Predictors of corporo-venocclusive dysfunction in men with bilateral nerve-sparing radical prostatectomy

• Published in: Journal of sexual medicine
• Main Authors: Flores, Jose M, Novaes, Luis F, Vertosick, Emily, Salter, Carolyn, Liso, Nicole, Vickers, Andrew J, Mulhall, John P, FECSM
• Format: Journal Article
• Language: English
• Published: 11.11.2024
• ISSN: 1743-6095; 1743-6109
• DOI: 10.1093/jsxmed/qdae157

Abstract Background Erectile dysfunction (ED) is seen in some men who have undergone bilateral nerve-sparing surgery. Corporo-venocclusive dysfunction (CVOD) is the major pathway to permanent ED after radical prostatectomy (RP). Aim To identify comorbidity factors that are associated with the presence of CVOD in men who had undergone bilateral nerve-sparing RP. Methods We included patients who had no ED before RP, underwent bilateral nerve-sparing RP, were unresponsive to pharmacotherapy, and had a penile Duplex Doppler Ultrasound (PDDU) with a diagnosis of CVOD. PDDU was performed with a redosing vasoactive agent protocol. A logistic regression model was created to define predictors of CVOD, defined as end-diastolic velocity (EDV) ≥ 5 cm/s bilaterally. Outcomes CVOD diagnosis. Results 135 patients with a median age of 60 (IQR 54, 64) years were included. 45% reported ≥2 comorbidities, 10% diabetes, 28% obstructive sleep apnea (OSA), and 44% were current or former smokers. At PDDU, 34% had less than penetration hardness erections, and 43% received 100 units of vasoactive agent. 44% were diagnosed with CVOD. Increased age at RP (OR 2.12 per 10 years, 95% CI 2.35, 3.73, P = .007) and OSA (OR 2.44, 95% CI 1.07, 5.73, P = .036) were associated with a diagnosis of CVOD. Clinical implications Comorbidities, especially OSA, have a role in erection recovery after surgery. Strengths and limitations The study used a well-established institutional RP nerve-sparing score, a strict PDDU vasoactive agent redosing protocol, validated cut-offs for CVOD diagnosis, and a validated erectile function questionnaire both pre- and post-operatively. The major limitation is that this is a cohort of men seeking treatment at a sexual medicine clinic for post-operative ED, which limits the generalizability of the results to patients without ED symptoms or who decided not to seek treatment. The dichotomous definition of comorbidities is also a limitation since patients can have differing degrees of comorbidities’ severity. Conclusion Older patients and the presence of OSA were associated with the presence of CVOD.