OBJECTIVE: To study the unique characteristics of erectile dysfunction (ED) in men who developed ED following testis cancer (TC) diagnosis and treatment.
PATIENTS AND METHODS: All men treated for TC who presented for sexual function evaluation were included in an institutional database. All men underwent standard evaluation including history/physical examination, completion of the International Index of Erectile Function (IIEF) questionnaire, testosterone/gonadotropin measurement and a penile duplex Doppler ultrasonography (DUS).
RESULTS: 76 men constituted the population. Mean age was 29±8 years. 25% were partnered. 39% had seminoma (S) and 61% non-seminomatous germ cell tumor (NSGCT). 66% of S patients had radiation. 79% of NSGCT had chemotherapy, 18% primary retroperitoneal lymph node dissection (RPLND) and 20% post-chemotherapy RPLND. The mean time to seek sexual medicine consultation was 12±7 months after treatment completion. Median number of vascular risk factors was 0 (range 0-2). Mean remaining testis size was 16±8 ml. Mean total testosterone, LH, FSH levels were 312±186 ng/dl, 9±7 IU/ml, 17±12 IU/ml. 26% had total testosterone levels < 300 ng/dl. 84% complained primarily of loss of erection sustaining capability. 24% had episodes of transient ED prior to TC diagnosis. Mean IIEF erectile function domain (EFD) score was 16±7. 100% of patients had a normal DUS. Mean peak systolic and end diastolic velocities were 48±16 and 1.2±2.2cm/s respectively. 88% responded with penetration hardness erections to PDE5 inhibitor (PDE5i) use (mean EFD score 27±5), however 12% did not (mean EFD score 17±6). No difference in hemodynamics existed between those men with and without hypogonadism.
CONCLUSIONS: Men with TC presenting with ED after treatment appear to uniformly have normal erectile hemodynamics, suggesting adrenaline-mediated ED. While the majority of TC survivors with ED respond successfully to PDE5i, a significant minority do not.
Written by:
Tal R, Stember DS, Logmanieh N, Narus J, Mulhall JP. Are you the author?
Male Sexual & Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Reference: BJU Int. 2013 Jun 27. Epub ahead of print.
doi: 10.1111/bju.12331
PubMed Abstract
PMID: 24053222
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