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John P Mulhall - One of the best experts on this subject based on the ideXlab platform.
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updating the international index of Erectile Function evaluation of a large clinical data set
The Journal of Sexual Medicine, 2020Co-Authors: Andrew J Vickers, Amy Tin, Karandeep Singh, Rodney L Dunn, John P MulhallAbstract:Abstract Introduction The International Index of Erectile Function (IIEF) is the predominant patient-reported outcomes instrument for assessing male sexual Function. There are obvious problems with the use of the IIEF in the assessment of an individual patient, such as for men who use injections and men who do not engage in intercourse. Aim The aim of the current study is to redesign the Erectile Function domain of the IIEF (IIEF6) to more accurately assess the individual patient. Methods In an observational study of men undergoing treatment for prostate cancer at a tertiary care institution, including 24,732 questionnaires completed by 6,780 individuals, IIEF6 scores were compared for patients using and not using Erectile aids. Men not engaging in sexual intercourse were asked to describe the reason. Main Outcome Measure The main outcome we were seeking was the IIEF6 scores. Results Mean scores before Erectile aids items were added was 17.7 compared with predicted scores of 18.3 vs 16.7 if patients reported their Function with vs without the use of aids. No intercourse was reported for 35% of surveys. Reasons given were lack of ability or confidence in 53%, lack of willing and available partner in 28%, “other” in 17% (including respondent’s or partner’s health issues, low libido, preference for nonpenetrative sex or for sex with men). Doubling the sum of the 3 nonintercourse IIEF6 questions had excellent properties (difference of 0.06, limits of agreement -3.10 to 3.22). Clinical Implications Erectile Function instruments must include items about Erectile aids. Men who report that they have not attempted intercourse should not be assumed to have Erectile dysFunction, but should be asked the reason why. For men who report lack of opportunity or preference for intercourse, the score of the 3 nonintercourse IIEF6 questions should be doubled. Strengths & Limitations This is a large study of patients in a real-world setting. Although the study only includes radical prostatectomy patients, and although the study cohort is not fully representative of the US prostate cancer population as a whole, these issues would not affect the key findings. Conclusion The IIEF6 can be redesigned to better assess the individual patient. Vickers AJ, Tin AL, Singh K, et al. Updating the International Index of Erectile Function: Evaluation of a Large Clinical Data Set. J Sex Med 2020;17:126–132.
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development of nomograms to predict the recovery of Erectile Function following radical prostatectomy
The Journal of Sexual Medicine, 2019Co-Authors: John P Mulhall, Nelson E. Bennett, Michael W Kattan, Jason Stasi, Bruno Nascimento, James A Eastham, Bertrand Guillonneau, Peter T ScardinoAbstract:Abstract Introduction Given the number of confounders in predicting Erectile Function recovery after radical prostatectomy (RP), a nomogram predicting the chance to be Functional after RP would be useful to patients’ and clinicians’ discussions. Aim To develop preoperative and postoperative nomograms to aid in the prediction of Erectile Function recovery after RP. Main Outcome Measures International Index of Erectile Function (IIEF) Erectile Function domain score-based Erectile Function. Methods A prospective quality-of-life database was used to develop a series of nomograms using multivariable ordinal logistic regression models. Standard preoperative and postoperative factors were included. Main Outcome Measures The nomograms predicted the probability of recovering Functional erections (Erectile Function domain scores ≥24) and severe Erectile dysFunction (≤10) 2 years after RP. Results 3 nomograms have been developed, including a preoperative, an early postoperative, and a 12-month postoperative version. The concordance indexes for all 3 exceeded 0.78, and the calibration was good. Clinical Implications These nomograms may aid clinicians in discussing Erectile Function recovery with patients undergoing RP. Strengths & Limitations Strengths of this study included a large population, validated instrument, nerve-sparing grading, and nomograms that are well calibrated with excellent discrimination ability. Limitations include current absence of external validation and an overall low comorbidity index. Conclusions It is hoped that these nomograms will allow for a more accurate discussion between patients and clinicians regarding Erectile Function recovery after RP. Mulhall JP, Kattan MW, Bennett NE, et al. Development of Nomograms to Predict the Recovery of Erectile Function Following Radical Prostatectomy J Sex Med 2019;16:1796–1802.
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Erectile Function recovery after radical prostatectomy in men with high risk features
The Journal of Urology, 2016Co-Authors: Pedro Recabal, Peter T Scardino, John P Mulhall, Melissa Assel, John E Musser, Ronald J Caras, Daniel D Sjoberg, Jonathan A Coleman, Raul O Parra, Karim TouijerAbstract:Purpose: We describe the efficacy of radical prostatectomy to achieve complete primary tumor excision while preserving Erectile Function in a cohort of patients with high risk features in whom surgical resection was tailored according to clinical staging, biopsy data, preoperative imaging and intraoperative findings.Materials and Methods: In a retrospective review we identified 584 patients with high risk features (prostate specific antigen 20 ng/ml or greater, clinical stage T3 or greater, preoperative Gleason grade 8-10) who underwent radical prostatectomy between 2006 and 2012. The probability of neurovascular bundle preservation was estimated based on preoperative characteristics. Positive surgical margin rates and Erectile Function recovery were determined in patients who had some degree of neurovascular bundle preservation.Results: The neurovascular bundles were resected bilaterally in 69 (12%) and unilaterally in 91 (16%) patients. The remaining patients had some degree of bilateral neurovascular b...
