PENILE LOW-INTENSITY EXTRACORPOREAL SHOCKWAVE THERAPY OR PHOSPHODIESTERASE TYPE-5 INHIBITORS IN THE TREATMENT OF POSTPROSTATECTOMY ERECTILE DYSFUNCTION
Stoykov B.A. 1 , Kolev N.H. 1 , Genov P. 1 , Dunev V.R. 1 , Vanov A. 1 , Atanasov J.A. 1 , Koleva M.I. 2
1Medical University Hospital, Dept. of Urology, Pleven, Bulgaria, 2Clinic Physiomed, Dept. of Physiotherapy, Pleven, Bulgaria
Introduction & Objectives: The experience gained in recent years with low-intensity extracorporeal shock wave therapy (LI-ESWT) demonstrates its safety, efficacy and good tolerance in the treatment of erectile dysfunction (ED). The aim of our study was to compare LI-ESWT with phosphodiesterase type-5 inhibitors (PDE5I) in terms of their efficacy and safety in patients with bilateral nerve-sparing radical retropubic prostatectomy (BNSRRP).
Materials & Methods: For the period from May 2015 to January 2017, 53 BNSRRP were committed. The patients were divided into 2 groups and in both groups treatment started immediately after the catheter was removed and lasted for 9 weeks. In group 1, 27 patients were included with 2 sessions LI-ESWT per week for 3 weeks. They were followed by 3 weeks without therapy, then repeated 2 sessions LI-ESWT per week for another three weeks. Group 2 included 26 patients, all of them received 25 mg of sildenafil citrate every evening. Patients were evaluated before surgery and at third and sixth month after the treatment. The effect of therapy was reported with the international index of erectile function (IIEF)-erectile function (EF) domain and the erection hardness score (EHS).
Results: 81.35% of the participants were between age of 60 and 67 years old. The mean age was 64 years old. In group 1, the mean IIEF-EF domain prior to surgery was 27 points and group 2 - 26 points. At third months post-treatment in group 1 - 16 (59%) of patients had normal EF (IIEF-EF domain ≥26 and EHS ≥3), 7 (26%) had improvement in IIEF score but still have mild to moderate ED (IIEF-EF domain 11-25 and EHS ≤ 2), and 4 (15%) had no response to treatment. In group 2 at the third month, 17 (65%) of patients had normal EF, 6 (23%) had improvement in IIEF and 3 (12%) had no response to treatment (p < 0.05). Six months after the therapy in group 1-19 (70%) of patients were with normal EF, 5 (19%) had improvement in IIEF score but still have mild to moderate ED, and 3 (11%) had no response to treatment. In group 2 at the sixth month, 19 (73%) of patients had normal EF, 4 (15%) had improvement in IIEF and 3 (12%) had no response to treatment (p < 0.05).
Conclusions: There was no statistically significant difference between the two groups of patients at the third and sixth months after initiation of treatment, both in the percentage of patients restoring their EF and in patients who experienced improvement or lack of treatment effect. These initial results indicate that LI-ESWT is as effective and safe as PDE5I after BNSRRP.
Eur Urol Suppl 2017; 16(11);e2919
Stoykov B.A. 1 , Kolev N.H. 1 , Genov P. 1 , Dunev V.R. 1 , Kotsev R.P. 1 , Tonchev P.T. 2 , Vanov A. 1 , Atanasov J.A. 1
1Medical University Hospital, Dept. of Urology, Pleven, Bulgaria, 2Medical University Hospital, Dept. of Surgery, Pleven, Bulgaria
Introduction & Objectives: Erectile dysfunction occurs in 25-75% of men undergoing radical retropubic prostatectomy (RRP). This study aims to assess by erectile function (EF) and overall satisfaction domains of the international index of erectile function (IIEF), how EF influences the overall satisfaction (OS) in patients 12 months after RRP.
