Browsing by Author "Salter, Carolyn A."

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Defining the impact of Peyronie's disease on the psychosocial status of gay men
    (Wiley, 2021-01) Salter, Carolyn A.; Nascimento, Bruno; Terrier, Jean-Etienne; Taniguchi, Hisanori; Bernie, Helen; Miranda, Eduardo; Jenkins, Lawrence; Schofield, Elizabeth; Mulhall, John P.; Urology, School of Medicine
    Background Little sexual health research has been conducted in gay men. Anecdotally, this population seems to experience more bother related to Peyronie's disease (PD). Objectives To examine the impact of PD on psychosocial factors in gay vs straight men. Materials and Methods All PD patients who were seen in the sexual medicine clinic were included. They completed three instruments: the PD questionnaire (PDQ), Self-Esteem and Relationship (SEAR) questionnaire, and a depression questionnaire (CES-D). We described demographics and sexual variables by sexual orientation. We then compared PDQ items and summary scores by sexual orientation, using a series of independent samples t tests. Results 34 consecutive gay and 464 straight men were included. Age and baseline characteristics were similar between the two cohorts, with the exception that fewer gay men were partnered (56% vs 87%, P < .01), and those with a partner had a shorter relationship duration: 109 ± 9 months vs 262 ± 175 months, P < .01. For the SEAR questionnaire, gay men demonstrated a more significant psychosocial impact of PD overall with lower SEAR sums (41 vs 57, P = .01) and a lower sexual relationship subdomain score (28 vs 47, P < .01). 41% of gay men vs 26% of straight men had CES-D scores consistent with depression as defined by a score of ≥16 (P = .09). In the PDQ domains, gay men scored less favorably with regard to bother scores (7 vs 5, P = .03) and pain scores (8 vs 4, P = .04). Discussion Gay men with PD experience significantly more psychosocial impact as evidenced by less favorable SEAR sum and sexual relationship scores, CES-D scores, and PDQ pain and bother domain scores. Conclusion The psychosocial impact of PD is significant in all men, but it appears to be greater in gay men.
  • Thumbnail Image
    Item
    Predictors of Worsening Erectile Function in Men with Functional Erections Early After Radical Prostatectomy
    (Oxford, 2022-12) Salter, Carolyn A.; Tin, Amy L.; Bernie, Helen L.; Nascimento, Bruno; Katz, Darren J.; Benfante, Nicole E.; Carlsson, Sigrid V.; Mulhall, John P.; Urology, School of Medicine
    Background: Prior studies suggest that men with good erectile function shortly after radical prostatectomy (RP) can subsequently have worsened erectile function. Aim: To determine the prevalence and predictors of early erectile function recovery post-RP and of worsening erectile function after initial erectile function recovery. Methods: We retrospectively queried our institutional database. Men who underwent RP during 2008-2017 and who completed the International Index of Erectile Function erectile function domain both pre-RP and serially post-RP, constituted the population. Functional erections were defined as International Index of Erectile Function (IIEF)-6 erectile function domain scores ≥24. We analyzed factors predicting functional erections at 3 months post-RP as well as factors predicting a decrease in functional erections between 3 and 6 months, defined as ≥2-point drop in the erectile function domain. Multivariable logistic regression models were used to identify predictors of early erectile function recovery and also of subsequent decline. Outcomes: Erectile function recovery rates at 3 months post-RP and predictive factors; rates of erectile function decline between 3-6 months and associated predictors. Results: Eligible patients comprised 1,655 men with median age of 62 (IQR 57, 67) years. Bilateral nerve-sparing (NS) surgery was performed in 71% of men, unilateral NS in 19%, and no NS in 10%. Of this population, 224 men (14%; 95% CI 12%, 15%) had functional erections at 3 months post-RP. On multivariable analysis, significant predictors of early erectile function recovery included: younger age (OR 0.93, P < .001), higher baseline erectile function domain score (OR 1.14, P < .001) and bilateral NS (OR 3.81, P = .002). The presence of diabetes (OR 0.43, P = .028) and a former smoking history (OR 0.63, P = .008; reference group: never smoker) was associated with the erectile dysfunction at 3 months post-RP. Of the men with early functional erections, 41% (95% CI 33%, 48%) had a ≥ 2-point decline in erectile function between 3 and 6 months. No factors were identified as predictors for this decline. Clinical implications: Only a small proportion of men have functional erections at 3 months post-RP and a notable number of them will experience a decline in erectile function between 3 and 6 months. Strengths and limitations: Strengths: large patient population and the use of validated questionnaire. Limitations: single-center retrospective study. Conclusion: A minority of men had functional erections 3 months post-RP, about half of whom had a decline in erectile function by month 6. We recommend appropriately counseling post-RP patients on the risk of such a decline in erectile function. Salter CA, Tin AL, Bernie HL, et al. Predictors of Worsening Erectile Function in Men with Functional Erections Early After Radical Prostatectomy. J Sex Med 2022;19:1790-1796.