Electrophysiological evaluation of alterations in penile sensation due to penile prosthesis implantation in patients with erectile dysfunction

Objective The present study was aimed to determine the effect of penile prosthesis implantation(PPI)surgery on penile sensation by evaluating the penile electromyography(EMG)variables.Methods The research was designed as a prospective study.Thirty patients who were diagnosed with organic erectile dysfunction and had underwent PPI surgery between January 2017 and January 2018 in the Urology Clinic of Antalya Training and Research Hospital were included in this study.Penile sensory EMG was performed on each patient 1 day prior to the surgery by the Physical Therapy and Rehabilitation clinic.Additionally,the control EMG study was also performed in the 3rd and 6th postoperative months.Results We included 27 patients in this study who attended regular follow-ups and had complete EMG results.Out of the 27 patients,23(85.2%)patients had received malleable(ProMedon)penile prosthesis,one(3.7%)patient had received a two-piece inflatable(Ambicor)penile prosthesis,and three(11.1%)patients had received a three-piece inflatable(AMS 700 CXR)penile prosthesis.The mean nerve conduction value(NCV)of the patients was 29.85(standard derivation:22.54;range:0-78.4)m/s during the preoperative period,whereas it was 27.64(standard derivation:24.72;range:0-83.3)m/s in the 3rd postoperative month and 24.80(standard derivation:22.31;range:0-88.4)m/s in the 6th postoperative month.There was no significant difference between preoperative NCV and 3rd postoperative month NCV(p=0.607).Similarly,no significant difference was observed between preoperative NCV and 6th postoperative month NCV(p=0.276).Additionally,the change between NCV values at postoperative 3rd and 6th months was not statistically significant(p=0.553).Conclusion Significant loss of penile sensation does not occur in patients who undergo PPI surgery.

Outcome of implanting penile prosthesis for treating erectile dysfunction： experience with 42 cases

Aim： To report a short-time result of three-piece inflatable penile prosthesis （IPP） implantation on treating patients with organic erectile dysfunction （ED）. Methods： Three-piece IPPs were implanted in 42 Chinese patients with ED refractory to systemic treatment between May 2002 and May 2004. The etiologies of ED were neurogenic （28 with paraplegia and seven with traumatic nervi-erigentes injury）, congenital venous leakage （5 cases）, fibrosis of corpus cavernosum （lcase） and Klinefelter＇s syndrome （1 case）. The follow-up period ranged from 24 to 57 months. Results： Implantation procedures were successfully performed upon all 42 patients. The length of implanted prosthesis was from 13 cm to 18 cm, and the diameter was 1 cm. The implanted prosthesis was made by the Medical Instrumentation Company of Muping （Muping, Shandong, China）. Localized infection occurred in only one patient and mechanical complications occurred in five patients. Coitus could be performed in 41 cases （97.6%）. Three patients with congenital venous leakage made their spouses pregnant after implantation. Conclusion： Implantation of three-piece IPP is an effective and safe modality for treating patients with ED. It can be well accepted by Chinese patients because of its efficacy.

Penile prosthesis implantation in Chinese patients wit severe erectile dysfunction： 10-year experience

