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Safety and efficacy of Rezūm™ in erectile dysfunction patients with and without an inflatable penile prosthesis[[es]]Seguridad y eficacia del sistema Rezūm® en pacientes con disfunción eréctil con y sin prótesis de pene inflable
Joshua S. Juea,
Corresponding author
jjue@northwell.edu

Corresponding author.
, Jean-Francois Eida,b
a Department of Urology, Lenox Hill Hospital, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, New York, USA
b Advanced Urological Care, PC, New York, USA
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    "titulo" => "Safety and efficacy of Rez&#363;m&#8482; in erectile dysfunction patients with and without an inflatable penile prosthesis&#91;&#91;es&#93;&#93;Seguridad y eficacia del sistema Rez&#363;m&#174; en pacientes con disfunci&#243;n er&#233;ctil con y sin pr&#243;tesis de pene inflable"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Lower urinary tract symptoms &#40;LUTS&#41; and erectile dysfunction &#40;ED&#41; are common health conditions in aging males&#46; LUTS are commonly attributed to benign prostatic hyperplasia &#40;BPH&#41; in men over the age of 50 years&#44; with autopsy evidence showing the presence of BPH in 70&#37; of sexagenarians&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Erectile dysfunction increases in prevalence with age and age-independent medical comorbidities&#44; which has led to estimates of ED to be as high as 200 million men by 2025&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Increasing evidence also suggests an age-independent association between LUTS and ED&#44; with metabolic syndrome potentially being a common potentiator of both conditions&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Sexual health&#44; including ejaculatory and erectile dysfunction are well described adverse effects of both medical and surgical therapies for BPH&#46; Prospective evidence has shown that daily single and combination drug therapy can significantly worsen sexual desire&#44; erectile function&#44; and ejaculatory function&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Surgical therapies can also significantly worsen ejaculatory and erectile function in men with normal preoperative function&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Although ejaculatory dysfunction is better described&#44; capsular perforation adjacent to the neurovascular bundles and thermal injury have been theorized to contribute to erectile dysfunction after BPH surgeries&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">While ED after BPH therapies has been well investigated&#44; the treatment of BPH after ED therapies yields different considerations&#46; Transurethral surgery after inflatable penile prosthesis &#40;IPP&#41; placement is often more difficult&#44; due to decreased scope mobility within the prostatic urethra&#46; IPP reservoirs are usually placed in the space of Retzius&#44; adjacent to the anterolateral portion of the prostate&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> A capsular perforation during BPH surgery can inadvertently damage the IPP reservoir&#44; due to the reservoir&#8217;s close proximity to the lateral lobe of the prostate&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> These injuries may be severe enough to result in complete device malfunction and require IPP removal and replacement&#44; which has occurred after the prostatic urethral lift procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Longitudinal data from 2 large randomized controlled trials suggest that Rez&#363;m&#8482; offers similar LUTS improvement compared to combination drug therapy&#44; but with significantly less negative impact on sexual function&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;10</span></a> With Rez&#363;m&#8482; showing promising LUTS and sexual function results&#44; we sought to evaluate the safety and efficacy of this therapy in IPP patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">This was a retrospective review of patients with erectile dysfunction who consecutively underwent Rez&#363;m&#8482; System water vapor thermal therapy &#40;Boston Scientific&#44; Malborough&#44; MA&#44; USA&#41; by a single surgeon from January 1st 2021 to December 31st 2021&#46; Patients with erectile dysfunction refractory to medical therapy underwent placement of a three-piece inflatable Coloplast &#40;Minneapolis&#44; MN&#44; USA&#41; penile prosthesis through a penoscrotal approach using the No-Touch technique&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> LUTS were treated with alpha&#40;1&#41; adrenergic receptor antagonists&#44; 5-alpha-reductase inhibitors&#44; beta&#40;3&#41; adrenergic receptor agonists&#44; and phosphodiesterase-5 inhibitors at the discretion of the surgeon&#46; Herbal remedy use for LUTS&#44; such as saw palmetto&#44; was also recorded&#46; All pharmacotherapy used to treat LUTS were collectively referred to as BPH medications&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Patient age&#44; presence of IPP&#44; date of IPP placement&#44; date of Rez&#363;m&#8482;&#44; date of most recent follow up&#44; number of BPH medications&#44; prior prostatic urethral lift&#44; International Prostate