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back to baseline Erectile Function recovery after radical prostatectomy from the patients perspective
The Journal of Sexual Medicine, 2013Co-Authors: Christian J Nelson, Peter T Scardino, James A Eastham, John P MulhallAbstract:Abstract Introduction A variety of Erectile Function recovery (EFR) rates are reported post‐radical prostatectomy (RP), with some suggesting EFR rates over 90% [1]. Clinical experience suggests that patients view EFR as getting back to their baseline (BTB) Erectile Functioning (EF) without the use of medication. Aim This study explores EFR defined as BTB. Method Men pre‐RP and 24 months post‐RP completed the Erectile Function Domain (EFD) of the International Index of Erectile Function and one question on phosphodiesterase type 5 inhibitor (PDE5i) use. Men using a PDE5i at baseline were excluded. Main Outcome Measures At 24 m, "back to baseline" was defined as achieving the baseline EFD score (within 1 point or higher). Analyses included descriptive statistics, chi‐square, and logistic regression. Results One hundred eighty men had an average age at RP of 59 (SD = 7) years. When including men who were using a PDE5i at 24 months, 43% (N = 78, 95% CI: 36–51%) returned BTB. When considering BTB without the use of a PDE5i, 22% (N = 39, 95% CI: 16% to 28%) returned BTB. When focusing on a subset of men with baseline EFD ≥ 24 (N = 132), 36% (N = 47, 95% CI: 28% to 44%) returned BTB at 24 months using a PDE5i and 16% (N = 21, 95% CI: 11% to 23%) without the use of a PDE5i. For this group, there was a significant difference by age ( P P Conclusions Twenty‐two percent of the entire sample and 16% of the men with Functional (EFD ≥ 24) baseline erections returned to BTB EF without the use of medication. Only 4% of men who were ≥60 years old with Functional erections pre‐surgery achieved BTB EF. Although gaining partial EF is also important, men pre‐RP should be educated on EFR and the chance of "back to baseline" EF.
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defining the impact of vascular risk factors on Erectile Function recovery after radical prostatectomy
BJUI, 2013Co-Authors: Patrick Ely Teloken, Peter T Scardino, Jason Stasi, James A Eastham, Christian J Nelson, Michael Karellas, John P MulhallAbstract:What's known on the subject? and What does the study add? Erectile Function recovery after radical prostatectomy is affected by surgical technique and patient factors. Age and preoperative Erectile Function are the 2 patient factors that have been consistently shown to impact postoperative Erectile Function. The presence of vascular risk factors preoperatively seems to negatively impact Erectile Function recovery after radical prostatectomy independently from age, preoperative Erectile Function and surgical technique. Objective To examine whether vascular risk factors (VRFs) affect Erectile Function (EF) recovery after radical prostatectomy (RP). Patients and Methods From our prospective database we identified patients with clinically localised prostate cancer who had undergone RP and had preoperative information on EF and VRFs (hypertension, hypercholesterolaemia, diabetes mellitus, coronary artery disease [CAD], and cigarette smoking), surgeon-graded nerve-sparing status, and EF data collected between 24 and 30 months after RP. Results In all, 984 patients were included in the analyses. The frequency of the VRFs was as follows: hypertension (38%), hypercholesterolaemia (36%), diabetes mellitus (7%), CAD (5%), and cigarette smoking (37%). On univariate analysis, EF between 24 and 30 months was associated with age (r = 0.37, P 3 VRFs; r = 0.15, P = 0.003). On multivariable analysis all variables remained statistically significant, and accounted for 28% of the total variance in EF between 24 and 30 months after RP. Conclusions The presence of VRFs seems to adversely affect EF recovery after RP independently of other factors. This observation might be useful for improving patient counselling before treatment and to support the development of new treatment strategies for Erectile dysFunction after RP.
James A Eastham - One of the best experts on this subject based on the ideXlab platform.
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development of nomograms to predict the recovery of Erectile Function following radical prostatectomy
The Journal of Sexual Medicine, 2019Co-Authors: John P Mulhall, Nelson E. Bennett, Michael W Kattan, Jason Stasi, Bruno Nascimento, James A Eastham, Bertrand Guillonneau, Peter T ScardinoAbstract:Abstract Introduction Given the number of confounders in predicting Erectile Function recovery after radical prostatectomy (RP), a nomogram predicting the chance to be Functional after RP would be useful to patients’ and clinicians’ discussions. Aim To develop preoperative and postoperative nomograms to aid in the prediction of Erectile Function recovery after RP. Main Outcome Measures International Index of Erectile Function (IIEF) Erectile Function domain score-based Erectile Function. Methods A prospective quality-of-life database was used to develop a series of nomograms using multivariable ordinal logistic regression models. Standard preoperative and postoperative factors were included. Main Outcome Measures The nomograms predicted the probability of recovering Functional erections (Erectile Function domain scores ≥24) and severe Erectile dysFunction (≤10) 2 years after RP. Results 3 nomograms have been developed, including a preoperative, an early postoperative, and a 12-month postoperative version. The concordance indexes for all 3 exceeded 0.78, and the calibration was good. Clinical Implications These nomograms may aid clinicians in discussing Erectile Function recovery with patients undergoing RP. Strengths & Limitations Strengths of this study included a large population, validated instrument, nerve-sparing grading, and nomograms that are well calibrated with excellent discrimination ability. Limitations include current absence of external validation and an overall low comorbidity index. Conclusions It is hoped that these nomograms will allow for a more accurate discussion between patients and clinicians regarding Erectile Function recovery after RP. Mulhall JP, Kattan MW, Bennett NE, et al. Development of Nomograms to Predict the Recovery of Erectile Function Following Radical Prostatectomy J Sex Med 2019;16:1796–1802.
