Factors affecting urinary continence and sexual potency recovery after robotic-assisted radical prostatectomy

ABSTRACT Introduction Robot-assisted radical prostatectomy (RARP) is the most recent surgical technique for localized prostate cancer. The Da Vinci (Intuitive Surgical, Sunnyvale, CA) system was first introduced in Brazil in 2008, with a fast growing number of surgeries performed each year. Objective Our primary endpoint is to analyze possible predictors of functional outcomes, related to patient and tumor features. As secondary endpoint, describe functional outcomes (urinary continence and sexual potency) from RARP performed in the Sírio-Libanês Hospital (SLH), a private institution, in São Paulo, from April 2008 to December 2015. Materials and Method Data from 104 consecutive patients operated by two surgeons from the SLH (MA and SA) between 2008 and 2015, with a minimum 12 months follow-up, were collected. Patient features (age, body mass index - BMI, PSA, date of surgery and sexual function), tumor features (tumor stage, Gleason and surgical margins) and follow-up data (time to reach urinary continence and sexual potency) were the variables collected at 1, 3, 6 and 12 month and every 6 months thereafter. Continence was defined as the use of no pad on medical interview and sexual potency defined as the capability for vaginal penetration with or without fosphodiesterase type 5 inhibitors. Results Mean age was 60 years old and mean BMI was 28.45 kg/m2. BMI >30kg/m2 (p<0.001) and age (p=0.011) were significant predictors for worse sexual potency after surgery. After 1, 3, 6 and 12 months, 20.7%, 45.7%, 60.9% and 71.8% from patients were potent, respectively. The urinary continence was reached in 36.5%, 80.3%, 88.6% and 92.8% after 1, 3, 6 and 12 months, respectively. Until the end of the study, only one patient was incontinent and 20.7% were impotent. Conclusion Age was a predictor of urinary and erectile function recovery in 12 months. BMI was significant factor for potency recovery. We obtained in a private hospital good functional results after 12 months of follow-up.

Effect of tadalafil 5mg daily treatment on the ejaculatory times, lower urinary tract symptoms and erectile function in patients with erectile dysfunction

ABSTRACT Objective To investigate the effect of a 5mg daily tadalafil treatment on the ejaculation time, erectile function and lower urinary tract symptoms (LUTS) in patients with erectile dysfunction. Materials and Methods A total of 60 patients diagnosed with erectile dysfunction were retrospectively evaluated using the international index of erectile function questionnaire-5 (IIEF-5), intravaginal ejaculatory latency time (IELT) and international prostate symptoms scores (IPSS). After the patients were treated with 5mg tadalafil once a day for three months, their erection, ejaculation and LUTS were assessed again. The fasting levels of blood glucose, total testosterone, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and total cholesterol were measured. The independent-samples t-test was used to compare the pre- and post-treatment scores of the patients. Results The mean age of the 60 participants was 50.4±7.9 and the mean baseline serum total testosterone, total cholesterol, and fasting blood sugar were 444.6±178.6ng dL-1, 188.7±29.6mg/dL-1,104 (80-360) mg dL-1, respectively. The mean baseline scores were 2.2±1.4 min for IELT, 9.5±3.7 for IIEF-5 and 14.1±4.5 for IPSS. Following the three-month daily 5mg tadalafil treatment, the scores were found to be 3.4±1.9 min, 16.1±4.7, and 10.4±3.8 for IELT, IIEF and IPSS, respectively. When the baseline and post-treatment scores were compared, a statistically significant increase was observed in the IELTs and IIEF-5 values whereas there was a significant decrease in IPSS (p<0.01). Conclusion A daily dose of 5mg tadalafil can be safely used in the treatment of erectile dysfunction and LUTS, that prolongs the ejaculatory latency time.

