Managing Erectile Dysfunction After Pelvic Radiotherapy.

In the event of proven erectile dysfunction (ED), specif ic treatment strategies are available in the following order : phosphodiesterase type 5 inhibitors (Cialis, Levitra, Viagra), intracavernous injections of vasoactive drugs and implanting a penile prosthesis. According to clinical experience, with all causes taken into considera tion, 25% of patients who suffer from ED do not respond to medical treatment. The penile implant is a highly effective alternative treatment where oral or injected drug therapy has proven unsuccessful or in cases where other medical treatments are contraindicated (1). According to our experience, the number of implant procedures performed increases by 15% each year and 35 prostheses will be implanted in 2009. Unfortunately, the penile implant remains a marginal therapy in Belgium despite being highly effective, having a very low complications rate and a satisfaction rating over 90%. Around 30 to 45,000 implant procedures are performed each year throughout the world with ten times more surgeries in the US than in Europe. In 2008, only 140 penile implants were performed in Belgium. There are an estimated 30 urologists who perform this proce dure and only two among this number perform more than 25 implant procedures per year. Therefore the majority of surgeons performing the procedure have less experience (three implants per year on average). This is not an ideal situation. As is the case in many European countries, it would appear that the low number of penile implants is a result of a lack of training and a shortage of information in the field, the cost of the implant, perioperative failings or complications in the case of insufficient experience. The medical legal risk is probably over-estimated but it does exist. The vast majority of implant models are inflatable. This advance, alongside the highly-informed support of doctors that are sensitive to ED patients and their partners’ quality of life, should make the process of deciding to get an implant more straight-forward. When is it time to consider a penile implant ?

Introduction: Erectile dysfunction(ED) is a serious condition which can affect men of all ages, with an important impact over the quality of life. When conservative therapy fails, a viable solution is the penile prosthesis implantation (PPI). Objective: The purpose of this paper is to present data from recent literature regarding the satisfaction rates of men who have undergone penile PPI and as well as the partners satisfaction rates, ease of use, informations regarding long term survival of these prosthesis, postoperative complications and long distance complications, the effectiveness and the way that penile prosthesis have influenced the quality of life of the men who have opted for this solution. Material and methods: We have analyzed recent long term studies concerning the outcomes of the PPI, studies which were made retrospectively, over a period of time of 10 to 15 years. Results: Compared with the conservative treatment for ED, the satisfaction rates achieved after penile prosthesis implantation are higher. According to these studies, the overall patient’s satisfaction is 70-90%. The difference between patient and their partners’ satisfaction rate is negligible, this difference ranging between 2 to 8%. The satisfaction rate regarding the adequate erection for sexual intercourse is 80-90%. The overall satisfaction rates for the malleable prostheses are lower compared with inflatable devices, 30-75%, respectively 75-90% for the inflatable prosthesis. The mechanical and overall survival rates for the malleable prosthesis range between 65-80% at 10 years, and 58-75% for the inflatable devices. Overall ease of use is rated as 78%. Complications after implantation can be encountered in less than 5% of cases and infections in less than 2%. The likelihood of continued use is higher in the group of the patients with the inflatable prosthesis compared with the malleable ones 70-80%, respectively 50-60%. Up to 85- 90% of patients with inflatable prosthesis would recommend them. Conclusions: PPI is a high effective treatment for erectile dysfunction, refractory to pharmacological treatment. The inflatable penile prosthesis (IPP) provides more overall satisfaction than the malleable ones. The patients with IPP are more likely to continue using their devices than those with the malleable prosthesis. PPI improves significantly the quality of life for patients with erectile dysfunction.

Current therapeutic strategies for erectile function recovery after radical prostatectomy – literature review and meta-analysis

Deep learning on genome-wide association studies to predict the patient-specific risk of radiation-induced erectile dysfunction.