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back to baseline Erectile Function recovery after radical prostatectomy from the patients perspective
The Journal of Sexual Medicine, 2013Co-Authors: Christian J Nelson, Peter T Scardino, James A Eastham, John P MulhallAbstract:Abstract Introduction A variety of Erectile Function recovery (EFR) rates are reported post‐radical prostatectomy (RP), with some suggesting EFR rates over 90% [1]. Clinical experience suggests that patients view EFR as getting back to their baseline (BTB) Erectile Functioning (EF) without the use of medication. Aim This study explores EFR defined as BTB. Method Men pre‐RP and 24 months post‐RP completed the Erectile Function Domain (EFD) of the International Index of Erectile Function and one question on phosphodiesterase type 5 inhibitor (PDE5i) use. Men using a PDE5i at baseline were excluded. Main Outcome Measures At 24 m, "back to baseline" was defined as achieving the baseline EFD score (within 1 point or higher). Analyses included descriptive statistics, chi‐square, and logistic regression. Results One hundred eighty men had an average age at RP of 59 (SD = 7) years. When including men who were using a PDE5i at 24 months, 43% (N = 78, 95% CI: 36–51%) returned BTB. When considering BTB without the use of a PDE5i, 22% (N = 39, 95% CI: 16% to 28%) returned BTB. When focusing on a subset of men with baseline EFD ≥ 24 (N = 132), 36% (N = 47, 95% CI: 28% to 44%) returned BTB at 24 months using a PDE5i and 16% (N = 21, 95% CI: 11% to 23%) without the use of a PDE5i. For this group, there was a significant difference by age ( P P Conclusions Twenty‐two percent of the entire sample and 16% of the men with Functional (EFD ≥ 24) baseline erections returned to BTB EF without the use of medication. Only 4% of men who were ≥60 years old with Functional erections pre‐surgery achieved BTB EF. Although gaining partial EF is also important, men pre‐RP should be educated on EFR and the chance of "back to baseline" EF.
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defining the impact of vascular risk factors on Erectile Function recovery after radical prostatectomy
BJUI, 2013Co-Authors: Patrick Ely Teloken, Peter T Scardino, Jason Stasi, James A Eastham, Christian J Nelson, Michael Karellas, John P MulhallAbstract:What's known on the subject? and What does the study add? Erectile Function recovery after radical prostatectomy is affected by surgical technique and patient factors. Age and preoperative Erectile Function are the 2 patient factors that have been consistently shown to impact postoperative Erectile Function. The presence of vascular risk factors preoperatively seems to negatively impact Erectile Function recovery after radical prostatectomy independently from age, preoperative Erectile Function and surgical technique. Objective To examine whether vascular risk factors (VRFs) affect Erectile Function (EF) recovery after radical prostatectomy (RP). Patients and Methods From our prospective database we identified patients with clinically localised prostate cancer who had undergone RP and had preoperative information on EF and VRFs (hypertension, hypercholesterolaemia, diabetes mellitus, coronary artery disease [CAD], and cigarette smoking), surgeon-graded nerve-sparing status, and EF data collected between 24 and 30 months after RP. Results In all, 984 patients were included in the analyses. The frequency of the VRFs was as follows: hypertension (38%), hypercholesterolaemia (36%), diabetes mellitus (7%), CAD (5%), and cigarette smoking (37%). On univariate analysis, EF between 24 and 30 months was associated with age (r = 0.37, P 3 VRFs; r = 0.15, P = 0.003). On multivariable analysis all variables remained statistically significant, and accounted for 28% of the total variance in EF between 24 and 30 months after RP. Conclusions The presence of VRFs seems to adversely affect EF recovery after RP independently of other factors. This observation might be useful for improving patient counselling before treatment and to support the development of new treatment strategies for Erectile dysFunction after RP.
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effect of repeated prostate biopsies on Erectile Function in men on active surveillance for prostate cancer
The Journal of Urology, 2012Co-Authors: John P Mulhall, Katharina Braun, Youness Ahallal, Daniel Sjoberg, Tarek Ghoneim, Mario Dominguez Esteban, Andrew J Vickers, James A EasthamAbstract:Purpose: Active surveillance is becoming an increasingly common management strategy for low grade prostate cancer and involves repeat prostate biopsies over time. It has been hypothesized that serial biopsies can lead to reduced Erectile Function in patients on active surveillance and we explored this hypothesis in a longitudinally followed cohort.Materials and Methods: We identified 342 men on active surveillance whose first biopsy occurred between 2000 and 2009. We investigated Erectile Function using patient reported outcomes, namely the 6 Erectile Function questions from the IIEF-6 (International Index of Erectile Function). We estimated the change in Erectile Function with time using locally weighted scatterplot smoothing.Results: The median (IQR) patient age in this cohort was 64 years (58–68). Median followup on active surveillance was 3.5 years (2.3–5.0) and the median number of biopsies was 5 (3–6). During the first 4 years on active surveillance Erectile Function decreased 1.0 point per year (95...