A prospective, randomized, single - blind study comparing intraplaque injection of thiocolchicine and verapamil in Peyronie's Disease: a pilot study

ABSTRACT Objectives: To compare the response to tiocolchicine and verapamil injection in the plaque of patients with Peyronie's disease. Materials and Methods: Prospective, single-blind, randomized study, selecting patients who have presented Peyronie's disease for less than 18 months. Thiocolchicine 4mg or verapamil 5mg were given in 7 injections (once a week). Patients who had received any treatment for Peyronie's disease in the past three months were excluded. The parameters used were the International Index of Erectile Function (IIEF-5) score, analysis of the curvature on pharmaco-induced erections and size of the plaque by ultrasonography. Results: Twenty-five patients were randomized, 13 received thiocolchicine and 12 were treated with verapamil. Both groups were statistically similar. The mean curvature was 46.7° and 36.2° before and after thiocolchicine, respectively (p=0.019) and 50.4° and 42.08° before and after verapamil, respectively (p=0.012). The curvature improved in 69% of patients treated with thiocolchicine and in 66% of those who received verapamil. Regarding sexual function, there was an increase in the IIEF-5 from 16.69 to 20.85 (p=0.23) in the thiocolchicine group. In the verapamil group the IIEF-5 score dropped from 17.50 to 16.25 (p=0.58). In the thiocolchicine group, the plaque was reduced in 61% of patients. In the verapamil group, 8% presented decreased plaque size. No adverse event was associated to thiocolchicine. Conclusion: The use of thiocolchicine in Peyronie's disease demonstrated improvement on penile curvature and reduction in plaque size. Thiocolchicine presented similar results to verapamil in curvature assessment. No significant side effects were observed with the use of tiocolchicine.

Transcorporal artificial urinary sphincter in radiated and non - radiated compromised urethra. Assessment with a minimum 2 year follow-up

ABSTRACT Purpose to assess the efficacy of transcorporal artificial urinary sphincter (AUS) implantation on continence for male stress urinary incontinence in cases of prior surgical treatment or/and radiation failure, and as a first option in radiation patients. Materials and Methods From March 2007 to August 2012, 37 male patients were treated with transcorporal AUS AMS™ 800. Twelve patients had primary placement of transcorporal cuff, a surgical option due to a previous history of radiation and 25 patients had secondary procedure after failure of AUS or urinary incontinence surgery. Functional urinary outcomes were assessed by daily pad use, 24-hour Pad-test and ICIQ-SF questionnaire. Quality of life and satisfaction were assessed based on I-QoL and PGI-I questionnaires. Results After a median of 32 months, the continence rate (0 to 1 pad) was 69.7%. Median pad test was 17.5g (0-159), mean ICIQ-SF score was 7.3/21 (±5.4) and mean I-QoL score was 93.9/110. A total of 88% of the patients reported satisfaction with the AUS. The 5-year actuarial revision-free for AUS total device was 51%. Patients for primary implant for radiation were not more likely to experience revision than non-radiation patients. Preservation of erections was reported in half of the potent patients. Conclusions Transcorporal AUS cuff placement is a useful alternative procedure option for severe male UI treatment, especially in patients with a compromised urethra after prior surgery or radiation. A high continence rate was reported and implantation as first option in radiation patients should be considered.

Safety and efficacy of low intensity shockwave (LISW) treatment in patients with erectile dysfunction

ABSTRACT The primary goal in the management strategy of a patient with ED would be to determine its etiology and cure it when possible, and not just to treat the symptoms alone. One of the new therapeutic strategies is the use of low intensity extracorporeal shockwave (LISW) therapy. The mechanism of shockwave therapy is not completely clear. It is suggested that LISW induces neovascularization and improvement of cavernosal arterial flow which can lead to an improvement of erectile function by releasing NO, VEGF and PCNA. Materials and Methods: 31 patients between February and June 2013 with mild to severe ED and non-Phosphodiesterase 5 inhibitors responders were enrolled. Patients underwent four weekly treatment sessions. During each session 3600 shocks at 0.09mJ/ mm2 were given, 900 shocks at each anatomical area (right and left corpus cavernosum, right and left crus). Improvement of the erectile function was evaluated using the International Index of Erectile Function (IIEF-EF), the Sexual Encounter Profile (SEP) diaries (SEP-Questions 2 and 3) and Global Assessment Questions (GAQ-Q1 and GAQ-Q2). Results: At 3-month follow-up IIEF-EF scores improved from 16.54±6.35 at baseline to 21.03±6.38. Patients answering ‘yes’ to the SEP-Q2 elevated from 61% to 89% and from 32% to 62% in the SEP-Q3. A statistically significant improvement was reported to the Global Assessment Questions (GAQ-Q1 and GAQ-Q2). Conclusion: In conclusion, we can affirm that LISW is a confirmed therapeutic approach to erectile dysfunction that definitely needs more long-term trials to be clarified and further verified.