We retrospectively evaluated the clinical outcome of penile prosthesis implantation （PPI） in Chinese patients with severe erectile dysfunction （SED）. From July 2000 to December 2011, 224 patients （mean age： 35.9±11.8 years, range： 20-75 years） with SED underwent PPI by experienced surgeon according to standard PPI procedure at our centre. A malleable prosthesis （AMS 650） was implanted in 45 cases （20.1%）, and a three-piece inflatable prosthesis （AMS 700 CXM or AMS 700 CXR） was implanted in 179 cases （79.9%）. Surgical outcomes, including postoperative complications, clinical efficacy and couple satisfaction, were evaluated over than 6 months postoperatively using medical record abstraction, IIEF-5, quality of life （QoL） scores, and the patient/partner sexual satisfaction score proposed by Bhojwani etaL Of the 224 patients eligible for the study, 201 subjects （89.7%） completed follow-up. All of patients could perform sexual intercourse post PPI with the mean postoperative IIEF-5 and QoL scores were 20.02±2.32 and 5.28±0.76, respectively, which were significantly improved compared with the preoperative scores （6.29±1.5 and 2.13±0.84, P〈0.01）. Of the 201 men, mechanical malfunction occurred in four cases （2.0%） and three cases were re-implanted new device, and two cases （1.0%） developed a mild curvature of the penis. Scrotal erosion with infection occurred in one case with diabetes mellitus （0.5%） and required complete removal of the implanted AMS 700 CXM. Satisfactory sexual intercourse at least twice per month was reported by 178 men （88.6%）, and overall satisfaction with the PPI surgery was reported by 89.0% of men and 82.5% of partners. Patient satisfaction in the three-piece inflatable prosthesis group was higher than in the malleable prosthesis group （P〈0.05）. Satisfaction, however, between the types of prostheses, did not differ in the partner survey. PPI is a safe and effective treatment option for Chinese patients with SED and experienced surgeon perform PPI according to standard PPI procedure could reduce the postoperative complications of PPI and could improve patient satisfaction ratio and QoL.

Penile prosthesis implantation and tunica albuginea incision without grafting in the treatment of Peyronie＇s disease with erectile dysfunction

We evaluated penile prosthesis implantation with tunica albuginea-relaxing incisions without grafting in the treatment of Peyronie＇s disease associated with erectile dysfunction. Between April 2005 and June 2011, 62 patients underwent surgery due to severe Peyronie＇s disease associated with erectile dysfunction. Malleable and inflatable penile prostheses were inserted in 49 and 13 cases, respectively. Penile prostheses were inserted into the corpora cavernosa using the standard ventral approach. After lifting the neurovascular bundle, the tunica albuginea was incised and opened at the plaque region to correct the deformities and to lengthen the penis. Subsequently, the wide neurovascular bundle was replaced, and all incisions of the tunica albuginea were covered to prevent corporal grafting. In the median follow-up of 35 months （range 14-82 months）, the penis was completely straightened in 59 （95%） patients. Numbness of the glans, which the patients found initially upsetting, decreased or disappeared spontaneously 3-6 months later. Penile prosthesis implantation with tunica albuginea incisions is a viable alternative in the treatment of Peyronie＇s disease because the extensive dissection of the neurovascular bundle allows a good approach to the plaque and provides excellent covering of the incised tunica albuginea without additional grafting.

Outcome of penile prosthesis implantation： are malleable prostheses an appropriate treatment option in patients with erectile dysfunction caused by prior radical surgery？

The aim of our study was to evaluate the outcome of penile prosthesis implantation in patients with various comorbidities as a cause of erectile dysfunction （ED）. The data of 181 patients who underwent surgery between 1998 and 2012 in two centers were evaluated. The mean age of the patients was 52.2 years （range： 31-71 years）. The study group contained 162 patients （89.5%） with malleable prostheses and 19 （10.5%） with inflatable implants. All patients were re-evaluated 1 month later to assess prosthesis function and complications, and further re-examinations were performed if needed. Satisfaction was defined as having satisfactory intercourse and happiness with the device in general. The follow-up period was at least 12 months for each patient. The postoperative complication rate was 32% （n = 58）. The number of complications with inflatable and malleable prostheses was 7 （3.9%） and 51 （28.1%）, respectively. Overall, 21 prostheses （11.6%） had to be removed because of various complications and patient dissatisfaction. Patients with prior radical surgery had higher extraction rates （n = 14.606, P 〈 0.05, Chi-square test）. The main reasons for removal were erosion （n = 11; 6.1%） and infection （n = 3; 2.1%）. With respect to satisfaction during intercourse, we found that 104 （57.5%） patients described themselves as very satisfied with the prosthesis, while 21 （11.6%） were unsatisfied. The high explantation rate in patients with prior surgery was remarkable in our study. Our results revealed that a malleable prosthesis should not be the preferred type of implant for patients with prior surgery.

