Lower ED Risk with Partial Nephrectomy

Erectile dysfunction (ED) is less likely to develop postoperatively in men who undergo partial rather than radical nephrectomy, a study found.

The study, which involved 432 men, is the first to demonstrate an increased risk of ED following radical nephrectomy (RN) versus partial nephrectomy (PN), researchers reported online in BJU International.

Researchers retrospectively analyzed data from 264 men who underwent RN had a 3.5 times increased risk of new-onset ED after surgery compared with the 168 men who underwent PN. Preoperatively, 18.6% of the RN group and 27.4% of the PN group had ED. After surgery, ED was present in 48.1% of the RN group and 36.9% of the PN group.

The researchers, led by Ithaar H. Derweesh, MD, of the University of California-San Diego Medical Center in La Jolla, explained that ED is a manifestation of endothelial dysfunction. ED may be the first sign of underlying systemic endothelial disease. Many patients with ED have pre-existing chronic kidney disease (CKD), with also is associated with an increased risk of cardiovascular morbidity and mortality. About 70% of men with CKD have concurrent ED. Dr. Derweesh and his colleagues hypothesized that PN would limit development of ED primarily due to renal function preservation.

Preoperatively, 11.7% of RN patients and 16.7% of PN patients had CKD, defined as an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2. The difference between the groups was not statistically significant. Postoperatively, however, a statistically significantly higher proportion of RN than PN patients had CKD (44.7% vs. 26.2%). The authors pointed out that the proportion of de novo ED was “strikingly similar” to the proportion of de novo eGFR below 60 (33% in the RN group and 9.76% in the PN group). Both preoperative and postoperative CKD were strong predictors of new-onset ED. Patients with preoperative CKD had a nearly ninefold increased likelihood of de novo ED compared with those without CKD before surgery. Postoperative CKD was associated with a 2.6 times increased risk of de novo ED.

“This supports that PN and renal function preservation limit the risk of at least one endothelial disease, and suggests it may reduce the risk of other cardiovascular disease compared with RN,” they wrote.

The investigators evaluated sexual function preoperative and postoperatively with the five-item Sexual Health Inventory for Men questionnaire. They defined ED as a SHIM score less than 22. The researchers excluded from their analyses patients who were not sexually active.

Dr. Derweesh's group observed that PN is now the preferred option for treating small renal masses, and noted that it confers equivalent oncologic outcomes and superior renal function outcomes. Data also show that that PN is associated with improved overall survival compared with RN, possibly because of a decrease in cardiovascular events.

The study, which involved 432 men, is the first to demonstrate an increased risk of ED following radical nephrectomy (RN) versus partial nephrectomy (PN), researchers reported online in BJU International.

Researchers retrospectively analyzed data from 264 men who underwent RN had a 3.5 times increased risk of new-onset ED after surgery compared with the 168 men who underwent PN. Preoperatively, 18.6% of the RN group and 27.4% of the PN group had ED. After surgery, ED was present in 48.1% of the RN group and 36.9% of the PN group.

The researchers, led by Ithaar H. Derweesh, MD, of the University of California-San Diego Medical Center in La Jolla, explained that ED is a manifestation of endothelial dysfunction. ED may be the first sign of underlying systemic endothelial disease. Many patients with ED have pre-existing chronic kidney disease (CKD), with also is associated with an increased risk of cardiovascular morbidity and mortality. About 70% of men with CKD have concurrent ED. Dr. Derweesh and his colleagues hypothesized that PN would limit development of ED primarily due to renal function preservation.

Preoperatively, 11.7% of RN patients and 16.7% of PN patients had CKD, defined as an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2. The difference between the groups was not statistically significant. Postoperatively, however, a statistically significantly higher proportion of RN than PN patients had CKD (44.7% vs. 26.2%). The authors pointed out that the proportion of de novo ED was “strikingly similar” to the proportion of de novo eGFR below 60 (33% in the RN group and 9.76% in the PN group). Both preoperative and postoperative CKD were strong predictors of new-onset ED. Patients with preoperative CKD had a nearly ninefold increased likelihood of de novo ED compared with those without CKD before surgery. Postoperative CKD was associated with a 2.6 times increased risk of de novo ED.

“This supports that PN and renal function preservation limit the risk of at least one endothelial disease, and suggests it may reduce the risk of other cardiovascular disease compared with RN,” they wrote.

The investigators evaluated sexual function preoperative and postoperatively with the five-item Sexual Health Inventory for Men questionnaire. They defined ED as a SHIM score less than 22. The researchers excluded from their analyses patients who were not sexually active.

Dr. Derweesh's group observed that PN is now the preferred option for treating small renal masses, and noted that it confers equivalent oncologic outcomes and superior renal function outcomes. Data also show that that PN is associated with improved overall survival compared with RN, possibly because of a decrease in cardiovascular events.

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