Men should be informed of transient changes in erectile function before biopsy, but should also be assured that such changes will return to normal.
introduce
Prostate biopsy is the gold standard procedure for diagnosing prostate cancer, the most common noncutaneous malignancy in men.this adverse events Common complications after this surgery are well known and include hematospermia, hematuria, urinary tract infection, rectal bleeding, and rectal discomfort. More serious complications, such as serious infections and sepsis, are less common.
Penile erection is a complex process that occurs through a series of vascular, neurological, and psychological events. Therefore, any impairment or alteration in the normal physiological sequence of these processes, such as aging, medication side effects, comorbidities, or psychological stress, may affect a patient’s erection quality.
Erectile dysfunction has been reported after prostate biopsy. However, there has been significant controversy over whether prostate biopsy predisposes patients to erectile dysfunction. Several well-studied factors may influence erectile dysfunction after prostate biopsy, including the patient’s age, damage to the neurovascular bundle during injection of local anesthesia, compression of the neurovascular bundle by hematoma or edema formation, the number of biopsies, anxiety. Relevant to biopsy, type of biopsy (transperineal or transrectal), and time interval since surgery.
The diagnosis of prostate cancer itself is associated with psychological stress, anxiety, and depression, which in turn can lead to erectile dysfunction. International Index of Erectile Function scores after prostate biopsy may take longer to return to baseline values in men diagnosed with cancer than in men with benign pathology. 8
The literature on erectile dysfunction after prostate biopsy is diverse and full of conflicting results. Therefore, a better understanding of the association between PB and ED is necessary for patient counseling and management. We hypothesized that prostate biopsy is associated with erectile dysfunction, but that this effect may be transient. To provide clear evidence on the duration and extent of ED after biopsy, we performed a systematic review and meta-analysis of validated measures of sexual function at 1, 3, and 6 months after prostate biopsy.
Purpose:
Because of the variability in the association between erectile dysfunction and prostate biopsy in the existing literature, we sought to conduct a systematic review and meta-analysis of male sexual dysfunction within 6 months of prostate biopsy.
Materials and methods:
We conducted a systematic literature search in 4 databases: MEDLINE® (via PubMed®), Embase® (via Ovid®), Web of Science™, and Cochrane Library. We included studies addressing sexual dysfunction in men of all ages who underwent transrectal or transperineal prostate biopsy for suspected prostate cancer.
Studies with International Index of Erectile Function 5 scores before and after biopsy at 1, 3, or 6 months were included. We performed an effect size meta-analysis comparing patients’ baseline International Index of Erectile Function-5 (IIEF-5) scores with post-biopsy IIEF-5 scores.
result:
We identified 9 studies that met the inclusion criteria, 6 of which examined transrectal prostate biopsy, 2 of transperineal prostate biopsy, and 1 of both.
One month after biopsy, the mean IIEF-5 score decreased by approximately 2.2 points (−0.43, p = 0.002), as determined by effect size.
However, at 3 and 6 months after biopsy, there was no difference compared to baseline (effect size = -0.08, p = 0.52 and effect size = -0.11, p = 0.18, respectively).