Prospective and long-term evaluation of erect penile length obtained with inflatable penile prosthesis to that induced by intracavernosal injection

We compared erect penile length after inflatable penile prosthesis （IPP） implantation with that induced by intracavemosal injection （ICI） before surgery. A total of 11 patients with full erections induced by ICI of 0.25 mL of Trimix （papaverine, phentolamine and prostaglandin E 1） at the time of penile color duplex Doppler ultrasonograpby were enrolled in this study. The patients subsequently underwent IPP implantation as the ultimate treatment for their erectile dysfunction （ED）. Erect penile length consequent to IPP implantation was measured at 6 weeks, 6 months and at I year after surgery. The Sexual Health Inventory for Men （SHIM） was administered before, and at 6 months and 1 year after IPP implantation. Erect penile length （mean ± s.c.） as induced by ICI was 13.2 ± 0.4 cm, whereas the lengths attained with IPP were 12.4 ± 0.3, 12.5 ± 0.3 and 12.5 ± 0.4 cm at the sixth week, sixth month and 1-year follow-ups, respectively. There were 0.83 ± 0.25, 0.75 ± 0.20 and 0.74 ± 0.15 cm decreases in erect penile length at 6 weeks, 6 months and 1 year, respectively, after IPP implantation when compared with that after ICI （P 〈 0.05）. The SHIM scores for patients reporting shorter penises were the same as those for patients without complaints at the 6-month and 1-year follow-ups （P 〉 0.05）. To our knowledge, this is the first study to objectively show a significant decrease in erect penile length after IPP implantation when compared with that after ICI. However, this decrease did not affect the effectiveness of IPP in treating ED.

Combination therapy for male erectile dysfunction and urinary incontinence

Urinary incontinence （UI） and erectile dysfunction （ED） are both very prevalent conditions. Insertion of an artificial urinary sphincter （AUS） and penile prosthesis （PP） is an effective and proven method of treatment for both conditions. With advancing age, as well as with increasing populations of patients radically treated for prostate cancer, the occurrence of both conditions found in the same patient is increasing. The purpose of this article was to analyze the available evidence for simultaneous surgical management of male ED and UI using prosthetic devices. The existing literature pertaining to dual implantation of AUS and PP was reviewed. The concomitant insertion of the PP with the male perineal sling was also considered. Concurrent ED and UI are increasingly seen in the post radical prostatectomy population, who are often younger and less willing to suffer with these conditions. Insertion of an AUS and PP, either simultaneously or as a two-stage procedure, appears to be a safe, efficacious and long-lasting method of treatment. The improvements in design of both the AUS and PP as well as the development of the single transverse scrotal incision have made simultaneous insertion of these prostheses possible. Dual implantation of the PP and male sling looks promising in a selected population. In conclusion, the insertion of the AUS and PP for the treatment of concurrent UI and ED is safe and effective. Simultaneous insertion of these prostheses in the same patient offers potential advantages in operative and recovery time and is associated with high patient satisfaction. Combination therapy should therefore be included in the arsenal of treatment of these conditions.

