Predictors of corporo-venocclusive dysfunction in men with bilateral nerve-sparing radical prostatectomy.

IF 3.3 3区医学 Q1 UROLOGY & NEPHROLOGY Journal of Sexual Medicine Pub Date : 2025-01-03 DOI:10.1093/jsxmed/qdae157

Jose M Flores, Luis F Novaes, Emily Vertosick, Carolyn Salter, Nicole Liso, Andrew J Vickers, John P Mulhall, Fecsm

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Abstract

Background: Erectile dysfunction (ED) is seen in some men who have undergone bilateral nerve-sparing surgery. Corporo-venocclusive dysfunction (CVOD) is the major pathway to permanent ED after radical prostatectomy (RP).

Aim: To identify comorbidity factors that are associated with the presence of CVOD in men who had undergone bilateral nerve-sparing RP.

Methods: We included patients who had no ED before RP, underwent bilateral nerve-sparing RP, were unresponsive to pharmacotherapy, and had a penile Duplex Doppler Ultrasound (PDDU) with a diagnosis of CVOD. PDDU was performed with a redosing vasoactive agent protocol. A logistic regression model was created to define predictors of CVOD, defined as end-diastolic velocity (EDV) ≥ 5 cm/s bilaterally.

Outcomes: CVOD diagnosis.

Results: 135 patients with a median age of 60 (IQR 54, 64) years were included. 45% reported ≥2 comorbidities, 10% diabetes, 28% obstructive sleep apnea (OSA), and 44% were current or former smokers. At PDDU, 34% had less than penetration hardness erections, and 43% received 100 units of vasoactive agent. 44% were diagnosed with CVOD. Increased age at RP (OR 2.12 per 10 years, 95% CI 2.35, 3.73, P = .007) and OSA (OR 2.44, 95% CI 1.07, 5.73, P = .036) were associated with a diagnosis of CVOD.

Clinical implications: Comorbidities, especially OSA, have a role in erection recovery after surgery.

Strengths and limitations: The study used a well-established institutional RP nerve-sparing score, a strict PDDU vasoactive agent redosing protocol, validated cut-offs for CVOD diagnosis, and a validated erectile function questionnaire both pre- and post-operatively. The major limitation is that this is a cohort of men seeking treatment at a sexual medicine clinic for post-operative ED, which limits the generalizability of the results to patients without ED symptoms or who decided not to seek treatment. The dichotomous definition of comorbidities is also a limitation since patients can have differing degrees of comorbidities' severity.

Conclusion: Older patients and the presence of OSA were associated with the presence of CVOD.

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双侧神经保留根治性前列腺切除术男性体静脉功能障碍的预测因素。

背景：一些接受过双侧神经保留手术的男性会出现勃起功能障碍（ED）。目的：在接受了双侧神经保留前列腺切除术的男性中，找出与出现勃起功能障碍相关的合并症因素：我们纳入了接受双侧神经保留RP术前无ED、对药物治疗无反应、阴茎双相多普勒超声（PDDU）诊断为CVOD的患者。阴茎多普勒超声检查是在重新使用血管活性药物的方案下进行的。建立了一个逻辑回归模型，以确定CVOD的预测因素，CVOD的定义是双侧舒张末期速度（EDV）≥5 cm/s：结果：CVOD 诊断：共纳入 135 名患者，中位年龄为 60（IQR 54，64）岁。45%的患者合并症≥2种，10%患有糖尿病，28%患有阻塞性睡眠呼吸暂停（OSA），44%目前或曾经吸烟。在 PDDU，34% 的人勃起硬度低于穿透力，43% 的人接受了 100 单位的血管活性剂治疗。44% 被诊断为 CVOD。勃起时年龄的增加（OR 为每 10 年 2.12，95% CI 为 2.35，3.73，P = .007）和 OSA（OR 为 2.44，95% CI 为 1.07，5.73，P = .036）与 CVOD 诊断有关：临床意义：合并症，尤其是 OSA，对术后勃起恢复有影响：该研究采用了完善的RP神经保留评分制度、严格的PDDU血管活性剂再用药方案、有效的CVOD诊断临界值以及有效的术前术后勃起功能问卷。该研究的主要局限性在于，研究对象是因术后ED而到性医学诊所寻求治疗的男性，这就限制了研究结果对无ED症状或决定不寻求治疗的患者的推广性。合并症的二分法定义也是一个限制因素，因为患者合并症的严重程度可能不同：结论：老年患者和 OSA 的存在与 CVOD 的存在有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Sexual Medicine 医学-泌尿学与肾脏学

CiteScore

6.20

自引率

5.70%

发文量

826

审稿时长

2-4 weeks

期刊介绍： The Journal of Sexual Medicine publishes multidisciplinary basic science and clinical research to define and understand the scientific basis of male, female, and couples sexual function and dysfunction. As an official journal of the International Society for Sexual Medicine and the International Society for the Study of Women''s Sexual Health, it provides healthcare professionals in sexual medicine with essential educational content and promotes the exchange of scientific information generated from experimental and clinical research. The Journal of Sexual Medicine includes basic science and clinical research studies in the psychologic and biologic aspects of male, female, and couples sexual function and dysfunction, and highlights new observations and research, results with innovative treatments and all other topics relevant to clinical sexual medicine. The objective of The Journal of Sexual Medicine is to serve as an interdisciplinary forum to integrate the exchange among disciplines concerned with the whole field of human sexuality. The journal accomplishes this objective by publishing original articles, as well as other scientific and educational documents that support the mission of the International Society for Sexual Medicine.