Improved patient-reported functional outcomes after nerve-sparing radical prostatectomy by using NeuroSAFE technique

Introduction. According to several studies, an increased body mass index (BMI) may be one of the unfavorable prognostic factors of prostate cancer (PC) associated with lower oncological and functional outcomes of radical prostatectomy (RP).Purpose of the study. To evaluate pathomorphological characteristics, recurrence-free survival, and restoration of erectile function (EF) after RP with nerve-sparing technique (NST) in obese patients.Materials and methods. The study group consisted of 91 patients with BMI ≥ 30 kg/m2 , the control group consisted of 356 patients with BMI < 30 kg/m2 who underwent RP with unilateral or bilateral NST from January 2012 to December 2019. A comparative analysis of pathomorphological results, the rate of complications, recurrence-free survival, and the dynamics of EF restoration in both groups was performed.Results. Obese patients had a larger prostate volume, a higher score for the International Prostate Symptom Score (IPSS) questionnaire. Unilateral and bilateral NST was used in both groups in equal proportions: 50.5% and 49.5% in the group with BMI ≥ 30 and 51.4% and 48.6% in the group with BMI < 30 (p = 0.88 ) There were no significant differences between the groups in the rate of adverse pathomorphological characteristics, serious postoperative complications and the volume of intraoperative blood loss. The five-year recurrence-free survival after RP was 93.1% in the BMI group ≥ 30 and 95.1% in the BMI group < 30 (p = 0.55). The total rate of EF recovery after RP with NST after 24 months was 75% and 78.5% (p = 0.24). The restoration of EF in obese patients was slower: sufficient for sexual intercourse EF after 6 and 12 months was observed in 17.9% and 32.1% versus 35.4% and 53.8% in the group with BMI < 30, and the meantime to recovery was 10.9 (± 1) and 8.6 (± 0.6) months, respectively (p = 0.04).Conclusions. Obesity does not affect the pathomorphological and oncological results of RP with NST. EF recovery in patients with a BMI of ≥ 30 is slowed down, however, 24 months after surgery, the results are comparable with the potency level in patients with a BMI < 30. The data obtained may be of value in counselling and planning surgical intervention in obese patients with PC.

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Low intensity shock wave therapy for erectile dysfunction: 6 months followup results

Urologicheskie vedomosti ◽

10.17816/uroved735-13 ◽

2017 ◽

Vol 7 (3) ◽

pp. 5-13

Author(s):

Igor A Korneyev ◽

Ivan V Telegin ◽

Ivan V Davydov ◽

Artem V Matveev ◽

Dmitrij V Rubanov ◽

...

Keyword(s):

Shock Wave ◽

Erectile Dysfunction ◽

Radical Prostatectomy ◽

Adverse Events ◽

Individual Variability ◽

Nerve Sparing ◽

Shock Wave Therapy ◽

Low Intensity ◽

Extracorporeal Shock Wave ◽

Patient Reported

Introduction. Low intensity extracorporeal shock wave therapy (ESWT) is a novel promising method of treatment for men with erectile dysfunction (ED). The efficacy of ESWT is not clearly determined and need further investigation. Aim of the study: To investigate 6 months followup efficacy and safety results from ESWT trial in patients with ED. Patients and methods. This open-label, longitudinal observational study investigated 6 months followup results in 19 men (mean age = 59.5 years) with organic ED (including 6 (32%) patients with type 2 diabetes mellitus and 6 (32%) patients after nerve-sparing radical prostatectomy) treated with 5-session weekly ESWT protocol using DornierAries delivery system (7500 shock waves, 1500 each session, 4 Hz). Information about adverse events was recorded. Effectiveness was assessed according to the International Index of Erectile Function and Sexual Health Inventory for Men after the 5th ESWT session and also in 1, 3 and 6 months. Results. No patient reported treatment-related adverse events. In 12 (63%), 11 (57%), 11 (57%) and 9 (47%) patients IIEF increased after the 5th ESWT session (also in 2 (33%) men with ED caused by radical prostatectomy), and in 1, 3, 6 months after treatment respectively, so the mean IIEF score in the group has become higher (p = 0.003, p = 0.050, p = 0.022, р > 0.1 respectively) as well as the IIEF general satisfaction domain score (p = 0.006 и p = 0.014, р = 0.011 и p = 0.028, respectively). Mean SHIM score growth was significantly higher after the 5th ESWT session only (р = 0.020), also in patients with diabetic ED (р = 0.041). Individual variability of both IIEF and SHIM scores after treatment was high, with IIEF lower in patients with advanced age (р = 0.015). Conclusions. In 6 months followup ESWT was safe in all and effective in many patients with ED. High individual variability of treatment efficacy needs further evaluation. (For citation: Korneyev IA, Telegin IV, Davydov IV, et al. Low intensity shock wave therapy for erectile dysfunction: 6 months followup results. Urologicheskie vedomosti. 2017;7(3):5-13. doi: 10.17816/uroved735-13).

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