Background Erectile Dysfunction is defined as the inability to achieve and maintain an erection sufficient for satisfactory sexual performance. Erectile dysfunction (ED) is a common disorder that affects at least 50% of males aged 50–70 years according to EAU Guidelines on male sexual dysfunction. Many therapeutic modalities have been implemented for the treatment of ED, including. Psychosexual therapy, PDE5i, intracavernous injection, external vacuum device, and finally penile prosthesis implantation after failure of the previous line of treatment. Penile prosthesis implantation is considered to be a satisfactory treatment of ED. To describe and evaluate the current evidence regarding the assessment of patient and partner satisfaction after semirigid penile prosthesis implant in our center. Methods This study included 20 patients with erectile dysfunction non-responding to PDE5-i and other medical treatment methods for erectile dysfunction and planning for penile prosthesis. This study was done from 1.1.2024 to 1.7.2024 in Znata hospital. Inclusion criteria: patient diagnosed with erectile dysfunction. Exclusion criteria: Peyronie’s disease, prostatitis, prostate cancer, BPH, and uncontrolled diabetic profile. Assessment of all cases was done by complete history and clinical examination of all cases and complete blood profile and renal profile, endocrine profile, and diabetic patients. Penile duplex ultrasound was done for all cases in our center. All cases were inserted semirigid penile prosthesis; the Tactra Boston Scientific type was done by M.A. and T.A. Results 20 CASES had successful of a penile prosthesis was inserted Satisfaction rate was observed by the Erectile Dysfunction Inventory of Treatment Satisfaction score and the International Index of Erectile Function score. The satisfaction rate is about 80% of the patient and partner. Complications in some cases, like hematoma, wound infection. Controlled by close observation and covered antibiotic. Conclusion Semirigid penile prosthesis Tactra Boston Scientific is an effective approach in the treatment of erectile dysfunction with underlying comorbidity, with an acceptable rate of postoperative complications. and was a high satisfaction rate for patients and partners, with improvement of quality of life.

Penile Implant Utilization Following Treatment for Prostate Cancer: Analysis of the SEER-Medicare Database

Penile prosthesis (PP) is the mainstay of treatment in Peyronie's disease (PD) with co-existent refractory erectile dysfunction (ED). This study aimed to assess the clinical outcomes of patients who underwent PP as the first-line surgical treatment in PD without ED. A total of 636 patients underwent PP for PD from 2012 to 2022, but only 168 patients who underwent PP as first-line surgical management for PD with or without ED were included in the study. The mean (SD) age of 168 patients was 56.3 years (12.4). The mean curvature of the "PD with ED" group and the "PD without ED" group were 38.2 (5.6) degrees and 42.2 (5.9) degrees. The median (IQR) follow-up was 56.0 months (34.5- 61.4). Most (86.9%) patients underwent 3-piece inflatable PP. An important finding is that 33 patients (19.6%) without ED had undergone PP. Mechanical failure requiring revision surgery was less common in the 'without ED' group than in the ED group (6.8% vs. 10.2%, p 0.04). Most PD patients without ED (87.9%, 29/33) and with ED (88.9%, 120/135) were "satisfied" after PP implantation at six months, as defined by a score of ≥4 on a 5-point Likert scale. If surgery is offered in PD, PP may be considered a safe and effective first-line surgical treatment regardless of the ED, given the acceptable complications and high satisfaction rates. However, this new concept warrants further research.