Initial experience of a single center with the use of ZSI 475 penile prosthesis

Objective:To evaluate surgical outcomes after implantation of the Zephyr ZSI 475 inflatable penile prosthesis(IPP)and patients’quality of life.Methods:From December 2014 to September 2018,15 patients underwent prosthesis implantation with ZSI 475.A retrospective review of clinical data was performed.Patients’quality of life after implantation was investigated with Quality of Life and Sexuality with Penile Prosthesis(QoLSPP)questionnaire.Results:The median age of patients was 57 years and the average follow-up time was 22 months.Twelve patients received a standard implantation due to severe erectile dysfunction(ED);three patients also presented penile curvature and additional corporoplasty with grafting was necessary.Three procedures had to be interrupted due to defects of the insertion tools.In one case a manufacturing defect resulted in a pump leak.In one case,a severe postoperative complication occurred,which requested explanation of the device.During the follow-up,four patients experienced mechanical failure of the prosthesis.Results of QoLSPP questionnaire at 12 months were skewed toward the positive end of the scale in all domains.Conclusion:In our initial experience,ZSI 475 suffered a high rate of mechanical failures;on the other hand,the company showed great commitment in order to improve the quality and reliability of the device.The lower cost of ZSI 475 may add to the chances of the product to become a cost-effective alternative to treat those patient who need a IPP.

Antibiotic-coated medical devices: with an emphasis on inflatable penile prosthesis

One of the most serious complications associated with the use of the inflatable penile prosthesis is infection. This can lead to significant morbidity for the patient, as well as significant health care costs. A number of methods have been used in attempts at minimizing the infection risk, including applying an antibiotic coating to the medical devise. This review aims to evaluate the effectiveness of these products in preventing clinically significant infections.

Simultaneous penile prosthesis and male sling/artificia urinary sphincter

Erectile dysfunction （ED） and stress urinary incontinence （SUI） from urethral sphincteric deficiency is not an uncommon problem. The commonest etiology is intervention for localized prostate cancer and/or radical cystoprostatectomy for muscle invasive bladder cancer. Despite advances in surgical technology with robotic assisted laparoscopic prostatectomy and nerve sparing techniques, the rates of ED and SUI remain relatively unchanged. They both impact greatly on quality of life domains and have been associated with poor performance outcomes. Both the artificial urinary sphincter and penile prosthesis are gold standard treatments with proven efficacy, satisfaction and durability for end-stage SUI and ED respectively. Simultaneous prosthesis implantation for concurrent conditions has been well described, mostly in small retrospective series. The uptake of combination surgery has been slow due in part to technical demands of the surgery and to an extent, a heightened anxiety over potential complications. This paper aims to discuss the technical aspect of concurrent surgery for both disease entity and the current published outcomes of the various surgical techniques with this approach.

Infrapubic versus Penoscrotal Approaches for Implantation of Semi-Rigid Penile Prosthesis

Background: Modification of surgical techniques to minimize wound infections in penile implant surgery using malleable prosthesis which is easy to use, of very low risk of mechanical failure and is financially suitable to improve outcome and ensures less complications. The aim of the study is to compare infrapubic approach and Penoscrotal approach in penile semi-rigid prosthesis implantation surgery. Patients and methods: Fifty patients were randomly divided into two groups and each group underwent one approach. Results: No statically significant differences were found between both groups in terms of operative time. Corporeal cross over was the most common intraoperative complications, 3 cases in IP approach and 6 cases in PS but not statistically significant. Peyronie’s disease patients underwent penile implant through infrapubic approach in 3 cases and PS in 4 cases with one recorded complication of keloid formations with IP. Urethral false passage reported only in one case with PS approach without affecting the procedure. Only minor complications including superficial wound infection which was significantly more with PS, 6/25 (24%) and IP 1/25 (4%), p value = 0.041. Penile and scrotal edema was common with IP approach (92%) in comparison with PS approach (60%). The urethral catheter can be abandoned with IP to avoid the risk of catheterizations. No significant relation between diabetes and infections and no erosions were encountered. Conclusion: Through this research work, infrapubic approach is better than Penoscrotal approach even if it is not commonly used by surgeon.

Erectile Dysfunction in Male with Glans Penis Apocrine Hydrocystoma: Organic or Psychogenic?

The location of the apocrine hydrocystoma in the penis region is rare. We present a case where we evaluated the erectile function of a patient presenting such an asymptomatic formation. We assessed the psychogenic component of the erectile dysfunction based on the association of the somatic component of the cyst with the patient’s inability to focus on sexual intercourse. The fear of traumatization of the cyst during sexual intercourse was considered as a triggering factor of the chain of insufficient or unsuccessful erections, and the sexual performance anxiety as a factor in maintaining this erectile dysfunction. Apparently, an organic cause induced an erectile dysfunction, through non-organic (predisposition, triggering and maintenance) mechanisms.

