{"doi":"10.1093/jsxmed/qdae157","title":"Predictors of corporo-venocclusive dysfunction in men with bilateral nerve-sparing radical prostatectomy","abstract":"BACKGROUND: Erectile dysfunction (ED) is seen in some men who have undergone bilateral nerve-sparing surgery. Corporo-venocclusive dysfunction (CVOD) is the major pathway to permanent ED after radical prostatectomy (RP). AIM: To identify comorbidity factors that are associated with the presence of CVOD in men who had undergone bilateral nerve-sparing RP. METHODS: We included patients who had no ED before RP, underwent bilateral nerve-sparing RP, were unresponsive to pharmacotherapy, and had a penile Duplex Doppler Ultrasound (PDDU) with a diagnosis of CVOD. PDDU was performed with a redosing vasoactive agent protocol. A logistic regression model was created to define predictors of CVOD, defined as end-diastolic velocity (EDV) ≥ 5 cm/s bilaterally. OUTCOMES: CVOD diagnosis. RESULTS: 135 patients with a median age of 60 (IQR 54, 64) years were included. 45% reported ≥2 comorbidities, 10% diabetes, 28% obstructive sleep apnea (OSA), and 44% were current or former smokers. At PDDU, 34% had less than penetration hardness erections, and 43% received 100 units of vasoactive agent. 44% were diagnosed with CVOD. Increased age at RP (OR 2.12 per 10 years, 95% CI 2.35, 3.73, P = .007) and OSA (OR 2.44, 95% CI 1.07, 5.73, P = .036) were associated with a diagnosis of CVOD. CLINICAL IMPLICATIONS: Comorbidities, especially OSA, have a role in erection recovery after surgery. STRENGTHS AND LIMITATIONS: The study used a well-established institutional RP nerve-sparing score, a strict PDDU vasoactive agent redosing protocol, validated cut-offs for CVOD diagnosis, and a validated erectile function questionnaire both pre- and post-operatively. The major limitation is that this is a cohort of men seeking treatment at a sexual medicine clinic for post-operative ED, which limits the generalizability of the results to patients without ED symptoms or who decided not to seek treatment. The dichotomous definition of comorbidities is also a limitation since patients can have differing degrees of comorbidities' severity. CONCLUSION: Older patients and the presence of OSA were associated with the presence of CVOD.","journal":"The Journal of Sexual Medicine","year":2024,"id":472425,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9514,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1307484,"name":"Luis F Novaes","orcid":"0009-0006-4382-4810","position":1,"is_corresponding":false},{"id":535214,"name":"Emily Vertosick","orcid":"0000-0001-6948-9850","position":2,"is_corresponding":false},{"id":763176,"name":"Carolyn A. Salter","orcid":"0000-0003-2561-5282","position":3,"is_corresponding":false},{"id":1307931,"name":"N Liso","orcid":null,"position":4,"is_corresponding":false},{"id":72212,"name":"Andrew J. Vickers","orcid":"0000-0003-1525-6503","position":5,"is_corresponding":false},{"id":232341,"name":"John P. Mulhall","orcid":"0000-0001-5455-3047","position":6,"is_corresponding":false},{"id":1307932,"name":"FECSM","orcid":null,"position":7,"is_corresponding":false},{"id":550095,"name":"José M. Flores","orcid":"0000-0002-8912-7037","position":0,"is_corresponding":true}],"reference_count":27,"raw_metadata":null,"created_at":"2026-07-19T02:05:53.032464Z","pmid":"39528243","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}