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subjective characterization of nerve sparing predicts recovery of Erectile Function after radical prostatectomy defining the utility of a nerve sparing grading system
The Journal of Sexual Medicine, 2011Co-Authors: Daniel J Moskovic, Farhang Rabbani, Peter T Scardino, James A Eastham, Bertrand Guillonneau, Christian J Nelson, Karim Touijer, Hannah H Alphs, John P MulhallAbstract:ABSTRACT Introduction Radical prostatectomy (RP) is a common technique for managing prostate cancer. Concern regarding Functional outcomes in patients prompted the development of nerve sparing to improve recovery of Erectile Function. Aim To assess if a cumulative nerve damage grading system is a more precise predictor of recovery of Erectile Function as compared to the current “all‐or‐none” grading system. Methods Baseline demographic, medical history, and International Index of Erectile Function (IIEF)‐Erectile Function domain (EFD) scores were collected. At the time of RP, patients were assigned a nerve sparing score (NSS) by their surgeon for each neurovascular bundle (left and right) to assess the quality of intraoperative nerve sparing (1—complete preservation, 4—complete resection). Patients completed IIEF questionnaires at 24 months after RP. Main Outcome Measures Group comparisons and multiple regression analyses were used to test the association between the NSS and IIEF‐EFD scores for patients with preoperative EFD scores ≥24. Results A total of 173 patients were included in this analysis. Mean age for patients was 59, and 62% of patients had at least one comorbidity. Baseline EFD scores were comparable between all NSS assignments. At 24 months, EFD scores were reduced by 7.2, 11.6, 13.9, and 15.4 points for patients with NSS grades of 2, 3, 4, and 5–8, respectively ( P P = 0.001), as did age ( P = 0.001) and baseline EFD score ( P = 0.02). Conclusions Our data support the adoption of a subjectively assigned NSS to more precisely predict Erectile Function outcomes and suggest that even minor nerve trauma significantly impairs the recovery of Erectile Function after procedures classically regarded as having achieved bilateral nerve sparing. Further studies are needed to identify the optimal NSS system. Moskovic DJ, Alphs H, Nelson CJ, Rabbani F, Eastham J, Touijer K, Guillonneau B, Scardino PT, and Mulhall JP. Subjective characterization of nerve sparing predicts recovery of Erectile Function after radical prostatectomy: Defining the utility of a nerve sparing grading system.
Peter T Scardino - One of the best experts on this subject based on the ideXlab platform.
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development of nomograms to predict the recovery of Erectile Function following radical prostatectomy
The Journal of Sexual Medicine, 2019Co-Authors: John P Mulhall, Nelson E. Bennett, Michael W Kattan, Jason Stasi, Bruno Nascimento, James A Eastham, Bertrand Guillonneau, Peter T ScardinoAbstract:Abstract Introduction Given the number of confounders in predicting Erectile Function recovery after radical prostatectomy (RP), a nomogram predicting the chance to be Functional after RP would be useful to patients’ and clinicians’ discussions. Aim To develop preoperative and postoperative nomograms to aid in the prediction of Erectile Function recovery after RP. Main Outcome Measures International Index of Erectile Function (IIEF) Erectile Function domain score-based Erectile Function. Methods A prospective quality-of-life database was used to develop a series of nomograms using multivariable ordinal logistic regression models. Standard preoperative and postoperative factors were included. Main Outcome Measures The nomograms predicted the probability of recovering Functional erections (Erectile Function domain scores ≥24) and severe Erectile dysFunction (≤10) 2 years after RP. Results 3 nomograms have been developed, including a preoperative, an early postoperative, and a 12-month postoperative version. The concordance indexes for all 3 exceeded 0.78, and the calibration was good. Clinical Implications These nomograms may aid clinicians in discussing Erectile Function recovery with patients undergoing RP. Strengths & Limitations Strengths of this study included a large population, validated instrument, nerve-sparing grading, and nomograms that are well calibrated with excellent discrimination ability. Limitations include current absence of external validation and an overall low comorbidity index. Conclusions It is hoped that these nomograms will allow for a more accurate discussion between patients and clinicians regarding Erectile Function recovery after RP. Mulhall JP, Kattan MW, Bennett NE, et al. Development of Nomograms to Predict the Recovery of Erectile Function Following Radical Prostatectomy J Sex Med 2019;16:1796–1802.
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Erectile Function recovery after radical prostatectomy in men with high risk features
The Journal of Urology, 2016Co-Authors: Pedro Recabal, Peter T Scardino, John P Mulhall, Melissa Assel, John E Musser, Ronald J Caras, Daniel D Sjoberg, Jonathan A Coleman, Raul O Parra, Karim TouijerAbstract:Purpose: We describe the efficacy of radical prostatectomy to achieve complete primary tumor excision while preserving Erectile Function in a cohort of patients with high risk features in whom surgical resection was tailored according to clinical staging, biopsy data, preoperative imaging and intraoperative findings.Materials and Methods: In a retrospective review we identified 584 patients with high risk features (prostate specific antigen 20 ng/ml or greater, clinical stage T3 or greater, preoperative Gleason grade 8-10) who underwent radical prostatectomy between 2006 and 2012. The probability of neurovascular bundle preservation was estimated based on preoperative characteristics. Positive surgical margin rates and Erectile Function recovery were determined in patients who had some degree of neurovascular bundle preservation.Results: The neurovascular bundles were resected bilaterally in 69 (12%) and unilaterally in 91 (16%) patients. The remaining patients had some degree of bilateral neurovascular b...
