knowledge of surgical anatomy of the prostate related to optimisation of cancer control and preservation of continence and erection in candidates for radical prostatectomy: an update. Eur Urol. 2016;70:301–11. doi: 10.1016/j.eururo. 2016.01.026.
  24. Salter C.A., Tin A.L., Bernie H.L., Nascimento B., Katz D.J., Benfante N.E., Carlsson S.V., Mulhall J.P. Predictors of Worsening Erectile Function in Men with Functional Erections Early After Radical Prostatectomy. J Sex Med. 2022;19(12):1790–1796. doi: 10.1016/j.jsxm.2022.08.193.
  25. Weyne E., Castiglione F., Van der Aa F., Bivalacqua T.J., Albersen M. Landmarks in erectile function recovery after radical prostatectomy. Nat Rev Urol. 2015;12:289–97. doi: 10.1038/nrurol.2015.72.

Қосымша файлдар

Қосымша файлдар
Әрекет
1. JATS XML

© Bionika Media, 2025