Ten-year experience with penile prosthetic surgery for the treatment of erectile dysfunction:outcomes of a tertiary referral center and predictors of early prosthetic infection

We aimed to evaluate ten-year outcomes of penile prosthesis(PP)implantation for the treatment of erectile dysfunction and to assess predictors of early prosthetic infection(EPI).We identified 549 men who underwent 576 PP placements between 2008 and 2018.Univariate and multivariate analyses were used to identify potential predictors of EPI.An EPI predictive nomogram was developed.Thirty-five(6.1%)cases of EPI were recorded with an explant rate of 3.1%.In terms of satisfaction,82.0%of the patients defined themselves as“satisfied,”while partner’s satisfaction was 88.3%.Diabetes(P=0.012),longer operative time(P=0.032),and reinterventions(P=0.048)were associated with EPI risk,while postoperative ciprofloxacin was inversely associated with EPI(P=0.014).Rifampin/gentamicin-coated 3-piece inflatable PP(r/g-c 3IPP)showed a higher EPI risk(P=0.019).Multivariate analyses showed a two-fold higher risk of EPI in diabetic patients,redo surgeries,or when a r/g-c 3IPP was used(all P<0.03).We showed that diabetes,longer operative time,and secondary surgeries were the risk factors for EPI.Postoperative ciprofloxacin was associated with a reduced risk of EPI,while r/g-c 3IPP had higher EPI rates without an increased risk of PP explant.After further validation,the proposed nomogram could be a useful tool for the preoperative counseling of PP implantation.

Efficacy of penile low-intensity shockwave treatment for erectile dysfunction:correlation with the severity of cavernous artery disease

We analyzed the efficacy of penile low-intensity extracorporeal shockwave treatment for erectile dysfunction(ED)combined with cavernous artery disease(CAD).ED was evaluated by the International Index of Erectile Function,subdividing patients into mild and moderate/severe forms.CAD was assessed using penile color Doppler ultrasonography.Patients(n=111)with a positive outcome after treatment,based upon the minimal clinically important difference of the International Index of ED,were followed up for 3 months and 6 months.We found a significant mean increase in the index of erectile function,with an overall improvement in hemodynamic parameters of the cavernous artery.In particular,93.9%of the patients with mild ED without CAD responded to treatment and 72.7%resumed normal erectile function.Only 31.2%of the patients with moderate/severe ED and CAD responded to treatment,and none resumed normal erectile function.All patients with mild ED and no CAD maintained the effects of therapy after 3 months,while no patients with moderate/severe ED and CAD maintained the benefits of treatment after 3 months.Thus,patients with mild ED and no CAD have better and longer lasting responses to such treatment,with a higher probability of resuming normal erectile function than patients with moderate/severe ED and CAD.

Penile sensory thresholds in subtypes of premature ejaculation： implications of comorbid erectile dysfunction

