Quantitative and qualitative assessment of erectile dysfunction in men after surgical interventional treatment of BPH
Article published in Urologia Polska 2007/60/4.

authors

Tomasz Jakubczyk, Piotr Kryst, Krzysztof Pych, Bartosz Dybowski, Albert Gugała, Grzegorz Madej, Ryszard Hanecki, Andrzej Borkowski: Katedra i Klinika Urologii Akademii Medycznej w Warszawie

keywords

BPH, erectile dysfunction, nocturnal penile tumescence and rigidity monitoring

summary

Introduction and the aim of the study. Onset or intensification of erectile dysfunction (ED) is thought to be one of potential complications of surgical management of benign prostatic hyperplasia (BPH). However exact mechanisms of its development remain unknown. The aim of the study was to assess the frequency of the onset/intensification of ED after surgical treatment of BPH and to define its etiology.

Material and methods. Quality of erections of patients scheduled for TransUrethral Resection of Prostate (TURP) or open prostatectomy (OP) were assessed subjectively by IIEF questionnaire and objectively by Nocturnal Penile Tumescence and Rigidity (NPTR) monitoring before the treatment as well as 3, 6, 12, 18 and 24 months after the procedure. The etiology of onset/intensification of ED subjectively reported by patients was recognized as psychogenic if standard parameters of NPTR monitoring were not worse than initially. In case of their decrease ED was considered organic, and such patients were further evaluated by Doppler examination after intracavernosal injection of alprostadil. The etiology of organic ED was subsequently subdivided into neurogenic, arteriogenic or insufficiency of veno-occlusive mechanism.

Results. Fifty one patients entered the study. Twelve of them withdrew their consent without any further evaluation, 5 were excluded because of indications for additional treatment due to persisting symptoms or prostate cancer found in the specimen. In the remaining group no differences were found between mean values of erectile domain of IIEF, number of erections and parameters of NPTR monitoring before and after the treatment. ED of various degree was observed by 47.7% patients before and 58.8% after the procedure. Significant change in quality of erections was observed by 11 out of 34 men – its decrease in 7 and increase in 4. Onset/intensification of ED was considered psychogenic in 4 out of 7 patients, whereas organic – which occurred only in TURP group – in 3 patients. Significant decrease in erectile functions were observed by 25% of patients after OP, and 19.2% after TURP. Mean follow-up was 10,7 months.

Conclusions. Nearly half of patients scheduled for surgical treatment of BPH observed ED of various degree prior to the procedure. No significant differences were found between mean values of subjective and objective parameters of erectile function before and after the treatment, however nearly 1/3 observed its significant change after the procedure. Etiology of onset/intensification of ED after the treatment was considered psychogenic in over a half of the patients.

