(268) PREDICTORS FOR USE OF ADVANCED ERECTILE DYSFUNCTION THERAPY FOLLOWING ROBOTIC ASSISTED RADICAL PROSTATECTOMY

Abstract Introduction Despite improvements in nerve-sparing techniques offered by Robotic Assisted Laparoscopic Radical Prostatectomy (RARP), nearly all patients undergoing this procedure will demonstrate some degree of erectile dysfunction (ED) thereafter. Emerging data indicate that older age and pre-surgical hypogonadism correlate with worsened post-surgical erectile dysfunction. Objective Herein, we sought to determine real world outcomes of erectile dysfunction therapy as they related to patient age, pre-surgical testosterone level, and testosterone replacement therapy (TRT) at time of RARP. Methods We identified patients undergoing RARP by a single surgeon at our institution from 2015-2023. We then collected demographics, pre-surgical total testosterone levels, type of erectile dysfunction therapy (none [No Tx], phosphodiesterase 5 inhibitor [PDE5], or intracavernosal injection [ICI]) and TRT use for each patient. Data were analyzed using GraphPad Prism Software. We performed statistical analysis using One-way ANOVA for comparison of multiple groups followed by Tukey’s post-test. P values less than 0.05 were deemed significant. Results We identified a total of 179 patients undergoing RARP (mean age 64 +/- 7 years) who had pre-operative testosterone levels measured (mean testosterone level 396 +/- 299 ng/dL). 74 patients (41%) were found to have untreated hypogonadism. 42 patients (23%) were found to already be receiving testosterone therapy pre-procedurally. Younger patients and those with a higher natural pre-surgical total testosterone level were more likely to proceed with erectile dysfunction therapy (Table 1). Interestingly, while patients on no testosterone therapy were more likely to utilize either no ED therapy or PDE5, those on testosterone therapy were considerably more likely to utilize more invasive ED therapy, namely ICI (Table 2). Conclusions Younger age, higher pre-RARP testosterone levels, and Testosterone Replacement Therapy as controlled for by a single surgeon’s operative technique correlate with a patient’s use of erectile dysfunction therapy. Knowledge from this study will aid the urologist in identifying those patients most likely to seek and benefit from post-RARP erectile dysfunction therapy. Disclosure No.