Materials & Methods: For the period from January 2013 to June 2016 in the Urology Clinic of the University Hospital "Dr. Georgi Stranski" - Pleven, 176 patients were operated with RRP. All patients answered the following questions: 1. Over the past 4 weeks, how often were you able to get an erection during sexual activity? 2. Over the past 4 weeks, when you had erections with sexual stimulation, how often were your erections hard enough for penetration? 3. Over the past 4 weeks, when you attempted sexual intercourse, how often were you able to penetrate (enter) your partner? 4. Over the past 4 weeks, during sexual intercourse, how often were you able to maintain your erection after you had penetrated your partner? 5. Over the past 4 weeks, during sexual intercourse, how difficult was it to maintain your erection to completion of intercourse? 13. Over the past 4 weeks, how satisfied have you been with you overall sex life? 14. Over the past 4 weeks, how satisfied have you been with your sexual relationship with your partner? 15. Over the past 4 weeks, how do you rate your confidence that you can get and keep your erection? Patients were considered to have a normal EF when IIEF-EF domain ≥26 points. Questions 13 and 14 concerned OS. According to the IIEF, OS is normal when IIEF-OS domain ≥9 points. The patients responded of these eight questions preoperatively and 12 months after surgery.
Results: Mean age of patients was 62.6 (±6.0) years. A total of 159 (90.3%) and 140 (79.5%) patients returned questionnaire pre- and postoperatively respectively. Questions 1,2,3,4,5,13,14 and 15 were answered by 135 (76.7%). Mean EF score pre- and postoperatively was 27.8 (± 1.2) and 10.2 (±1.1) respectively (p=0). A total of 102 (75.6%) of answered patients were potent preoperatively. A total of 19 (14.1%) of them were potent postoperatively (p < 0.00001). A total of 114 (84.4%) of answered patients were with OS (9-10 points) preoperatively. A total of 34 (25.2%) of them were with OS (9-10 points) postoperatively (p < 0.001).
Conclusions: Even though there is a severe reduction in erectile function 12 months postoperatively, the reduction in overall satisfaction is not so pronounced. This is important preoperative information to communicate to patients.
Eur Urol Suppl 2017; 16(11);e2918
BASIC SEXUAL FUNCTION OF PATIENTS CANDIDATES FOR BILATERAL NERVE-SPARING RADICAL RETROPUBIC PROSTATECTOMY
Stoykov B.A. , Kolev N.H. , Genov P. , Dunev V.R. , Kotsev R.P. , Vanov A. , Atanasov J.A. , Al-Shargabi F.
Medical University Hospital, Dept. of Urology, Pleven, Bulgaria
Introduction & Objectives: Necessity of preoperative evaluation of the sexual function in patients undergoing bilateral nerve sparing radical retropubic prostatectomy (BNSRRP) is bеing more emphasized because of the fact that in the last few years prostate cancer is more frequently diagnosed in young patients. The aim of our study is to make objective evaluation of the basic sexual function in patients with clinically localized prostate cancer which are candidates for BNSRRP, using internationally validated questionnaires. To find correlation on one hand between these questionnaires and the individual judgement of candidates and on the other hand between comorbidities of the patients and degree of erectile dysfunction (ED).
Materials & Methods: From the period January 2014 to March 2017 at the Urology clinic at "Dr.Georgi Stranski" university Hospital - Pleven, 64 patients opted BNSRRP and reported to have preserved erectile function (EF) and wish to maintain it post surgery. The inclusion criteria in the study were patients in stage T1c, Gleason score 6, life expectancy over 10 years and normal preoperative sexual function. The patient history and comorbidities were noted on the day of hospitalization. The subjective assessment of the patient's potency is compared with International Index of Erectile Function (IIEF).
Results: According to the EF domain of the IIEF, baseline normal EF was assessed in 28 patient (44%). Twelve patients (18.8%) had mild ED, 9 patients (14.1%) had mild to moderate ED, 7 patients (10.9%) had moderate and 8 (12.5%) had severe ED. The results showed that a significant number of patients with clinically localized prostate cancer who were candidates for BNSRRP reported to be fully potent but actually had impaired EF preoperatively. There is also a pronounced correlation between concomitant diseases and EF.
Conclusions: Using the IIEF, we found that less than half of all subjects selected for bilateral nerve sparing radical retropubic prostatectomy have preserve sexual function preoperatively. This indicates that the majority of patients had impaired EF before surgery. This requires wider use of internationally validated questionnaires for a more accurate prognosis of postoperative sexual function. Last but not least, the results from these questionnaires may require a change in the operative technique and the treatment method used.