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back to baseline Erectile Function recovery after radical prostatectomy from the patients perspective
The Journal of Sexual Medicine, 2013Co-Authors: Christian J Nelson, Peter T Scardino, James A Eastham, John P MulhallAbstract:Abstract Introduction A variety of Erectile Function recovery (EFR) rates are reported post‐radical prostatectomy (RP), with some suggesting EFR rates over 90% [1]. Clinical experience suggests that patients view EFR as getting back to their baseline (BTB) Erectile Functioning (EF) without the use of medication. Aim This study explores EFR defined as BTB. Method Men pre‐RP and 24 months post‐RP completed the Erectile Function Domain (EFD) of the International Index of Erectile Function and one question on phosphodiesterase type 5 inhibitor (PDE5i) use. Men using a PDE5i at baseline were excluded. Main Outcome Measures At 24 m, "back to baseline" was defined as achieving the baseline EFD score (within 1 point or higher). Analyses included descriptive statistics, chi‐square, and logistic regression. Results One hundred eighty men had an average age at RP of 59 (SD = 7) years. When including men who were using a PDE5i at 24 months, 43% (N = 78, 95% CI: 36–51%) returned BTB. When considering BTB without the use of a PDE5i, 22% (N = 39, 95% CI: 16% to 28%) returned BTB. When focusing on a subset of men with baseline EFD ≥ 24 (N = 132), 36% (N = 47, 95% CI: 28% to 44%) returned BTB at 24 months using a PDE5i and 16% (N = 21, 95% CI: 11% to 23%) without the use of a PDE5i. For this group, there was a significant difference by age ( P P Conclusions Twenty‐two percent of the entire sample and 16% of the men with Functional (EFD ≥ 24) baseline erections returned to BTB EF without the use of medication. Only 4% of men who were ≥60 years old with Functional erections pre‐surgery achieved BTB EF. Although gaining partial EF is also important, men pre‐RP should be educated on EFR and the chance of "back to baseline" EF.
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defining the impact of vascular risk factors on Erectile Function recovery after radical prostatectomy
BJUI, 2013Co-Authors: Patrick Ely Teloken, Peter T Scardino, Jason Stasi, James A Eastham, Christian J Nelson, Michael Karellas, John P MulhallAbstract:What's known on the subject? and What does the study add? Erectile Function recovery after radical prostatectomy is affected by surgical technique and patient factors. Age and preoperative Erectile Function are the 2 patient factors that have been consistently shown to impact postoperative Erectile Function. The presence of vascular risk factors preoperatively seems to negatively impact Erectile Function recovery after radical prostatectomy independently from age, preoperative Erectile Function and surgical technique. Objective To examine whether vascular risk factors (VRFs) affect Erectile Function (EF) recovery after radical prostatectomy (RP). Patients and Methods From our prospective database we identified patients with clinically localised prostate cancer who had undergone RP and had preoperative information on EF and VRFs (hypertension, hypercholesterolaemia, diabetes mellitus, coronary artery disease [CAD], and cigarette smoking), surgeon-graded nerve-sparing status, and EF data collected between 24 and 30 months after RP. Results In all, 984 patients were included in the analyses. The frequency of the VRFs was as follows: hypertension (38%), hypercholesterolaemia (36%), diabetes mellitus (7%), CAD (5%), and cigarette smoking (37%). On univariate analysis, EF between 24 and 30 months was associated with age (r = 0.37, P 3 VRFs; r = 0.15, P = 0.003). On multivariable analysis all variables remained statistically significant, and accounted for 28% of the total variance in EF between 24 and 30 months after RP. Conclusions The presence of VRFs seems to adversely affect EF recovery after RP independently of other factors. This observation might be useful for improving patient counselling before treatment and to support the development of new treatment strategies for Erectile dysFunction after RP.
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measuring Erectile Function after radical prostatectomy comparing a single question with the international index of Erectile Function
BJUI, 2012Co-Authors: Raanan Tal, Farhang Rabbani, Peter T Scardino, John P MulhallAbstract:Study Type – Harm (individual cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Measuring Erectile Function after radical prostatectomy is challenging: While lengthy questionnaires may be more comprehensive and accurate, a single question tool may be more easily administered, for clinical and research purpose. The present study compares the performance of a single question and the widely used International Index of Erectile Function (TIEF) in assessment of post radical prostatectomy Erectile Function. OBJECTIVE • To present a single-question institutional Erectile Function scale, which was developed at Memorial Sloan-Kettering Cancer Center (MSKCC) before the availability of the International Index of Erectile Function (IIEF), and to compare its performance with the IIEF. Erectile Function status assessment after radical prostatectomy is a significant challenge both for research purposes and in clinical practice. Recently, there has been a shift away from complex questionnaire use such as the IIEF and regression to single-item assessment of Erectile Function. PATIENTS AND METHODS • Our Erectile Function score, a single question 5-point score based on physician–patient interview, was applied to 276 patients with prostate cancer after radical prostatectomy. Based on the Erectile Function score, patients were grouped into five groups. The mean IIEF score and the mean score of questions 3 and 4 of the IIEF were calculated and compared across the groups. • Each score group was compared with the preceding group and tested for significant difference. The Erectile Function domain of the IIEF and the institutional score were tested for correlation. RESULTS • The complete Erectile Function domain score from the IIEF was available for 170 patients and scores from questions 3 and 4 were available for 220 patients. The institutional Erectile Function score categorized the subjects into distinct groups based on Erectile Function status. • The institutional Erectile Function score was highly correlated with the IIEF Erectile Function domain score (r=−0.692, P < 0.001) and with the questions 3 and 4 combined score (r=−0.678, P < 0.001). CONCLUSIONS • The MSKCC Erectile Function scale is a practical, readily administered method to assess Erectile Function in patients with prostate cancer after radical prostatectomy. • The Erectile Function score, as determined by this scale, is highly correlated with the IIEF Erectile Function domain score.
Yutian Dai - One of the best experts on this subject based on the ideXlab platform.
