Less than half of men who initiate intracorporeal injections (ICI) for post-prostatectomy erectile dysfunction (PPED) are still satisfied with the treatment years later, report researchers.
Although the treatment is effective, the most common reasons for discontinuing the treatment in a study conducted by Herbert Lepor (New York University School of Medicine, USA) and team were dislike of injecting into the penis and pain associated with the injections.
Previous studies have assessed experience with ICI in men with PPED, but none of these have reported outcomes beyond a mean of 4 years, says the team. In addition, none have examined preoperative factors associated with the characteristics of those men undergoing radical prostatectomy who choose to try ICI.
"To our knowledge, our report represents the longest follow up experience with ICI, independent of the etiology of ED," write Leport et al in the Journal of Urology.
Their 8-year follow-up study included 140 men who tried ICI after radical retropubic prostatectomy for localized prostate cancer. Of the 135 men who completed a satisfaction survey, 10% reported they were very satisfied, 34% that they were satisfied, 35% unsatisfied, and 21% very unsatisfied.
Reasons for discontinuing ICI (reported by 102 men) were a dislike of administering the injections (47%), an aversion to the pain associated with the injections (33%), regain of adequate erection (19%), not having a sexual partner (6%), and other reasons (3%).
Overall, only 24% of the men exposed to ICI were still using the treatment at 8 years.
Further analysis showed that men who tried ICI had significantly greater preoperative sexual function scores (as assessed by the UCLA prostate cancer index) than those who did not initiate the treatment, at a mean of 75.2 compared with 65.6, respectively.
"Men with better baseline erections may be more inclined to try a more invasive therapy such as ICI, especially early in the postoperative course," say Leport and team.
Compared with nonusers of ICI, users also had greater declines in sexual function scores from baseline to 3 months and from baseline to 2 years, at means of ‑53.5 versus ‑44.5 and ‑33.9 versus ‑26.1, respectively. This suggests that the magnitude of the early and more permanent loss of erectile function attributable to radical prostatectomy is another factor that drives the use of ICI, say the researchers.
Although many men discontinue ICI treatment, the fact that 44% of the men who did continue with the therapy were still satisfied 8 years later suggests durability of the initial favorable response. This durability probably improves quality of life for the patient after prostatectomy, concludes the team.
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