Quantitative and qualitative assessment of erectile dysfunction in men after surgical interventional treatment of BPH
Article published in Urologia Polska 2007/60/4.
Tomasz Jakubczyk, Piotr Kryst, Krzysztof Pych, Bartosz Dybowski, Albert Gugała, Grzegorz Madej, Ryszard Hanecki, Andrzej Borkowski
- Katedra i Klinika Urologii Akademii Medycznej w Warszawie
BPH, erectile dysfunction, nocturnal penile tumescence and rigidity monitoring
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.
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