Penile hypersensitivity plays an important role in premature ejaculation （PE）, but differences in penile sensitivity among subtypes of PE are unknown. Therefore, we compared penile sensory thresholds in PE subtypes of lifelong and acquired PE, PE with and without erectile dysfunction （ED）, PE with an intravaginal ejaculation latency time 〈1 min and 〉1 min, and PE with and without orgasmic pleasure perceptual dysfunction. During August 2014 to January 2016, 136 patients with PE were included. Penile warm, cold, and vibratory thresholds were measured. Data of clinical characteristics, sexual life, Premature Ejaculation Diagnostic Tool （PEDT） score, and the 5-item version of the International Index of Erectile Function （IIEF-5） score were collected. Vibratory thresholds of the PE with ED group were higher in the right coronal sulcus （median amplitude： 4.92 vs 3.65 μm, P= 0.02） and the right penile shaft （median amplitude： 3.87 vs 3.30 μm, P = 0.03）, while differences in penile sensory thresholds between other subtypes were not significant. The median PEDT score was lower in the PE without ED group （12 vs 14, P 〈 0.001）. The IIEF-5 and PEDT scores were negatively correlated （r = -0.29, P 〈 0.001）. Patients with orgasmic pleasure perceptual dysfunction had a lower median IIEF-5 score （20 vs 21, P = 0.02）. Patients with PE and ED had lower penile sensitivity, and ED was associated with more severe symptoms and weaker orgasmic pleasure perception. In men with PE, management of comorbid ED is necessary. In case of side effects in erectile function, topical anesthetics should be cautiously used in men with PE and ED.

Age is not a number when it comes to penile prosthesis surgery:A case series and mini literature review

Backgound:Given the overall aging of the population,erectile dysfunction(ED)has become an increasingly relevant issue.When elective surgery is offered,the patient's age is often noted as a potential limiting factor.The aim of this study is to investigate the safety of implanting penile prostheses(PPs)in men 90 years and older,and report the potential complications associated with this population.Methods:The database was screened between the years 2003 and 2023 to identify patients at least 90 years and older who underwent implantation of PP by a single surgeon at MD Anderson Cancer Center and Memorial Hermann Texas Medical Center.We collected demographic information,their anesthesia perioperative assessment,surgical procedure details,and postoperative pathway.Results:Between 2003 and 2023,2000 men underwent PP surgery.Three patients were 90 years or older at the time of PP surgeries.All surgeries were performed without intraoperative or postoperative complications.Following the surgery,patients were monitored,and the patients with implantations demonstrated the ability to use the device and reported satisfaction.Conclusion:This case series demonstrates that implantation of PP is a safe and effective treatment for elderly men with ED.Maintaining a satisfactory sexual life in this age group is vital and achievable through inflatable PP insertion.There are several factors that must be considered prior to operating on an older patient.However,with proper patient selection and preoperative optimization,this operation can be effectively performed in these patients.

Novel protective penile collar following inflatable penile prosthesis placement: the “Wang Collar”

Penile rehabilitation after inflatable penile prosthesis(IPP)implantation for the treatment of erectile dysfunction includes leaving the device partially inflated so as to preserve the penile length and to maintain hemostasis.With a partially inflated device,the penis becomes more sensitive and more susceptible to unintended insults during the immediate postoperative management.The“Wang Collar,”a device intended to protect the penis in the early postoperative period,is hereby described.Three hundred and forty-eight patients had the 44Wang Collar"included as part of their post-1 PP management from August 2014 to February 2019.The protective collar,devised from a polystyrene cup with the bottom removed,is secured with a tape over the previously dressed and partially inflated penis.In order to evaluate the effectiveness of this device,we conducted surveys on the perioperative staff at three different institutions.The“Wang Collar”has been found to be beneficial in the early postoperative care of patients.Based on the answers to our questionnaire,the perioperative personnel found this device to be highly protective,especially when transporting the patient after IPP surgery,easy to work with,and almost never bothersome or irritative to the patient.We present a novel penile device after IPP placement,which we have found to improve patient satisfaction in the postoperative period.In addition,it eases the care of the patient by the perioperative staff.It is now our routine to use this device after IPP surgery.Further research is necessary to evaluate whether this device can decrease postoperative wound complications.