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epalrestat an aldose reductase inhibitor restores Erectile Function in streptozocin induced diabetic rats
International Journal of Impotence Research, 2019Co-Authors: Baibing Yang, Zhiwei Hong, Zheng Zhang, Tao Song, Leilei Zhu, Hesong Jiang, Guotao Chen, Y Chen, Yutian DaiAbstract:Epalrestat, an aldose reductase inhibitor (ARI), was adopted to improve the Function of peripheral nerves in diabetic patients. The aim of this study was to investigate whether epalrestat could restore the Erectile Function of diabetic Erectile dysFunction using a rat model. From June 2016, 24 rats were given streptozocin (STZ) to induce the diabetic rat model, and epalrestat was administered to ten diabetic Erectile dysFunction (DED) rats. Intracavernous pressure (ICP) and mean systemic arterial pressure (MAP), levels of aldose reductase (AR), nerve growth factor (NGF), neuronal nitric oxide synthase (nNOS), α-smooth muscle antigen (α-SMA), and von Willebrand factor (vWF) in the corpus cavernosum were analyzed. We discovered that epalrestat acted on cavernous tissue and partly restored Erectile Function. NGF and nNOS levels in the corpora were increased after treatment with epalrestat. We also found that the content of α-SMA-positive smooth muscle cells and vWF-positive endothelial cells in the corpora cavernosum were declined. Accordingly, epalrestat might improve Erectile Function by increasing the upregulation of NGF and nNOS to restore the Function of the dorsal nerve of the penis.
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intracavernous transplantation of bone marrow derived mesenchymal stem cells restores Erectile Function of streptozocin induced diabetic rats
The Journal of Sexual Medicine, 2011Co-Authors: Xuefeng Qiu, Yun Chen, Run Wang, Haocheng Lin, Yajing Wang, Yutian DaiAbstract:Introduction. Erectile dysFunction (ED) is a frequent complication of diabetes mellitus. The efficacy of common ED therapies is low for diabetes-associated ED. Aim. To explore the effects of transplantation of bone marrow-derived mesenchymal stem cells (BM-MSCs) on improving Erectile Function of streptozocin (STZ)-induced diabetic rats. Methods. Male Sprague Dawley rats were injected either with STZ to induce diabetes or with citrate buffer as controls. Rat BM-MSCs were harvested and labeled with CM-DiI (Chloromethylbenzamido derivatives of 1,1'-dioctadecyl- 3,3,3',3'-tetramethylindocarbocyanine perchlorate), and then transplanted into corporal cavernosum of STZ-induced diabetic rats. Four weeks after transplantation, all rats were analyzed for Erectile Function and penile histology. Main Outcome Measures. Erectile Function was evaluated by the ratio between intracavernous pressure (ICP) and mean arterial pressure (MAP) during electrostimulation of cavernous nerve. Fate of transplanted BM-MSCs was identified using immunofluorescence staining. Smooth muscle and endothelium in corpora cavernosum were assessed using immunohistochemistry. Results. After BM-MSCs transplantation, the ICP/MAP ratio was increased significantly compared with diabetic controls. Content of smooth muscle and endothelium in corporal cavernosa of BM-MSCs transplanted rats was significantly increased compared to diabetic controls. Immunofluorescence analysis demonstrated that CM-DiI- labeled BM-MSCs could stay in corporal cavernosa for at least 4 weeks and some of them expressed von Willebrand Factor, CD31, calponin, or a-smooth muscle actin, cells markers for endothelial cells or smooth muscle cells, respectively. Conclusion. Intracavernous transplantation of BM-MSCs had beneficial effects on Erectile Function of diabetic rats and increased the content of endothelium and smooth muscle in corporal cavernosum. Qiu X, Lin H, Wang Y, Yu W, Chen Y, Wang R, and Dai Y. Intracavernous transplantation of bone marrow-derived mesenchymal stem cells restores Erectile Function of streptozocin-induced diabetic rats. J Sex Med 2011;8:427-436.
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effect of caffeine on Erectile Function via up regulating cavernous cyclic guanosine monophosphate in diabetic rats
Journal of Andrology, 2008Co-Authors: Rong Yang, Jiuling Wang, Yun Chen, Zeyu Sun, Run Wang, Yutian DaiAbstract:Erectile dysFunction (ED) is a common complication of diabetes mellitus. Phosphodiesterase-5 (PDE5) inhibitors, which inhibit the breakdown of intracellular cyclic guanosine monophosphate (cGMP), are used to treat diabetic ED. Caffeine, a nonselective PDE inhibitor used in our daily diet, is controversial regarding its effect on Erectile Function. To investigate the effect of caffeine on Erectile Function in diabetic rat models and explore the mechanism, male Sprague-Dawley rats were injected with streptozotocin to induce diabetes mellitus. The rats with blood glucose levels above 300 mg/dL were selected for the study. The rats were divided into 4 groups: group A (normal control rats), group B (diabetic rats treated with normal saline), group C (diabetic rats treated with caffeine, 10 mg/kg per day), and group D (diabetic rats treated with caffeine, 20 mg/kg per day). After 8 weeks of treatment, intracavernous pressure (ICP) was measured to assess Erectile Function. The radioimmunoassay was used to evaluate the level of cGMP in the cavernosum. The ICP and the cavernous cGMP decreased significantly in the diabetic rats compared with normal controls. An 8-week administration of caffeine at the given dosages increased the ICP and cavernous cGMP in diabetic rats. Caffeine consumption improved the Erectile Function of diabetic rats by up-regulating cavernous cGMP.
Jonathan H Lief - One of the best experts on this subject based on the ideXlab platform.
