A team of researchers has developed new tools to better predict how well and how completely men will recover their erectile function after radical prostatectomy.
Radical prostatectomy has always carried with it the risk of temporary or even permanent loss of erectile function. This procedure involves the surgical removal of the prostate gland and surrounding tissues that have been found to be cancerous.
To the consternation of men facing this surgical procedure, the prospects for future erectile function have generally been uncertain. Now, a team of researchers has developed a set of nomograms or relative-value charts to help more accurately predict postoperative outcomes after radical prostatectomy.
What’s a Nomogram?
According to Lexico.com, a nomogram is “a diagram representing the relations between three or more variable quantities by means of a number of scales.” These scales are arranged in such a manner “that the value of one variable can be found by a simple geometrical construction, e.g. by drawing a straight line intersecting the other scales at the appropriate values.”
Drawing on quality-of-life data from previous prostatectomies and their outcomes relative to erectile function, researchers were able to develop three nomograms — preoperative, early postoperative, and 12-month postoperative.
Looking Beyond Surgery
In the past, according to lead author John P. Mulhall, M.D., rates of postoperative ED have ranged from 10 to 90 percent in the scientific literature. However, he told UrologyTimes.com, “surgeons should be able to give each patient a realistic expectation for his outcome” using the set of nomograms developed by Mulhall’s research team.
The first or preoperative nomogram takes into account such factors as the patient’s age, presence of any other ED-relevant disorders, and his baseline score on an International Index of Erectile Function (IIEF) questionnaire. Among the ED-relevant disorders taken into consideration are coronary artery disease, peripheral vascular disease, stroke, diabetes, hypertension, hyperlipidemia, hypercholesterolemia, obesity, and smoking status.
Nerve Sparing Considered
The second or early postoperative nomogram also takes into consideration the degree to which the patient’s surgical procedure spared nerves essential to erectile function. This was done using the nerve-sparing status scoring system in use at Memorial Sloan Kettering Cancer Center in New York. That system assigns a score of 1 for total nerve-sparing, 2 for mild injury, 3 for moderate damage, and 4 for total resection.
The third and last in the series of nomograms is for use 12 months after surgery, and it factors in the patient’s IIEF score at that point in time. In his interview with UrologyTimes.com, Mulhall noted that the prediction of erectile function recovery did not take into account the use of PDE5 inhibitors such as Viagra. This was necessarily omitted because early data on which the nomograms were based did not indicate if and when men on PDE5 inhibitor therapy discontinued such treatment.
Can ED Drugs Help?
Prior studies have found that some men who’ve temporarily lost erectile function after prostate surgery were able to get and keep erections suitable for intercourse by using Viagra or one of the other oral ED drugs known as PDE5 inhibitors. However, these drugs have not worked for all men after prostate surgery.
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