Objective:Penile prosthesis surgery is indicated based on undesirability, contraindication or ineffectiveness of non-surgical options for erectile dysfunction. This definitive treatment is often delayed after initial diagnosis. Our objective was to develop a prediction tool based on a patient’s clinical history to determine likelihood of ultimately receiving a penile prosthesis.Research design and methods:This retrospective analysis used claims data from Commercial and Medicare supplemental databases. Inclusion criteria were 18 years of age with 1 year of continuous enrollment at the first diagnosis of erectile dysfunction. Patients’ demographics, co-morbidities and erectile dysfunction therapy were derived based on enrollment, medical and prescription histories.Main outcome measures:The Cox proportional hazards model with stepwise selection was used to identify and quantify (using relative risk) factors associated with a future penile prosthesis implant. Co-morbidities and therapies present prior to the index erectile dysfunction diagnosis were analyzed as fixed covariates.Results:Approximately 1% of the dataset’s population (N = 310,303 Commercial, N = 74,315 Medicare, respectively) underwent penile prosthesis implantation during the study period (3928 patients in the overall population: 2405 patients [0.78%] in the Commercial and 1523 patients [2.05%] in the Medicare population). Factors with the greatest predictive strength of penile prosthesis implantation included prostate cancer diagnosis (relative risk: 3.93, 2.29; 95% CI, 3.57–4.34, 2.03–2.6), diabetes mellitus (2.31, 1.23; 2.12–2.52, 1.1–1.37) and previous treatment with first-line therapy (1.39, 1.33; 1.28–1.5, 1.2–1.47) (all P < 0.01).Conclusion:The presence and extent of specific medical history factors at the time of erectile dysfunction diagnosis predict an individual’s future likelihood of penile prosthesis. Calculating the likelihood of penile prosthesis implantation based on the weight of these factors may assist clinicians with the definition of a care plan and patient counseling. The precision of the model may be limited by factors beyond medical history information that possibly influence the decision to proceed to surgery.

Long-term potency after iodine-125 radiotherapy for prostate cancer and role of sildenafil citrate

AMS 700CX/CXM Inflatable Penile Prosthesis Has High Mechanical Reliability at Long-Term Follow-Up

247 Comparison of Complication Rates Related to Penile Prosthesis and Advance™ Male Slings Versus Penile Prosthesis and Artificial Urinary Sphincters: National Multi-Institutional Analysis of NSQIP Database

Objectives Erectile dysfunction (ED) is traditionally viewed as a condition affecting older men, with insertion of a penile prostheses (PP) reserved for refractory cases. However, there has been a notable increase in the incidence of ED amongst younger males, leading to an increased need for PPs in men aged 35 yrs and younger. Methods Between August 2007 and February 2024, all patients aged 35 yrs and younger undergoing virgin implantation of a PP were collected. Patients undergoing PP implantation secondary to phalloplasty were excluded. Results A total of 56 men aged 35 yrs or younger received a PP, with a mean age of 29 yrs (±4 yrs, range 18-35 yrs). Indications for implantation included priapism (19/56, 33.9%), psychogenic ED (17/56, 30.4%), and vasculogenic or neurogenic ED (20/56, 35.7%). Notably, 17 patients (30.4%) reported lifelong ED, having never experienced a spontaneous erection suitable for penetration. Among the 17 patients with psychogenic ED, 64.7% (11/17) had previously engaged with clinical psychology, and 58.8% (10/17) had received a formal psychiatric diagnosis. A malleable prosthesis was implanted in 17 patients (30.4%), while 39 (69.6%) received a three-piece inflatable prosthesis. Overall, 75% (42/56) of patients expressed satisfaction with their prosthesis, with dissatisfaction primarily attributed to perceived short length. Patient satisfaction in the inflatable prosthesis group (33/39, 84.6%) was higher than in the malleable prosthesis group (9/17, 52.9%). The revision rate at five years was 32.1% (18/56), with 33.3% (6/18) of these patients undergoing conversion from a malleable to an inflatable prosthesis. There was only 1 (1.8%) case of implant infection which necessitated removal and subsequent delayed re-implantation. Conclusions This case series highlights the growing prevalence of treatment-resistant ED in men aged 35 yrs and younger requiring PP insertion. Our findings indicate that a substantial proportion of these cases are psychogenic in nature, emphasising the need for comprehensive psychological evaluation prior to surgical intervention. The high satisfaction rates among patients with inflatable prostheses suggest that, despite the challenges posed by younger patients, effective outcomes can be achieved with appropriate selection and management. Conflicts of Interest Nil to declare.

MP76-18 “PARTNER PROSTHESIS PANIC”: MANAGEMENT OF FEMALE SEXUAL DYSFUNCTION IN PARTNERS OF MEN UNDERGOING PENILE PROSTHESIS IMPLANTATION

Evaluation of the impact of the urinary symptoms on quality of life of patients with painful bladder syndrome/chronic pelvic pain and radiation cystitis: EURCIS study

Gastrointestinal symptoms after pelvic radiotherapy: Role for the gastroenterologist?