Abstract: PD69-10
Sources of Funding: none

Introduction

As survival following radical cystectomy (RC) improves, it is important to increase focus on survivorship issues such as sexual function. Therefore, our objective was to determine the rates of erectile dysfunction (ED) treatment use in bladder cancer patients prior to and following RC and to determine if surgical approach affects these treatment rates in order to better understand current patterns of care.

Methods

Male bladder cancer patients undergoing RC were identified in the MarketScan database (2010-2014). ED treatment was defined as use of phosphodiesterase-5 inhibitors, intracavernosal injections, vacuum erection devices, urethral suppositories, or implantable penile prosthesis. ED treatment use was assessed at baseline (in the year prior to RC) and at 6-month intervals (0-6, 7-12, 13-18, 19-24 months) following RC. At each time point, ED treatment use was compared between patients who underwent open RC (ORC) and minimally-invasive RC (MIRC). Multivariable logistic regression models were used to identify predictors of ED treatment use at 6-month intervals following RC.

Results

In the cohort of 1176 patients, at baseline, 6.5% (n=77) of patients used ED treatments. The rates of ED treatment use at 0-6, 7-12, 13-18, and 19-24 months following RC were 15.2%, 12.7%, 8.1%, and 10.1% respectively. At baseline and all follow-up time points assessed, the rates of ED pharmacotherapy use between the ORC (n=1009) and MIRC (n=167) groups were comparable. In the multivariable model, predictors of ED treatment use in 0-6 months following RC were age <50 (OR=3.17 95% CI [1.68, 6.01]), baseline ED treatment use (OR=5.75 95%CI [3.08, 10.72]), neoadjuvant chemotherapy (OR=1.72 95%CI [1.13, 2.61]), and neobladder diversion (OR=2.40 95%CI [1.56, 3.70]). Baseline ED treatment use continued to be associated with ED treatment use at 6-12 months (OR=5.63 95%CI [2.42, 13.10]) and 13-18 months (OR=8.99 95%CI [3.05, 26.51]) following RC. Surgical approach (MIRC vs. ORC) was not associated with ED treatment use at any of the follow-up points.

Conclusions

ED treatment use following RC is quite low, and is not associated with surgical approach. The strongest predictor of ED treatment use following RC is baseline treatment use followed by younger age. These findings suggest either ED treatment is of low priority for RC patients or sexual function issues may not be commonly discussed with patients following RC. Urologists should consider discussing sexual function more frequently with their RC patients.

Funding

none