Diabetes, smoking predict erectile dysfunction in men after radical prostatectomy

A recent study reports functional erection in a small proportion of men 3 months after undergoing radical prostatectomy (RP). Of these, nearly half have shown a decline in erectile function at 6 months. Of note, the presence of diabetes and a smoking history are associated with erectile dysfunction.

The authors retrospectively probed an institutional database, assessing men who underwent RP from 2008 to 2017 and who completed the International Index of Erectile Function erectile function domain both pre- and post-RP. Functional erection was defined as International Index of Erectile Function (IIEF)-6 erectile function domain scores ≥24.

Factors predicting functional erections at 3 months after RP and a decrease in functional erections between 3 and 6 months, defined as ≥2-point drop in the erectile function domain, were examined. The authors identified the predictors of early erectile function recovery and of subsequent decline using multivariable logistic regression models.

A total of 1,655 men (median age 62 years) were included in the analysis, of whom 71 percent underwent bilateral nerve-sparing (NS) surgery, 19 percent unilateral NS, and 10 percent no NS. In addition, 224 men (14 percent) had functional erections at 3 months post-RP.

Multivariable analysis revealed the following predictors of early erectile function recovery: younger age (odds ratio, 0.93; p<0.001), higher baseline erectile function domain score (OR, 1.14; p<0.001), and bilateral NS (OR, 3.81; p=0.002). On the other hand, diabetes (OR, 0.43; p=0.028) and smoking history (OR, 0.63; p=0.008) were predictive of erectile dysfunction at 3 months post-RP.

Among men with early functional erections, 41 percent had at least a 2-point decline in erectile function between 3 and 6 months. However, no factors predictive of such decline were identified.

“We recommend appropriately counselling post-RP patients on the risk of such a decline in erectile function,” the authors said.