202 Utilization of Erectile Dysfunction Therapies Following Radical Prostatectomy

Erectile dysfunction (ED) following radical prostatectomy (RP) has been well described. Treatment traditionally follows a stepwise progression, starting with PDE5 inhibitors (PDE5i) followed by intra-cavernosal injection (ICI) and finally placement of an inflatable penile prosthesis (IPP). Large cohort studies have tried to describe quantitative utilization of these treatments following RP; however, the applicability of these studies in clinical management is limited due to the use of diagnosis and procedure code data. We sought to better characterize how men specifically seeking care for ED following RP utilized the various available therapies. Retrospective review of 183 men who had previously undergone radical prostatectomy for prostate cancer between 1993 and 2013, presenting to a single academic urology clinic with a chief complaint of ED. We evaluated the sequential utilization of PDE5i, ICI and IPP in this targeted population. The average age of this cohort at time of RP was 58 years. Every patient was initially managed with PDE5i either individually or in combination. 127 men (69%) progressed to ICI following the initial use of PDE5i. 23 men (12% of the initial study cohort) underwent placement of IPP following ICI. 7 men (4% of the initial study cohort) underwent IPP without first utilizing ICI. Therefore, 30 men (16% of the initial study cohort) underwent placement of IPP for management of ED following RP. Time to progression to IPP was on average 5.8 years following RP. Insurance and Marital status did not differ among the treatment groups.