736

ERECTILE FUNCTION FOLLOWING A BILATERAL NERVE-SPARING RADICAL RETROPUBIC PROSTATECTOMY. RESULTS OF MULTIVARIATE ANALYSIS

Giuseppe Zanni, Andrea Salonia, Andrea Gallina, Antonino Saccà, Nazareno Suardi, Luigi F DaPozzo, Vincenzo Scattoni, Renzo Colombo, Alberto Briganti, Patrizio Rigatti, Francesco Montorsi*, Milano, Italy

INTRODUCTION AND OBJECTIVE: Aim of the study was to evaluate the postoperative erectile function in patients (pts) undergoing bilateral nerve-sparing radical retropubic prostatectomy (BNSRRP) for clinically localized prostate cancer (pCa), and to correlate the results with several preop and postop parameters.

METHODS: From November 2002 to September 2004, 704 consecutive pts (mean+/-SD age: 65.4+/-7.3 yrs) with pCa underwent RRP; 322 (46%) underwent a BNSRRP; 134 (42%) were of the urban area, had a complete data collection [namely, medical history, scoring of urinary and general subjective symptoms (e.g. IIEF, IPSS, CESD, EDITS, ICQ-SF), determination of non-urological co-morbidities, BMI] and entered this prospective analysis.

RESULTS: Pre-op parameters. Age: 61.8+/-6.3 yrs. BMI: 25.6+/-3.0. IIEF-tot: 37.9+/-22.0; IIEF-EF: 15.0+/-10.1; CESD: 14.5+/-6.6; IPSS: 9.0+/-6.7. Post-op parameters. Time after surgery (months): 11.0+/-5.0. Patients were stratified according to the post-op treatment for the recovery erectile function, as follows: no treatment (Group 1: 55/134; 41%), on-demand intracavernous PGE1 (Group 2: 10/134; 8%), on demand PDE5-I (Group 3: 43/134; 32%), PDE5-I as rehabilitative treatment (Group 4: 26/134, 19%). On demand PGE1 promoted the greatest IIEF-EF score (ANOVA: F-ratio 13.51, p<0.001), the greatest IIEF-intercourse satisfaction (F-ratio 11.99, p<0.001) as well as the greatest IIEF-Orgasmic Function (F-ratio 10.02, p<0.001) but the 4 groups did not show a significant difference in terms of satisfaction for the treatment (EDITS: F-ratio: 1.34; p=0.27). A direct comparison did not show a significant difference in terms of IIEF-EF between Group 3 and Group 4 pts (namely, 19.7+/-7.9 vs 16.4+/-10,3; p=0.14). A multivariate analysis showed that postop IIEF-EF was significantly correlated to postop IIEF-Sexual desire (r=3.14; p<0.0001), postop CESD (r=0.24; p=0.01) and postop urinary incontinence as defined by the ICQ-SF questionnaire (r=-0.46; p=0.008) as independent variables. The multivariate analysis did not show any significant correlation between postop EF and BMI, age, preop PSA, preop CESD, postop IPSS, time since surgery.

CONCLUSIONS: Postoperative erectile function after BNSRRP is significantly correlated with the rate of postop sexual desire, mood deflection and rate of urinary continence. There is no significant difference in terms of erectile function recovery between patients taking PDE5I on demand vs on a daily basis.

737

INTERIM ANALYSIS OF THE EARLY USE OF MUSE FOLLOWING RADICAL PROSTATECTOMY (RP) TO FACILITATE EARLY SEXUAL ACTIVITY AND RETURN OF SPONTANEOUS ERECTILE FUNCTION

Rupesh Raina*, Ashok Agarwal, Kalyana C Nandipati, Craig D Zippe, Cleveland, OH

INTRODUCTION AND OBJECTIVE: To assess whether early MUSE treatment following radical prostatectomy (RP) facilitate earlier sexual activity and return of natural erections in men with erectile dysfunction (ED) following bilateral nerve-sparing (NS) RP.

METHODS: A total of 91 patients were included in this prospective study: 56 received early MUSE and 35 (Control group) did not receive any early treatment. Patients in the early MUSE group received 125 micrograms (mcg) 3 times/week for the first 6 weeks. At 6 weeks the MUSE dose was titrated to 250 mcg, 3 times/week for 4 months. Patients who could not tolerate the 250 mcg doses remained at 125 mcg for 4 months. Treatment efficacy was analyzed by the patient’s response to the Sexual Health Inventory for Men (SHIM) questionnaire.

RESULTS: In the MUSE Group, 38/56 (68%) continued MUSE treatment. At 6 months, 28/38 (74%) of the patients resumed sexual activity, 15/28 (53%) had natural erections sufficient for vaginal penetration without MUSE, 13/28 (47%) used MUSE as an adjuvant treatment for attempted/successful intercourse. In the Control Group, 13/35 (37%) resumed sexual activity, 4/13 (30.7%) had natural erections sufficient for vaginal penetration, 9/13 (69.3%) were dissatisfied with the erections and used oral therapy/erectaids as adjuvant treatments. The baseline and 6 month SHIM scores for the MUSE group were 21.14 and18.92, respectively (see Table 1), compared to the Control Group; 22.02 and 12.02. The MUSE discontinuation rate was 32% (18/56). Nine of the 18 (50%) discontinued because of inadequate erections, 5 (28%)due to loss of sexual interest, and 4 (22%) due to local pain/burning.

CONCLUSIONS: Early MUSE therapy following radical prostatectomy increases the incidence of sexual activity, increases the incidence of erections sufficient for intercourse and may shorten the neuropraxia period.

* P <0.05, Data expressed in Mean + Standard deviation

738

TOPICAL ALPROSTADIL FOR THE TREATMENT OF PREMENOPAUSAL WOMEN WITH FEMALE SEXUAL AROUSAL DISORDER (FSAD)

Raymond A Costabile*, Charlottesville, VA; James G McMurray, Huntsville, AL; Gita Singh, Ft. Wayne, IN; Mitchell Wiatrak, Milwaukee, WI; Craig Peterson, Mountain View, CA

INTRODUCTION AND OBJECTIVE: Previous clinical trials have demonstrated that compared to placebo, topical alprostadil results in increased genital engorgement, increased physical and subjective arousal in-clinic, and a greater increase in the proportion of successful sexual encounters at home in postmenopausal women with FSAD. This study evaluated the response to topical alprostadil administered at home for the treatment of premenopausal women with FSAD.

METHODS: Following a 4-week non-treatment run-in period, 51 premenopausal women with a diagnosis of FSAD, as confirmed by medical history, questionnaire assessments, and subject interview, were randomly assigned to treatment with alprostadil 400 mcg (A) and placebo (P) in a double blind, crossover-design study. Each treatment period lasted for 2 months, and treatments were administered in random order. Efficacy measures were based on the proportion of successful and satisfactory sexual encounters, and the number of successful and satisfactory encounters per unit time, as recorded in subject diaries. Additional endpoints included changes in other diary questions assessing arousal, and Female Sexual Function Index (FSFI) and Female Sexual Distress Scale (FSDS) questionnaire responses.

RESULTS: Of randomized subjects, 25 reported on the use of at least 6 doses during each treatment period and were considered for the valid efficacy population. Responses to (A) and (P) are summarized below: Application site burning, the most common adverse event, was reported by 36% of subjects following P and 43% following A. The majority of these reports were "mild" and transient.

CONCLUSIONS: Preliminary evidence exists for the effectiveness of topical alprostadil in premenopausal women with FSAD.

Read Male / Female Sexual Dysfunction Selected Abstracts - Part 4

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