Penile rehabilitation with a vacuum erectile device in an animal model is related to an antihypoxic mechanism： blood gas evidence

Our previous study showed that vacuum erectile device （VED） therapy has improved erectile function in rats with bilateral cavernous nerve crush （BCNC） injuries. This study was designed to explore the mechanism of VED in penile rehabilitation by analyzing cavernous oxygen saturation （SO2） and to examine the effect of VED therapy on preventing penile shrinkage after BCNC. Thirty adult Sprague- Dawley rats were randomly assigned into three groups： group 1, sham surgery; group 2, BCNC; and group 3, BCNC＋VED. Penile length and diameter were measured on a weekly basis. After 4 weeks of therapy, the penile blood was extracted by three methods for blood gas analysis （BGA）： method 1, cavernous blood was aspirated at the flaccid state; method 2, cavernous blood was aspirated at the traction state; and method 3, cavernous blood was aspirated immediately after applying VED. SO2 values were tested by the blood gas analyzer. The results showed that VED therapy is effective in preventing penile shrinkage induced by BCNC （Penile shortening： BCNC group 1.9±1.1 mm; VED group 0.3±1.0 mm; P〈0.01. Penile diameter reduction： BCNC group 0.28±0.14 mm; VED group 0.04±0.14 mm; P〈0.01）. The mean SO2±s.d. values were increased by VED application （88.25%±4.94%） compared to the flaccid （76.53%±4.16%） or traction groups （78.93%±2.56%） （P〈0.05）. The calculated blood constructs in the corpus cavernosum right after VED application were 62% arterial and 38% venous blood. These findings suggest that VED therapy can effectively preserve penile size in rats with BCNC injury. The beneficial effect of VED therapy is related to antihypoxia by increasing cavernous blood SO2.

Endovascular treatment of vasculogenic erectile dysfunction

The treatment of erectile dysfunction （ED） has been a fascination involving multiple medical specialities over the past century with urologic, cardiac and surgical experts all contributing knowledge toward this multifactorial disease. With the well-described association between ED and cardiovascular disease, angiography has been utilized to identify vasculogenic impotence. Given the success of endovascular drug-eluting stent （DES） placement for the treatment of coronary artery disease, there has been interest in using this same technology for the treatment of vasculogenic ED. For men with inflow stenosis, DES placement to bypass arterial lesions has recently been reported with a high technical success rate. Comparatively, endovascular embolization as an approach to correct veno-occlusive dysfunction has produced astonishing procedural success rates as well. However, after a thorough literature review, arterial intervention is only recommended for younger patients with isolated vascular injuries, typically from previous traumatic experiences. Short-term functional outcomes are less than optimal with long-term results yet to be determined. In conclusion, the hope for a minimally invasive approach to ED persists but additional investigation is required prior to universal endorsement.

A prospective randomized controlled study on scheduled PDE5i and vacuum erectile devices in the treatment of erectile dysfunction after nerve sparing prostatectomy

Cavernous nerve injury is an important cause of erectile dysfunction(ED).Although protective nerve technology has been widely used in nerve-sparing radical prostatectomy(nsRP),the incidence of ED is still very high after surgery.The purpose of our study was to evaluate erectile function(EF)and penile length in the non-erectile state(PLNES)following scheduled phosphodiesterase 5 inhibitor(PDE5i),vacuum erectile device(VED)treatment,and combination therapy after nsRP.One hundred patients with localized prostate cancer and normal EF were randomized to scheduled PDE5i group,VED treatment group,a combined treatment group,and the control group without any intervention.The International Index of Erectile Function-5(IIEF-5)scores and PLNES were evaluated after 6 months and 12 months of treatment.Sexual Encounter Profile(SEP-Question 2 and SEP-Question 3)were evaluated after 12 months of treatment.Ninety-one of the 100 randomized patients completed the study.We found that the 5 mg tadalafil once a day(OaD)combined with VED can help improve IIEF-5 scores in nsRP patients after both 6 months and 12 months.VED alone or combined with tadalafil OaD can help patients maintain PLNES.VED combined with tadalafil OaD can improve the rate of successful penetration(SEP-Question 2)after 12 months.There were no significant differences in the return to target EF after 12 months among the groups.No significant correlation was noted between the variables and return to target EF(IIEF≥17),and between the variables and effective shortening of the patient’s penis(shortening≥1 cm)after 12 months of intervention.