Evaluation of sexual function in patients submitted to ureteroscopic procedures

ABSTRACTObjective:We aimed to evaluate the possible effects of ureteroscopic procedures on the sexual function of both genders.Materials and Methods:A total of 102 sexually active cases (60 male, 42 female) undergoing ureteroscopic procedures were included in this study. Sexual function has been evaluated in detail by using International Index of Erectile Function (IIEF) in male and Female Sexual Function Index (FSFI) forms in female cases both before and 1-month after the procedures. Pre-and postoperative data were evaluated in a comparative manner.Results:The pre-and postoperative mean IIEF scores were 57.86±2.26 and 54.57±2.48 (p=0.19) in males and the mean FSFI scores were 13.58±1.46 and 14.46±1.52 (p=0.41), respectively in females. Evaluation of these values showed that regarding the effects of this procedure on male cases although the total scores for sexual function were not influenced it was observed a significant reduction in the intercourse satisfaction sub-domain (IIEF-IS) in males (p<0.05). In female cases however, unlike the male cases no statistically significant alterations with respect to these scores were noted (p=0.418).Conclusion:Ureteroscopic interventions could have some adverse effects on the sexual function particularly in male cases. However, it is clear that further prospective studies in both genders with large population of cases are certainly needed in order to outline this unresolved but important subject.

Validation of Portuguese version of Quality of Erection Questionnaire (QEQ) and comparison to International Index of Erectile Function (IIEF) and RAND 36-Item Health Survey

Purpose To validate the Quality of Erection Questionnaire (QEQ) considering Brazilian social-cultural aspects. Materials and Methods To determine equivalence between the Portuguese and the English QEQ versions, the Portuguese version was back-translated by two professors who are native English speakers. After language equivalence had been determined, urologists considered the QEQ Portuguese version suitable. Men with self-reported erectile dysfunction (ED) and infertile men who had a stable sexual relationship for at least 6 months were invited to answer the QEQ, the International Index of Erectile Function (IIEF) and the RAND 36-Item Health Survey (RAND-36). The questionnaires were presented together and answered without help in a private room. Internal consistency (Cronbach’s α), test-retest reliability (Spearman), convergent validity (Spearman correlation) coefficients and known-groups validity (the ability of the QEQ Portuguese version to differentiate erectile dysfunction severity groups) were assessed. Results We recruited 197 men (167 ED patients and 30 non-ED patients), mean age of 53.3 and median of 55.5 years (23-82 years). The Portuguese version of the QEQ had high internal consistency (Cronbach α=0.93), high stability between test and retest (ICC 0.83, with IC 95%: 0.76-0.88, p<0.001) and Spearman correlation coefficient r=0.82 (p<0.001), which demonstrated the high correlation between the QEQ and IIEF results. The correlations between the QEQ and RAND-36 were significantly low in ED (r=0.20, p=0.01) and non-ED patients (r=0.37, p=0.04). Conclusion The QEQ Portuguese version presented good psychometric properties and high convergent validity in relation to IIEF. The low correlations between the QEQ and the RAND-36, as well as between the IIEF and the RAND-36 indicated IIEF and QEQ specificity, which may have resulted from the patients’ psychological adaptations that minimized the impact of ED on ...

Sexual Function after Non-Nerve-Sparing Radical Cystoprostatectomy: A Comparison between Ileal Conduit Urinary Diversion and Orthotopic Ileal Neobladder Substitution

Objective To compare the erectile function (EF) and sexual desire (SD) in men after radical cystoprostatectomy (RCP) who had either an ileal conduit urinary diversion or orthotropic ileal neobladder substitution. Materials and Methods Eighty one sexually active men with bladder cancer were enrolled in this prospective study. After RCP according to patients' preferences they underwent either ileal conduit urinary diversion (n = 41) or orthotropic ileal neobladder substitution (n = 40). EF and SD were assessed using International Index of Erectile Function (IIEF) questionnaire. Patients were assessed at 4-week before surgery and were followed up at 1, 6, and 12-month postoperatively using the same questionnaire. Results Postoperatively the EF and SD domains deteriorated significantly in both groups, but in a small proportion of the patients submitted to ileal neobladder they gradually improved with time (P = 0.006). At 12-month postoperative period, 4 (9.8%) and 14 (35.0%) patients in ileal conduit and ileal neobladder groups were able to achieve erections hard enough for vaginal penetration and maintained their erection to completion of intercourse, respectively (P = 0.006). Among patients in the ileal conduit and ileal neobladder groups, additional 4 (9.8%) and 7 (17.1%) patients were able to get some erection, but were unable to maintain their erection to completion of intercourse (P = 0.02). At 12-month follow up period 24.4% of the ileal conduit and 45.0% of the ileal neobladder patients rated their sexual desire very high or high (P = 0.01). Conclusion When performed properly, orthotopic ileal neobladder substitution after RCP offers better long-term results in terms of EF and SD. .