references

De la Rosette J, Alivizatos G, Madersbacher S et al: Guidelines of Benign Prostatic Hyperplasia. Edition 2006.
Miner M, Rosenberg MT, Perelman MA: Treatment of lower urinary tract symptoms in benign prostatic hyperplasia and its impact on sexual function.
Clin Ther 2006, 28 (1):13-25.
Broderick GA, Foreman MM: Iatrogenic erectile dysfunction: pharmacological
and surgical therapies that alter male sexual behaviour and erectile performance. Rozdział w: Textbook of Erectile Dysfunction. Ed. Carson C, Kirby R, Goldstein I. Isis Medical Media, Oxford 1999, 149-168.
Larson TR: Current treatment optons for benign prostatic hyperplasia and their impact on sexual function. Urol 2003, 61, 692-698.
Kinn AC, Helmy-Dhejne C, Larsson J: Sexual function one year after transurethral prostatic resection. Patients’ own assessments. Scand J Urol Nephrol 1998, 32 (1), 33-35.
Bieri S, Iselin CE, Rohner S: Capsular perforation localisation and adenoma size as prognostic indicators of erectile dysfunction after transurethral prostatectomy. Scand J Urol Nephrol 1997, 31 (6), 545-548.
Lefaucheur JP, Yiou R, Salomon L et al: Assessment of penile small nerve fiber damage after transurethral resection of the prostate by measurement
of penile thermal sensation. Urol 2000, 164 (4), 1416-1419.
Poulakis V, Ferakis N, Witzsch R et al: Erectile dysfunction after transurethral
prostatectomy for lower urinary tract symptoms: results from a center with over 500 patients. Asian J Androl 2006, 8 (1), 69-74.
De Giorgi G, Luciani LG, Valotto C et al: Role of risk factors for erectile dysfunction in patients undergoing transurethral resection of the prostate:
early impact on sexual function. Arch Ital Urol Androl 2005, 77 (3),143-145.
Lindner A, Golomb J, Korzcak D et al: Effects of prostatectomy on sexual function. Urology 1991, 38 (1): 26-28.
Tscholl R, Largo M, Poppinghaus E et al: Incidence of erectile impotence secondary to transurethral resection of benign prostatic hyperplasia, assessed by preoperative and postoperative Snap Gauge tests. J Urol 1995, 153 (5), 1491-1493.
Taher A: Erectile dysfunction after transurethral resection of the prostate: incidence and risk factors. World J Urol 2004, 22 (6), 457-460.
Słojewski M, Grabowski M, Sikorski A: Pomiar nocnych wzwodów członka przy użyciu aparatu Rigiscan. Wiad Lek 1997, 50 (1-3), 55-58.
Basar MM, Atan A, Tekdogan UY: New concept parameters of Rigiscan i differentiation of vascular erectile dysfunction: is it a useful test? Int J Urol 2001, 8 (12), 686-691.
Levine LA: Nocturnal penile tumescence and rigidity monitoring for the evaluation ef erectile dysfunction. Rozdział w: Textbook of Erectile Dysfunction. Ed. Carson C, Kirby R, Goldstein I. Isis Medical Media, Oxford 1999: 267-277.
Broderick GA: Evidence based assessment of erectile dysfunction. Int J Impot Res 1998, 10 supp. 2, S64-73.
Brookes ST, Donovan JL, Peters TJ et al: Sexual dysfunction in men after treatment for lower urinary tract symptoms: evidence from randomised controlled trial. BMJ 2002, 324, 1059.
Gacci M, Bartoletti R, Figlioli S et al: Urinary symptoms, quality of life and sexual function in patients with benign prostatic hypertrophy before and after prostatectomy: a prospective study. BJU Int 2003, 91, 196-200.
McMahon CG, Touma K: Predictive value of patients history and correlation of nocturnal penile tumescence, colour duplex Doppler ultrasonography and dynamic cavernosometry and cavernosography in the evaluation of erectile dysfunction. Int J Impot Res 1999, 11 (1), 47-51.
Soderdahl DW, Knight RW, Hansberry KL: Erectile dysfunction following transurethral resection of the prostate. J Urol 1996, 156 (4), 1354-1356.
Uygur MC, Gur E, Arik AI et al: Erectile dysfunction following treatments of benign prostatic hyperplasia: a prospective study. Andrologia 1998, 30, 5-10.
Karadeniz T, Topsakal M, Aydogmus A, Beksan M: Role of RigiScan in the etiologic differential diagnosis of erectile dysfunction. Urol Int 1997, 59 (1), 41-45.
Yang CC, Porter MP, Penson DF: Comparison of the International Index of Erectile Function erectile domain scores and nocturnal penile tumescence and rigidity measurements: does one predict the other? BJU Int 2006, 98, 105-109.
Udelson D, Park K, Sadeghi-Nejad H et al: Axial penile buckling forces vs Rigiscan radial rigidity as a functrion of intracavernosal pressure: why Rigiscan does not predict functiona erections in individual patients. Int J Impot Res 1999, 11 (6), 327-337.
Melman A, Fogarty J, Hafron J: Can self-administered questionnaires supplant
objective testing of erectile function? A comparison between the International Index of Erectile Function and objective studies. Int J Impot Res 2006, 18 (2),126-129.
Yaman O et al: Comparison of international index of erectile function with nocturnal penile tumescence and rigidity testing in evaluation of erectile dysfunction. Int J Impot Res 2006, 18 (2): 186-189.
Tokatli Z, Akand M, Yaman O et al: Comparison of international index of erectile function with nocturnal penile tumescence and rigidity testing in evaluation of erectile dysfunction. Int J Impot Res 2006, 18 (2), 186-189.

correspondence