Non-surgically Related Causes of Erectile Dysfunction After Bilateral Nerve-sparing Radical Prostatectomy

G Gandaglia; G Lista; N Fossati; N Suardi; A Gallina; M Moschini; L Bianchi; MS Rossi; R Schiavina; SF Shariat; A Salonia; F Montorsi; A Briganti

Disclosures

Prostate Cancer Prostatic Dis. 2016;19(2):185-190. 

In This Article

Results

Baseline Characteristics

Table 1 depicts clinical and pathological characteristics of patients included in the study. Overall, 212 (29.6%) patients were treated with the robot-assisted approach. Median (IQR) age at surgery was 60.7 (56.6–65.9) years. Overall, 151 (21.1%), 52 (7.3%), 47 (6.6%), 107 (14.9%) and 359 (50.1%) patients had severe, moderate, mild to moderate, mild and no ED, respectively. A total of 185 (25.8%) patients reported a preoperative CES-D score of ≥16. Overall, 74 (10.3%) patients underwent aRT. Overall, 29 (4.1%) patients underwent sRT. When patients were stratified according to administration of aRT, significant differences were observed in PSA at diagnosis, biopsy Gleason, clinical stage, risk group, surgical approach, pathologic stage, pathologic Gleason, presence of positive surgical margins and use of PDE5-Is (all P<0.001).

Kaplan–Meier Analyses

Median (IQR) follow-up for survivors was 48 (45.5–50.6) months. The 3-year EF recovery rate in the overall population was 60.1% (Figure 1). The 3-year EF recovery rates were 29.1, 41.9, 59.7 and 73.9% in patients with severe, moderate and mild-to-moderate, mild and no ED, respectively (P<0.001; Figure 2). Patients with a CES-D score of <16 had significantly higher 3-year EF recovery rates as compared with their counterparts with CES-D score ≥16 (60.8 vs 49.2%, respectively; P=0.03; Figure 3). Patients who did not receive aRT had significantly higher 3-year EF recovery rates as compared with their counterparts treated with aRT (59.8 vs 40.7%, respectively; P<0.001; Figure 4).

Figure 1.

Erectile function (EF) recovery rate in the overall population.

Figure 2.

Erectile function (EF) recovery rates after stratifying patients according to the baseline International Index of Erectile Function-EF domain (IIEF-EF). ED, erectile dysfunction.

Figure 3.

Erectile function (EF) recovery rates after stratifying patients according to preoperative depressive status as measured by the Center for Epidemiologic Studies-Depression (CES-D) questionnaire.

Figure 4.

Erectile function (EF) recovery rates after stratifying patients according to the administration of adjuvant radiotherapy (aRT).

Uni- and Multivariable Cox Regression Analyses

In univariable regression models, age, surgical approach, preoperative CES-D score, preoperative IIEF-EF, administration of on-demand or chronic PDE5-Is and aRT represented significant predictors of EF recovery after BNSRP (all P≤0.02; Table 2). These covariates were confirmed as independent predictors of EF recovery after surgery in multivariable regression analyses (all P≤0.047). Patients treated with robot-assisted BNSRP had 1.47-fold higher probability of experiencing EF recovery as compared with their counterparts undergoing the standard approach (P<0.001). Moreover, patients without preoperative depression had a 1.25-fold higher probability of recovering EF after surgery as compared with those with a CES-D score of ≥16 (P=0.047). Men with mild and no ED preoperatively had 2.6- and 3.3-fold higher probability of recovering EF after surgery as compared with their counterparts with severe ED before BNSRP (all P<0.001). Patients receiving aRT had a 1.5-fold higher risk of ED after surgery as compared with their counterparts left untreated (P=0.03). Finally, men treated with chronic PDE5-Is after surgery had 1.4-fold higher probability of recovering EF as compared with those not receiving any proerectile medications (P=0.01).

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