Long-term follow-up of penile curvature correction utilizing autologous albugineal crural graft

PURPOSE: Peyronie's disease is an acquired connective tissue disorder of the penile tunica albuginea with fibrosis and inflammation. The disease produces palpable plaques, penile curvature and pain during erections. Usually it results in impairment of the quality of life. Our objective is to review the long-term results of the albugineal grafting harvested from the penile crura for the treatment of severe penile curvature. MATERIALS AND METHODS: Thirty-three patients with Peyronie's disease were submitted to a grafting with tunica albuginea from the penile crura for the correction of penile curvature. The results were evaluated after 6 months of the procedure. Variables studied were overall satisfaction with the procedure, correction of the penile curvature, erectile capacity, penile shortening and the presence of surgical complications. RESULTS: Mean follow-up after surgery was 41 months. Complete correction of the curvature was achieved in 30 patients (90%). The mean preoperative curvature was 91.8 degrees and median plaque length was 2 cm (ranged from 1 to 5 cm). Three patients (9%) experienced recurrence of the penile curvature and required a new procedure. In 30 men (90%) the procedure fulfilled their expectations and in 31 patients (93.9%) their opinions were that sexual partners were satisfied with the penile correction. Penile shortening or augmentation was referred in 6 (18.1%) and 1 (3%) patient, respectively. CONCLUSION: Our series demonstrated that grafting the albugineal defect after incision of the tunica albuginea with tunica from the crus for the correction of penile curvature is safe and results in satisfactory straight erections duringa long-term follow-up.

Disfunção erétil: resultados do estudo da vida sexual do brasileiro / Erectile dysfunction: results of the Brazilian sexual life study

OBJETIVO: Estimar a prevalência da disfunção erétil (DE) e fatores de risco associados em amostra da população brasileira. MÉTODOS: Estudo transversal com amostra de conveniência de 2.862 homens, maiores de 18 anos, por meio de questionário anônimo e auto-responsivo. A prevalência de DE na amostra foi obtida mediante questão global derivada diretamente da definição de DE. Os dados foram submetidos a testes Qui-quadrado e t de Student. Foram utilizadas análises de regressão logística para cálculos dos riscos. RESULTADOS: A prevalência encontrada de DE foi 45,1 por cento (31,2 por cento mínima, 12,2 por cento moderada e 1,7 por cento completa). Indivíduos com DE apresentaram comprometimento da auto-estima, dos relacionamentos interpessoais, menos relações sexuais por semana, mais relações extraconjugais, queixas de falta de desejo sexual e ejaculação rápida. Comparados aos homens com idades entre 18 e 39 anos, aqueles com 60 a 69 têm 2,2 (95 por cento IC; 1,4-3,4; p < 0,01) mais risco para DE, enquanto para aqueles com 70 anos ou mais, a chance triplica (95 por cento IC; 1,4-6,3; p < 0,01). Houve associação inversa entre nível educacional e risco para DE. Raça amarela, desemprego, alguma afiliação religiosa, história de tumor de próstata, hipertensão arterial sistêmica (HAS) e depressão aumentaram a chance para DE. CONCLUSÃO: A prevalência de DE é alta e comparável à de outros estudos. Homens com DE apresentam menos atividade sexual e prejuízo da qualidade de vida. Idade e condição socioeconômica precária agravam o risco para DE. Ações terapêuticas e preventivas devem ser implementadas para minimizar o impacto negativo desta condição, particularmente em países em desenvolvimento.

