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Sexual function criteria post laparoscopic radical prostatectomy: a reverse systematic review.

Tomás Bernardo Costa Moretti1, Diego Moreira Capibaribe1, Natália Dalsenter Avilez1

  • 1UroScience, Department of Urology, University of Campinas (UNICAMP), and Pontifical Catholic University of Campinas (PUC-Campinas), Av. John Boyd Dunlop-Jardim Ipaussurama, Campinas, São Paulo, CEP 13034-685, Brazil.

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Summary

A reverse systematic review (RSR) revealed that the simple "Erection Sufficient for Intercourse" (ESI) criterion for post-prostatectomy erectile dysfunction (PPED) became predominant after laparoscopic radical prostatectomy (LRP). This ESI criterion showed worse PPED rates compared to more complex measures.

Keywords:
Erectile dysfunctionImpotenceProstate cancerProstatectomyReverse systematic reviewSexual function

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Area of Science:

  • Urology
  • Surgical Oncology
  • Evidence Synthesis

Background:

  • Post-prostatectomy erectile dysfunction (PPED) is a significant concern following laparoscopic radical prostatectomy (LRP).
  • Standardized and consistent criteria for evaluating PPED are crucial for accurate assessment and comparison across studies.
  • The influence of different classification criteria on reported PPED rates remains an area requiring clarification.

Purpose of the Study:

  • To apply a novel reverse systematic review (RSR) methodology to evaluate PPED rates after LRP.
  • To assess the impact of various classification criteria on the reported incidence of PPED.
  • To analyze the temporal trends in the adoption of different PPED evaluation criteria.

Main Methods:

  • A reverse systematic review (RSR) was conducted using data from January 1, 2000, to December 31, 2020.
  • PPED rates were assessed at multiple time points (1, 3, 6, 12, 18 months) post-LRP.
  • Four common criteria were analyzed: 'Erection Sufficient for Intercourse' (ESI), 'IIEF-5 > 17', 'IIEF-5 > 22', and 'Not Available'.

Main Results:

  • The review encompassed 40 systematic reviews, 81 cohorts, and 21,618 patients undergoing LRP.
  • The ESI criterion was the most frequently used for PPED evaluation (75.3%), followed by 'IIEF-5 > 22' (11.1%).
  • Despite its simplicity, ESI reported lower PPED rates at 1, 3, 6, and 12 months compared to 'IIEF-5 > 22', and its use became predominant after 2010.

Conclusions:

  • The RSR methodology effectively demonstrated the evolution of PPED evaluation criteria in the 'natural history' of LRP.
  • The preference for the simpler ESI criterion, despite yielding potentially less accurate PPED rates, was evident.
  • This highlights the need for standardized PPED assessment to ensure reliable data interpretation in LRP outcomes.