Eur Urol Suppl 2017; 16(11);e2917
DISCONTINUATION RATE OF DAPOXETINE IN PATIENTS WITH LIFELONG PREMATURE EJACULATION: 1-YEAR OBSERVATIONAL STUDY
Genov P. 1 , Kolev N. 2 , Dunev V. 2 , Stoykov B. 2 , Vanov A. 2 , Atanasov J. 2
1MHAT Ruse, Dept. of Urology, Ruse, Bulgaria, 2UMHAT "Georgi Stranski", Dept. of Urology, Pleven, Bulgaria
Introduction & Objectives: Premature ejaculation is the most common sexual dysfunction in men, however it is not well understood. Although Dapoxetine is the only oral pharmacological agent approved for the treatment of premature ejaculation, which is considered a "gold standard" and a first choice agent with high efficacy, the incidence of discontinuation of treatment with it is very high. Our aim was to investigate the discontinuation rate of Dapoxetine in patients with premature ejaculation and the reasons for stopping treatment in real practice.
Materials & Methods: 78 patients with lifelong premature ejaculation were included in the study by taking 30 or 60 mg Dapoxetine as needed. and were followed for 1 year. The mean age of the patients was 29 (18-46) years. Patient visits to clinics were at 3, 6 and 12 months. The patients discontinuation rates from treatment and the reasons for this were assessed.
Results: Of all patients, only 18.5% continue treatment for the entire 1-year period. The cumulative treatment discontinuation rates at 3, 6 and 12 months were respectively 34.1%, 69.6% and 81.5% . It is noteworthy that 69.6% of patients stop their treatment in the first 6 months. The reasons for discontinuation of treatment that patients refers are: 19.5% high costs, 38.1% disappointment that premature ejaculation is an incurable disease and that Dapoxetine is needed to be taken every time sexual intercourse is contemplated, 12.3% due to undesirable medication effects, 20.3% due to dissatisfaction with the treatment effect and 9.8% due to the search for other treatment options.
Conclusions: The rate of discontinuation of Dapoxetine treatment is very high. The main reasons for the discontinuation are the high costs and the disappointment that it has always been necessary to take the medicine when planning sexual intercourse, which that does not allow patients to be spontaneous. In the future, alternative methods of treatment should be sought in patients with lifelong premature ejaculation.
Eur Urol Suppl 2017; 16(11);e2830
Genov P. 1 , Kolev N. 2 , Dunev V. 2 , Stoykov B. 2 , Vanov A. 2 , Atanasov J.2
1MHAT Ruse, Dept. of Urology, Ruse, Bulgaria, 2UMHAT , Dept. of Urology, Pleven, Bulgaria
Introduction & Objectives: Although premature ejaculation (PE) is a common male sexual dysfunction, it is poorly understood. Men with PE report low satisfaction with their sexual relationship, low satisfaction with sexual intercourse, difficulty relaxing during intercourse, and less frequent intercourse. However, the negative impact of PE extends beyond sexual dysfunction. PE can have a detrimental effect on self-confidence and the relationship with the partner, and may sometimes cause mental distress, anxiety, embarrassment and depression. Our aim was to investigate the quality of sexual life in men with lifelong PE treated with dapoxetine, using the Brief Male Sexual Functional Inventory (BMSFI).
Materials & Methods: Between September 2014 and March 2016 we include 52 patients with lifelong premature ejaculation taking 30 or 60 mg dapoxetine as needed, which were followed for 1 year. The BMSFI questionnaire was completed at the beginning of the treatment, on the 3-rd, 6-th and 12-th months.
Results: 24 points was the mean result in patients before treatment from BMSFI indicating significant worsening of sexual function and quality of life in all five questionnaire domains. At the third month timepoint, the score rises to 32 points, indicating high patient satisfaction shortly after the onset of treatment. The sixth and twelve months of onset of treatment maintained a steady tendency to increase the score, respectively 37 and 40 points. The results in the domain of ejaculation have changed and increased most rapidly and clearly, but they also increased the results in all other domains, showing a higher end-to-date satisfaction of patients from their sexual life.
Conclusions: Premature ejaculation worsens the overall sexual function and quality of life of patients and leads to problems in controlling ejaculation. Improving control and lengthening ejaculation time by using dapoxetine leads to higher overall patient satisfaction in all aspects of sexual function and life.
Eur Urol Suppl 2017; 16(11);e2829