OBJETIVE: To estimate the prevalence of ED and related risk factors in a sample of the Brazilian male population. METHODS: Cross-sectional study was carried out with a convenience sample of 2,862 men, 18 years of age or older, using an anonymous self-administered questionnaire. ED prevalence in the sample was obtained by a general question which was directly derived from the ED definition. Data were submitted to chi-square or Student's t tests. Logistic regression analyses were used for risk factor calculations. RESULTS: The prevalence of ED was 45.1 percent (31.2 percent mild, 12.2 percent moderate and 1.7 percent complete). Subjects with ED presented lower self-esteem, hindered interpersonal relationships, fewer sexual intercourses per week, more extra-marital relationships, complaints of lack of libido and premature ejaculation. When compared with men aged 18-39 years, men aged 60-69 presented 2.2 higher risk of ED (95 percent CI; 1.4-3.4; p < 0.01), whereas men aged 70 or older presented 3.0 higher risk of ED (95 percent CI; 1.4-6.3; p < 0.01). Level of education was inversely proportional to risk of ED. Yellow race, unemployment, religious affiliation, prostate tumor, hypertension and depression were variables that increased ED risk. CONCLUSION: The prevalence of ED was high and comparable to that found in other studies. Subjects with ED suffer from less sexual activity and poorer quality of life. Age and lower socioeconomic level are directly proportional to ED risk. Therapeutic and preventive measures should be implemented to minimize the negative impact of this condition, especially in developing countries.

Função sexual de homens submetidos a transplante hepático / Sexual function of males subjected to liver transplantation

OBJETIVO: Avaliar a qualidade de vida sexual masculina antes e depois do transplante hepático. MÉTODOS: Foi enviado questionário de avaliação para 56 doentes masculinos, que tinham idade superior a 18 anos e que sobreviveram mais de seis meses após o transplante hepático. O questionário continha 15 perguntas com cinco ou seis alternativas de resposta para mensurar a função sexual masculina segmentada por cinco componentes: função erétil, função orgástica, desejo sexual, satisfação com a relação sexual e satisfação com a vida sexual como um todo. As respostas geraram valores numéricos, os quais foram agrupados dentro de cada domínio e comparados antes e depois do transplante hepático. RESULTADOS: Vinte e cinco doentes responderam completamente o questionário. Todas os cinco componentes da função sexual melhoraram após o transplante hepático, sendo que o escore da função erétil aumentou de 21,12±8,07 para 26,52±5,22 (p=0,004), da função orgástica de 7,28±3,05 para 9,36±1,47 (p=0,008), da função desejo sexual de 6,64±2,58 para 8,68±1,35 (p=0,005), da satisfação com relação sexual de 9,16±3,83 para 12,52±2,65 (p<0,0001) e da satisfação com a vida sexual de 7,12±2,64 para 9,24±1,65 (p=0,002). CONCLUSÕES: A disfunção sexual é comum em homens com hepatopatia crônica grave e o transplante hepático melhora todos os componentes da função sexual: função erétil, orgasmo, desejo sexual, satisfação na relação sexual e satisfação pessoal

Rol del urólogo en el manejo de los pacientes con lesión medular / Urologist's role in the management of patients with spinal cord injury

Se analiza la importancia y circunstancias en las cuales los pacientes lesionados medulares requieren del cuidado del urólogo. A través de una experiencia de 5 años con 120 pacientes se describe el manejo de los traumatismos genitourinarios, vejiga neurogénica y disfunción erectil relacionados con una lesión de la médula espinal. El Trauma se analiza en 94 pacientes con lesión medular traumática (78 por ciento de la serie). Hubo lesiones asociadas en el 48 por ciento, el índice de Gravedad de Lesiones (ISS) promedio fue de 30,2 y el 84 por ciento debió ser operado por lesiones traumáticas. Se analizan dos períodos históricos de manejo de vejiga neurogénica y se discuten nuestras pautas actuales de tratamiento con caracterismo intermitente, drogas específicas y cirugía reconstructiva vesical. Con ellas hemos logrado una vejiga balanceada y totalmente continente en más del 70 por ciento de los casos. Sólo 7 pacientes requieren sonda o permanencia y ninguno ha desarrollado insuficiencia renal crónica. La disfunción sexual fue enfocada en forma protocolizada y multidisciplinaria. Se analizó la erección en 93 de los 105 varones de la serie. Los pacientes sin erección útil fueron entrenados para autoinyectoterapia (27 pacientes) y a un paciente se le implantó una prótesis. El 52 por ciento de los pacientes está sexualmente activo y la principal causa de inactividad es la falta de pareja (y no de erección). Sólo el 17 por ciento de los pacientes permanece con una limitación sexual derivada de su lesión medular. Es esencial que el urólogo comprenda las etapas por las que atraviesan estos enfermos y sus necesidades, para poder establecer una relación cercana y efectiva, ya que el control urológico del lesionado medular será de por vida