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Erectile Function durability following permanent prostate brachytherapy
International Journal of Radiation Oncology Biology Physics, 2009Co-Authors: Al V Taira, Gregory S Merrick, Wayne M Butler, Kent E Wallner, Robert W Galbreath, Richard L Anderson, Brian S Kurko, Jonathan H LiefAbstract:Purpose To evaluate long-term changes in Erectile Function following prostate brachytherapy. Methods and Materials This study included 226 patients with prostate cancer and preimplant Erectile Function assessed by the International Index of Erectile Function-6 (IIEF-6) who underwent brachytherapy in two prospective randomized trials between February 2001 and January 2003. Median follow-up was 6.4 years. Pre- and postbrachytherapy potency was defined as IIEF-6 ≥ 13 without pharmacologic or mechanical support. The relationship among clinical, treatment, and dosimetric parameters and Erectile Function was examined. Results The 7-year actuarial rate of potency preservation was 55.6% with median postimplant IIEF of 22 in potent patients. Potent patients were statistically younger ( p = 0.014), had a higher preimplant IIEF ( p p = 0.002), and were more likely to report nocturnal erections ( p = 0.008). Potency preservation in men with baseline IIEF scores of 29–30, 24–28, 18–23, and 13–17 were 75.5% vs. 73.6%, 51.7% vs. 44.8%, 48.0% vs. 40.0%, and 23.5% vs. 23.5% in 2004 vs. 2008. In multivariate Cox regression analysis, preimplant IIEF, hypertension, diabetes, prostate size, and brachytherapy dose to proximal penis strongly predicted for potency preservation. Impact of proximal penile dose was most pronounced for men with IIEF of 18–23 and aged 60–69. A significant minority of men who developed postimplant impotence ultimately regained Erectile Function. Conclusion Potency preservation and median IIEF scores following brachytherapy are durable. Thoughtful dose sparing of proximal penile structures and early penile rehabilitation may further improve these results.
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Erectile Function after prostate brachytherapy
The Journal of Urology, 2006Co-Authors: Gregory S Merrick, Wayne M Butler, Kent E Wallner, Robert W Galbreath, Richard L Anderson, Brian S Kurko, Jonathan H Lief, Zachariah AllenAbstract:Purpose: To evaluate Erectile Function after permanent prostate brachytherapy using a validated patientadministered questionnaire and to determine the effect of multiple clinical, treatment, and dosimetric parameters on penile Erectile Function. Methods and Materials: A total of 226 patients with preimplant Erectile Function determined by the International Index of Erectile Function (IIEF) questionnaire underwent permanent prostate brachytherapy in two prospective randomized trials between February 2001 and January 2003 for clinical Stage T1c-T2c (2002 American Joint Committee on Cancer) prostate cancer. Of the 226 patients, 132 were potent before treatment and, of those, 128 (97%) completed and returned the IIEF questionnaire after brachytherapy. The median follow-up was 29.1 months. Potency was defined as an IIEF score of >13. The clinical, treatment, and dosimetric parameters evaluated included patient age; preimplant IIEF score; clinical T stage; pretreatment prostate-specific antigen level; Gleason score; elapsed time after implantation; preimplant nocturnal erections; body mass index; presence of hypertension or diabetes mellitus; tobacco consumption; the volume of the prostate gland receiving 100%, 150%, and 200% of the prescribed dose (V100/150/200); the dose delivered to 90% of the prostate gland (D90); androgen deprivation therapy; supplemental external beam radiotherapy (EBRT); isotope; prostate volume; planning volume; and radiation dose to the proximal penis. Results: The 3-year actuarial rate of potency preservation was 50.5%. For patients who maintained adequate posttreatment Erectile Function, the preimplant IIEF score was 29, and in patients with brachytherapyrelated ED, the preimplant IIEF score was 25. The median time to the onset of ED was 5.4 months. After brachytherapy, the median IIEF score was 20 in potent patients and 3 in impotent patients. On univariate analysis, the preimplant IIEF score, patient age, presence of nocturnal erections, and dose to the proximal penis predicted for postimplant Erectile Function. However, in multivariate analysis, only the preimplant IIEF score and the D50 to the proximal crura were statistically significant predictors of brachytherapyrelated Erectile Function. Conclusions: Using a patient-administered validated quality-of-life instrument, brachytherapy-induced ED occurred in 50% of patients at 3 years. On multivariate analysis, preimplant Erectile Function and the D50 to the proximal crura were the best predictors of brachytherapy-related Erectile Function. Because the proximal penis is the most significant treatment-related predictor of brachytherapy-related ED, techniques to minimize the radiation dose to the proximal penis may result in improved rates of potency preservation. © 2005 Elsevier Inc. Brachytherapy, Erectile Function, Prostate, Proximal penis, Quality of life.
