Pain associated with prostaglandin E
PGE1
intracavernosal injection
pain
radical prostatectomy
Journal
Andrology
ISSN: 2047-2927
Titre abrégé: Andrology
Pays: England
ID NLM: 101585129
Informations de publication
Date de publication:
26 Oct 2024
26 Oct 2024
Historique:
revised:
08
09
2024
received:
11
05
2024
accepted:
08
10
2024
medline:
27
10
2024
pubmed:
27
10
2024
entrez:
27
10
2024
Statut:
aheadofprint
Résumé
Intracavernosal injection therapy is often used as second-line therapy for erectile dysfunction associated with radical prostatectomy when therapy with phosphodiesterase-5 inhibitors has failed, but prostaglandin E1-containing vasoactive agents are associated with penile pain in some men. To define the incidence of pain with prostaglandin E1-containing intracavernosal injection mixtures for erectile dysfunction associated with radical prostatectomy when therapy with phosphodiesterase-5 inhibitors has failed, and whether pain was a predictor of erectile function recovery. Men who underwent radical prostatectomy and were commenced on intracavernosal injection within 12 months of radical prostatectomy were included. A pain visual analog scale (0-10) was used to assess the degree of pain. Erectile function recovery was defined as the International Index of Erectile Function domain score ≥24 using phosphodiesterase-5 inhibitors at 24 months. The study included 566 patients, mean age was 58 ± 14 (42-74) years. Duration post-radical prostatectomy at intracavernosal injection training was 3.5 ± 3.5 m. Nerve sparing status: bilateral 76%, unilateral 13%, and non-nerve sparing 11%. Incidence of pain with intracavernosal injection per nerve sparing status: bilateral 10% of patients, unilateral 32%, non-nerve sparing 92% (p < 0.001). Median visual analog scale in those experiencing pain: bilateral 4 (interquartile range 3, 5), unilateral 5.5 (interquartile range 3, 6), non-nerve sparing 7 (interquartile range 3, 9) (p < 0.001). Phosphodiesterase-5 inhibitors success at 24 months (no pain vs. pain): bilateral 70% vs. 40% (p < 0.001), unilateral 50% vs. 28% (p < 0.001), non-nerve sparing 10% vs. 0% (p < 0.001). On multivariate analysis, predictors of failure to respond to phosphodiesterase-5 inhibitors at 24 months post-radical prostatectomy included baseline erectile function, increasing age, incomplete nerve-sparing surgery, and presence of pain. The presence of penile pain with intracavernosal injection is associated with poorer erectile function recovery post-radical prostatectomy. Incidence of pain is high in men with non-nerve sparing radical prostatectomy; older patient age, poorer nerve sparing, poor baseline erectile function, and the presence of penile pain with prostaglandin E1-containing intracavernosal injection medication, were predictive of poor erectile function recovery using phosphodiesterase-5 inhibitors at 24 months.
Sections du résumé
BACKGROUND
BACKGROUND
Intracavernosal injection therapy is often used as second-line therapy for erectile dysfunction associated with radical prostatectomy when therapy with phosphodiesterase-5 inhibitors has failed, but prostaglandin E1-containing vasoactive agents are associated with penile pain in some men.
OBJECTIVES
OBJECTIVE
To define the incidence of pain with prostaglandin E1-containing intracavernosal injection mixtures for erectile dysfunction associated with radical prostatectomy when therapy with phosphodiesterase-5 inhibitors has failed, and whether pain was a predictor of erectile function recovery.
MATERIALS AND METHODS
METHODS
Men who underwent radical prostatectomy and were commenced on intracavernosal injection within 12 months of radical prostatectomy were included. A pain visual analog scale (0-10) was used to assess the degree of pain. Erectile function recovery was defined as the International Index of Erectile Function domain score ≥24 using phosphodiesterase-5 inhibitors at 24 months.
RESULTS
RESULTS
The study included 566 patients, mean age was 58 ± 14 (42-74) years. Duration post-radical prostatectomy at intracavernosal injection training was 3.5 ± 3.5 m. Nerve sparing status: bilateral 76%, unilateral 13%, and non-nerve sparing 11%. Incidence of pain with intracavernosal injection per nerve sparing status: bilateral 10% of patients, unilateral 32%, non-nerve sparing 92% (p < 0.001). Median visual analog scale in those experiencing pain: bilateral 4 (interquartile range 3, 5), unilateral 5.5 (interquartile range 3, 6), non-nerve sparing 7 (interquartile range 3, 9) (p < 0.001). Phosphodiesterase-5 inhibitors success at 24 months (no pain vs. pain): bilateral 70% vs. 40% (p < 0.001), unilateral 50% vs. 28% (p < 0.001), non-nerve sparing 10% vs. 0% (p < 0.001). On multivariate analysis, predictors of failure to respond to phosphodiesterase-5 inhibitors at 24 months post-radical prostatectomy included baseline erectile function, increasing age, incomplete nerve-sparing surgery, and presence of pain.
DISCUSSION
CONCLUSIONS
The presence of penile pain with intracavernosal injection is associated with poorer erectile function recovery post-radical prostatectomy.
CONCLUSIONS
CONCLUSIONS
Incidence of pain is high in men with non-nerve sparing radical prostatectomy; older patient age, poorer nerve sparing, poor baseline erectile function, and the presence of penile pain with prostaglandin E1-containing intracavernosal injection medication, were predictive of poor erectile function recovery using phosphodiesterase-5 inhibitors at 24 months.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : National Institutes of Health/National Cancer Institute (NIH/NCI) with a Cancer Center Support Grant to Memorial Sloan Kettering Cancer Center
ID : P30-CA008748
Organisme : a SPORE grant in Prostate Cancer to Dr. H. Scher
ID : P50-CA92629
Organisme : Patient-Centered Outcomes Research Institute
ID : ME-2018C2-13253
Pays : United States
Organisme : the Sidney Kimmel Center for Prostate and Urologic Cancers, and David H. Koch through the Prostate Cancer Foundation
Informations de copyright
© 2024 American Society of Andrology and European Academy of Andrology.
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