Severe SUI predicts severe erectile dysfunction after radical prostatectomy

A new study demonstrated that, after radical prostatectomy, men with severe stress urinary incontinence (SUI) are significantly more likely to have severe erectile dysfunction, according to findings presented at the 24th Annual Fall Scientific Meeting of the Sexual Medicine Society of North America.¹

At 12 months, 42% of men with continence/mild SUI reported having no/mild ED compared with 46% of men who reported having severe ED. The rates were 22% and 70% (P < .001), respectively, in men with severe SUI.

“We know that after radical prostatectomy, SUI and ED are significant complications that have a negative impact on patients’ quality of life. So with this study, we wanted to evaluate the prevalence of ED in the first year post-surgery in men with SUI who received radical prostatectomy,” presenting author Jose M. Flores, MD, assistant attending urologic surgeon at Memorial Sloan Kettering, said when describing the background of the study.

Accordingly, Flores et al’s study included men who received radical prostatectomy and had follow-up data for at least 1 year following surgery. Men were not eligible for the study if they received androgen deprivation therapy (ADT) or radiation therapy either prior to or following radical prostatectomy.

Overall, there were 9953 men in the study. The median patient age was 62 years (range, 56-67). The median Gleason grade group before surgery was 2 (range, 2-3) and the median PSA level was 5.7 ng/ml (range, 4.3-8.1). Patients had a median of 1 comorbidity and 19% had 3 or more comorbidities. Diabetes was reported in 10% of patients and obstructive sleep apnea in 27%. About three-fourths (73%) of patients had bilateral nerve-sparing surgery (NSS), 20% had unilateral NSS, and 7% had resection on both sides.

The study design defined post-surgery SUI based on the number of pads patients used each day: continence/mild SUI was 0 to 1 pad daily; moderate SUI was 2 pads daily; and severe SUI was 3 or more pads daily. Scores on the International Index of Erectile Function (IIEF) were used to define ED severity: normal erectile function (≥24), mild ED (18-23), moderate ED (11-17), and severe ED (≤10). SUI and ED were assessed at 3, 6, and 12 months after radical prostatectomy.

At all 3 time points, the prevalence of severe ED was higher in patients with severe SUI versus patients with continence/mild SUI. Further, using a multivariable logistic regression model, the researchers found that severe SUI was an independent predictor for severe ED after radical prostatectomy.

At 3 months, 31% of men with continence/mild SUI described having no/mild ED, while 59% reported having severe ED. Among men with severe SUI, the rates were 18% and 75% respectively (P < .001).

At 6 months, 35% of men with continence/mild SUI reported no/mild ED and 51% reported severe ED. The rates were 20% and 70% (P < .001) respectively, for men with severe SUI.

And at 12 months, 42% of men with continence/mild SUI reported having no/mild ED compared with 46% of men who reported having severe ED. The rates were 22% and 70% (P < .001), respectively, in men with severe SUI.

The multivariable logistic regression model also showed that patient age (per decade increase), baseline erectile function (per unit increase), nerve sparing status (both sides resected), number of comorbidities (having ≥3), and PDE5i exposure after radical prostatectomy were also independent predictors of severe erectile dysfunction after radical prostatectomy.

Regarding the strengths of the study, Flores highlighted the study’s large audited database and the researchers’ rigorous assessment of SUI and ED. He noted the study being a retrospective data analysis as its primary limitation.

Flores also noted that he had no disclosures to report related to this research.

Reference

1. Elshafei A, Ljubetic BM, Novaes LF, et al. Prevalence of Erectile Dysfunction in Men with Stress Urinary Incontinence After Radical Prostatectomy. Presented at: 24th Annual Fall Scientific Meeting of the Sexual Medicine Society of North America; November 16-18, 2023; San Diego, CA. Abstract 49.