MUA Abstracts

Erectile Dysfunction Following Minimally Invasive Treatments For Prostate Cancer.

Chaikin DC, Broderick GA, Malloy TR, Malkowicz SB, Whittington R, Wein,AJ Division of Urology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA. Urology 1996 Jul;48(1):100-4

Objectives
Cryosurgical ablation of the prostate (CSAP) and interstitial radiotherapy (IR) are relatively new procedures intended to be less invasive than radical prostatectomy for the treatment of prostate cancer. Despite absence of long-term or intermediate data of efficacy, many patients choose one of these therapies because they presume their potency will be maintained. We report our experience with CSAP, IR, and post-procedure erectile dysfunction.

Methods
Global sexual assessments were made in 12 months after therapy in 28 CSAP patients, and at 18months in 37 IR patients. Each patient was contacted by telephone following his procedure. The patients were asked several questions regarding their sexual function both preoperatively and postoperatively. The questionnaire was administered only to the patient.

Results
Twenty-eight of 36 patients who underwent CSAP responded to the questionnaire (78%). Twenty patients were potent preoperatively (71%). The mean age of the potent group was 69 years (range 54 to 82). Following therapy, 2 of these patients (10%) reported potency at 12 months. Thirty-seven of 42 patients whounderwent IR responded to the questionnaire (88%). Twenty-seven were potent preoperatively (73%). The mean age of the potent group was 70 years (range 56 to 83). The mean follow-up was 18 months (range 5 to 36). Following therapy, 15 patients reported potency (55%). All of the patients who reported potency felt that the quality of their erections had decreased following radiation.

Conclusions
Our short-term results with IR and CSAP suggest a significant adverse effect on erectile function. Our results suggest that enhanced preservation of potency should not be used as an enticement in the promotion of IR or CSAP.

Radical Prostatectomy in Patients with Indwelling Inflatable Penile Prosthesis.

Schanne FJ, Carpiniello V, Chaikin D. Department of Urology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA. Urology 1998 Oct;52(4):715-6

Patients with impotence who have undergone placement of an inflatable penile prosthesis (IPP) and then subsequently are diagnosed with carcinoma of the prostate (CaP) present a surgical dilemma. We performed radical retropubic prostatectomy on 3 patients with clinically localized CaP and an indwelling IPP. At laparotomy all 3 patients had the IPP reservoir relocated to facilitate dissection. In each case the reservoir was relocated to the left hypogastrium within the extraperitoneal space without disrupting the vacuum tubing system. There were no complications related to IPP, no IPP was injured, and each IPP was reactivated successfully 6 weeks after surgery.