Erectile dysfunction in men treated for testicular cancer. (June 2014)

• Record Type: Journal Article
• Authors: Tal, Raanan; Stember, Doron S.; Logmanieh, Nina; Narus, Joseph; Mulhall, John P.
• Is Part Of: BJU international. Volume 113:Number 6(2014:Jun.)
• Page Start: 907
• Page End: 910
• Publication Date: 2014-06
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.12331
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju12331-sec-0001" sec-type="section"> <title>Objective</title> <p> <list id="bju12331-list-0001" list-type="bullet"> <list-item> <p>To study the unique characteristics of erectile dysfunction (ED) in a population of men who developed ED after testicular cancer (TC) diagnosis and treatment.</p> </list-item> </list> </p> </sec> <sec id="bju12331-sec-0002" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju12331-list-0002" list-type="bullet"> <list-item> <p>All men treated for TC who presented for sexual function evaluation were included in an institutional database.</p> </list-item> <list-item> <p>All men underwent standard evaluation including a history/physical examination, completion of the International Index of Erectile Function (IIEF) questionnaire, testosterone/gonadotropin measurement and penile duplex Doppler ultrasonography (DUS).</p> </list-item> </list> </p> </sec> <sec id="bju12331-sec-0003" sec-type="section"> <title>Results</title> <p> <list id="bju12331-list-0003" list-type="bullet"> <list-item> <p>The study population comprised 76 men whose mean (<sc>sd</sc>) age was 29 (8) years and of whom 25% were married/had a partner. In all, 39% of the patients had seminoma and 61% had non‐seminomatous germ‐cell tumour (NSGCT).</p> </list-item> <list-item> <p>A total of 66% of patients with seminoma underwent radiation therapy. Of the patients with NSGCT, 79% received chemotherapy, 18% underwent primary retroperitoneal lymph node dissection (RPLND) and 20% underwent post‐chemotherapy RPLND.</p> </list-item> <list-item> <p>The mean (<sc>sd</sc>) time before seeking sexual medicine consultation was 12 (7) months after treatment completion, the median (range) number of vascular risk factors was 0 (0–2) and the mean (<sc>sd</sc>) remaining testis volume was 16 (8) mL. Mean (<sc>sd</sc>) total testosterone, luteinizing hormone, follicle‐stimulating hormone levels were 312 (186) ng/dL, 9 (7) IU/mL, 17 (12) IU/mL. A total of 26% of patients had total testosterone levels <300 ng/dL.</p> </list-item> <list-item> <p>In all, 84% of patients complained primarily of loss of erection‐sustaining capability and 24% had episodes of transient ED before TC diagnosis. The mean (<sc>sd</sc>) IIEF erectile function domain score was 16 (7).</p> </list-item> <list-item> <p>All the patients (100%) had a normal DUS. Mean (<sc>sd</sc>) peak systolic and end‐diastolic velocities were 48 (16) and 1.2 (2.2) cm/s, respectively.</p> </list-item> <list-item> <p>A total of 88% of patients responded to phosphodiesterase type 5 inhibitor (PDE5i) use with erections sufficient for penetration, but 12% did not (mean [<sc>sd</sc>] erectile function domain score 27 [5] vs 17 [6]).</p> </list-item> <list-item> <p>There were no differences in haemodynamics between those men with and without hypogonadism.</p> </list-item> </list> </p> </sec> <sec id="bju12331-sec-0004" sec-type="section"> <title>Conclusions</title> <p> <list id="bju12331-list-0004" list-type="bullet"> <list-item> <p>Men with TC presenting with ED after treatment appear uniformly to have normal erectile haemodynamics, suggesting adrenaline‐mediated ED.</p> </list-item> <list-item> <p>While the majority of TC survivors with ED respond successfully to PDE5i, a significant minority do not.</p> </list-item> </list> </p> </sec> </abstract>