Erectile Dysfunction Treatment Following Radical Cystoprostatectomy: Analysis of a Nationwide Insurance Claims Database
Authors: Chappidi Meera R. , Kates Max , Sopko Nikolai A. , Joice Gregory A. , Tosoian Jeffrey J. , Pierorazio Phillip M. , Bivalacqua Trinity J. 
Published: April 2017

Abstract

Introduction
To improve care for patients after radical cystoprostatectomy (RCP), focus on survivorship issues such as sexual function needs to increase. Previous studies have demonstrated the burden of erectile dysfunction (ED) after RCP to be as high as 89%.

Aim
To determine the rates of ED treatment use (phosphodiesterase type 5 inhibitors, injectable therapies, urethral suppositories, vacuum erection devices, and penile prosthetics) in patients with bladder cancer before and after RCP to better understand current patterns of care.

Methods
Men with bladder cancer undergoing RCP were identified in the MarketScan database (2010–2014). ED treatment use was assessed at baseline (during the 1 year before RCP) and at 6-month intervals (0–6, 7–12, 13–18, 19–24 months) after RCP. Multivariable logistic regression models were used to identify predictors of ED treatment use at 6-month intervals after RCP.

Outcomes
ED treatment rates and predictors of ED treatment at 0–6, 7–12, 13–18, 19–24 month follow-up after RCP.

Results
At baseline, 6.5% of patients (77 of 1,176) used ED treatments. The rates of ED treatment use at 0 to 6, 7 to 12, 13 to 18, and 19 to 24 months after RCP were 15.2%, 12.7%, 8.1%, and 10.1% respectively. Phosphodiesterase type 5 inhibitors were the most commonly used treatment at all time points. In the multivariable model, predictors of ED treatment use at 0 to 6 months after RCP were age younger than 50 years (odds ratio [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 to 12 months (OR = 5.63, 95% CI = 2.42–13.10) and 13 to 18 months (OR = 8.99, 95% CI = 3.05–26.51) after RCP.

Clinical Implications
While the burden of ED following RCP is known to be high, overall ED treatment rates are low. These findings suggest either ED treatment is low priority for RCP patients or education about potential ED therapies may not be commonly discussed with patients following RCP. Urologists should consider discussing sexual function more frequently with their RCP patients.

Strengths & Limitations
Strengths include the use of a national claims database, which allows for longitudinal follow-up and detailed information on prescription medications and devices. Limitations include the lack of pathologic and oncologic outcomes data.

Conclusion
ED treatment use after RCP is quite low. The strongest predictor of ED treatment use after RCP was baseline treatment use. These findings suggest ED treatment is a low priority for patients with RCP or education about potential ED therapies might not be commonly discussed with patients after RCP. Urologists should consider discussing sexual function more frequently with their patients undergoing RCP.