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Erectile Function after prostate brachytherapy
International Journal of Radiation Oncology Biology Physics, 2005Co-Authors: Gregory S Merrick, Wayne M Butler, Kent E Wallner, Robert W Galbreath, Richard L Anderson, Brian S Kurko, Jonathan H Lief, Zachariah AllenAbstract:Purpose: To evaluate Erectile Function after permanent prostate brachytherapy using a validated patient-administered questionnaire and to determine the effect of multiple clinical, treatment, and dosimetric parameters on penile Erectile Function. Methods and materials: A total of 226 patients with preimplant Erectile Function determined by the International Index of Erectile Function (IIEF) questionnaire underwent permanent prostate brachytherapy in two prospective randomized trials between February 2001 and January 2003 for clinical Stage T1c-T2c (2002 American Joint Committee on Cancer) prostate cancer. Of the 226 patients, 132 were potent before treatment and, of those, 128 (97%) completed and returned the IIEF questionnaire after brachytherapy. The median follow-up was 29.1 months. Potency was defined as an IIEF score of ≥13. The clinical, treatment, and dosimetric parameters evaluated included patient age; preimplant IIEF score; clinical T stage; pretreatment prostate-specific antigen level; Gleason score; elapsed time after implantation; preimplant nocturnal erections; body mass index; presence of hypertension or diabetes mellitus; tobacco consumption; the volume of the prostate gland receiving 100%, 150%, and 200% of the prescribed dose (V 100/150/200 ); the dose delivered to 90% of the prostate gland (D 90 ); androgen deprivation therapy; supplemental external beam radiotherapy (EBRT); isotope; prostate volume; planning volume; and radiation dose to the proximal penis. Results: The 3-year actuarial rate of potency preservation was 50.5%. For patients who maintained adequate posttreatment Erectile Function, the preimplant IIEF score was 29, and in patients with brachytherapy-related ED, the preimplant IIEF score was 25. The median time to the onset of ED was 5.4 months. After brachytherapy, the median IIEF score was 20 in potent patients and 3 in impotent patients. On univariate analysis, the preimplant IIEF score, patient age, presence of nocturnal erections, and dose to the proximal penis predicted for postimplant Erectile Function. However, in multivariate analysis, only the preimplant IIEF score and the D 50 to the proximal crura were statistically significant predictors of brachytherapy-related Erectile Function. Conclusions: Using a patient-administered validated quality-of-life instrument, brachytherapy-induced ED occurred in 50% of patients at 3 years. On multivariate analysis, preimplant Erectile Function and the D 50 to the proximal crura were the best predictors of brachytherapy-related Erectile Function. Because the proximal penis is the most significant treatment-related predictor of brachytherapy-related ED, techniques to minimize the radiation dose to the proximal penis may result in improved rates of potency preservation.
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Erectile Function after permanent prostate brachytherapy
International Journal of Radiation Oncology Biology Physics, 2002Co-Authors: Gregory S Merrick, Wayne M Butler, Robert W Galbreath, R L Stipetich, L J Abel, Jonathan H LiefAbstract:Purpose: To determine the incidence of potency preservation after permanent prostate brachytherapy using a validated patient-administered questionnaire and to evaluate the effect of multiple clinical and treatment parameters on penile Erectile Function. Methods and Materials: Four hundred twenty-five patients underwent permanent prostate brachytherapy from April 1995 to October 1999. Two hundred nine patients who were potent before brachytherapy and who at the time of the survey were not receiving hormonal therapy were mailed the specific Erectile questions of the International Index of Erectile Function (IIEF) questionnaire with a self-addressed stamped envelope. The questionnaire consisted of 5 questions, with a maximal score of 25. Of the 209 patients, 181 (87%) completed and returned the questionnaire. The mean and median follow-up was 40.4 14.9 and 40.6 months, respectively (range 19 ‐75). Preimplant Erectile Function was assigned using a three-tiered scoring system (2 erections always or nearly always sufficient for vaginal penetration; 1 erections sufficient for vaginal penetration but considered suboptimal; 0 the inability to obtain erections and/or erections inadequate for vaginal penetration). Postimplant potency was defined as an IIEF score >11. The clinical parameters evaluated for Erectile Function included patient age, preimplant potency, clinical T-stage, pretreatment prostate-specific antigen level, Gleason score, elapsed time after implantation, hypertension, diabetes mellitus, and tobacco consumption. Treatment parameters included radiation dose to the prostate gland, use of hormonal manipulation, use of supplemental external beam radiotherapy (EBRT), choice of isotope, prostate volume, and planning volume. The efficacy of sildenafil citrate in brachytherapy-induced Erectile dysFunction (ED) was also evaluated. Results: Pretreatment Erectile Function scores of 2 and 1 were assigned to 125 and 56 patients, respectively. With a 6-year follow-up, 39% of patients maintained potency after prostate brachytherapy, with a plateau on the potency preservation curve. Postimplant preservation of potency (IIEF >11) correlated with preimplant Erectile Function (50.4% vs. 13.2% for preimplant scores of 2 and 1, respectively, p 70 years old, respectively, p <0.004), use of supplemental EBRT (52.0% vs. 26.4% for patients without and with EBRT, p <0.001), and a history of diabetes mellitus (41.4% vs. 0% for patients without and with diabetes, respectively, p 0.017). In multivariate analysis, clinical stage, radiation dose to the prostate gland, hormonal manipulation, choice of isotope, history of hypertension, and tobacco consumption had no effect on the ultimate preservation of potency. Only the preimplant potency score, use of supplemental EBRT, and diabetes maintained statistical significance. Sixty-two patients used sildenafil, with 53 (85%) reporting a favorable response. When potent patients were grouped with the ED patients who used sildenafil, the 6-year actuarial rate of potency preservation was 92%. Including the 70 impotent patients who never used sildenafil, the actuarial 6-year rate of potency preservation with and without pharmacologic support was 54% and 39%, respectively. Conclusion: Our results suggest that brachytherapy-induced ED is more common than previously reported and may be the result of obtaining patient information by means of a validated quality-of-life instrument by mail and not by personal interview. In multivariate analysis, only pretreatment potency, supplemental EBRT, and diabetes maintained statistical significance. Most patients with brachytherapy-induced ED responded favorably to sildenafil. Although the 6-year actuarial incidence of potency preservation was 39%, 52% of patients not receiving supplemental EBRT maintained potency. In addition, with pharmacologic support, 92% of patients maintained potency. © 2002 Elsevier Science Inc. Prostate, Brachytherapy, Erectile Function, Quality of life.