Symptom Score &#40;IPSS&#41;&#44; IPSS Quality of Life Index &#40;QOL&#41;&#44; uroflowmetry maximum flow rate &#40;Q<span class="elsevierStyleInf">max</span>&#41;&#44; and uroflowmetry average flow rate &#40;Q<span class="elsevierStyleInf">avg</span>&#41; before and after Rez&#363;m&#8482; were obtained&#46; The preoperative IPSS&#44; QOL&#44; Q<span class="elsevierStyleInf">max</span>&#44; and Q<span class="elsevierStyleInf">avg</span>&#44; were obtained from the visit immediately prior to Rez&#363;m&#8482; surgery&#46; The postoperative IPSS&#44; QOL&#44; Q<span class="elsevierStyleInf">max</span>&#44; and Q<span class="elsevierStyleInf">avg</span>&#44; were obtained from the most recent visit&#46; Patient age&#44; follow-up time after Rez&#363;m&#8482;&#44; and time between IPP placement and Rez&#363;m&#8482; were calculated as medians with interquartile ranges&#46; Independent two-sample T-tests were used to compare the baseline demographics and clinical characteristics between patients with and without an IPP&#46; Independent two-sample T-tests were also used to compare the postoperative IPSS&#44; QOL&#44; Q<span class="elsevierStyleInf">max</span>&#44; and Q<span class="elsevierStyleInf">avg</span> between patients with and without an IPP&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Among all patients with erectile dysfunction&#44; linear regression was performed to determine if the number of BPH medications&#44; preoperative Q<span class="elsevierStyleInf">max</span> or Q<span class="elsevierStyleInf">avg</span> were associated with postoperative Q<span class="elsevierStyleInf">max</span> or Q<span class="elsevierStyleInf">avg</span>&#46; Linear regression was also performed in only patients with an IPP to determine if the number of BPH medications&#44; preoperative Q<span class="elsevierStyleInf">max</span> or Q<span class="elsevierStyleInf">avg</span> were associated with postoperative Q<span class="elsevierStyleInf">max</span> or Q<span class="elsevierStyleInf">avg</span>&#46; Type-I error rate was set to 5&#37;&#44; where P values &#60;0&#46;05 were considered statistically significant&#46; All statistical analyses were computed using IBM SPSS Statistics Version 26&#46;0 &#40;Armonk&#44; NY&#58; IBM Corp&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">A total of 17 patients with erectile dysfunction who underwent Rez&#363;m&#8482; from January 1st 2021 to December 31st 2021 were identified&#46; The median follow-up after Rez&#363;m&#8482; was 65 days &#40;interquartile range &#91;IQR&#93;&#58; 19&#8211;86&#41;&#46; 11 of these patients had undergone IPP placement prior to undergoing Rez&#363;m&#8482;&#46; The median time between IPP placement and Rez&#363;m&#8482; was 30 months &#40;interquartile range &#91;IQR&#93;&#58; 17&#8211;94&#41;&#46; The median age of all ED patients and in patients with an IPP was 68 years &#40;interquartile range &#91;IQR&#93;&#58; 63&#8211;78 and 59&#8211;79&#44; respectively&#41;&#46; There were no significant differences in baseline demographics and clinical characteristics between patients with and without an IPP&#46; One patient with an IPP had a prior prostatic urethral lift with persistence of lower urinary tract symptoms&#46; The full comparison of baseline patient demographics and characteristics are displayed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">A comparison of postoperative characteristics found that there was no significant difference between IPSS and QOL scores between patients with and without an IPP&#46; However&#44; postoperative Q<span class="elsevierStyleInf">max</span> &#40;10&#46;9&#8239;mL&#47;s vs 9&#46;8&#8239;mL&#47;s&#44; p&#8239;&#61;&#8239;0&#46;04&#41; and Q<span class="elsevierStyleInf">avg</span> &#40;7&#46;5&#8239;mL&#47;s vs 6&#46;0&#8239;mL&#47;s&#44; p&#8239;&#61;&#8239;0&#46;03&#41; were significantly higher in patients with an IPP compared to patients without an IPP &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Among all ED patients&#44; the number of BPH medications&#44; preoperative Q<span class="elsevierStyleInf">max</span> or Q<span class="elsevierStyleInf">avg</span> were not associated with postoperative Q<span class="elsevierStyleInf">max</span> or Q<span class="elsevierStyleInf">avg</span> &#40;Supplemental Tables 1a and 1b&#41;&#46; In the subset of patients with an IPP&#44; the number of BPH medications&#44; preoperative Q<span class="elsevierStyleInf">max</span> or Q<span class="elsevierStyleInf">avg</span> were also not associated with postoperative Q<span class="elsevierStyleInf">max</span> or Q<span class="elsevierStyleInf">avg</span> &#40;Supplemental Tables 2a and 2b&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Two patients without an IPP went into urinary retention within 4 weeks of undergoing Rez&#363;m&#8482;&#44; which required urethral catheterization and resumption of preoperative BPH medications&#46; No complications were encountered in patients with an IPP&#46; There were no infectious or IPP device malfunction complications&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">This is the first study to evaluate the safety and efficacy of Rez&#363;m&#8482; in patients with an IPP&#46; Our results suggest that Rez&#363;m&#8482; is a safe procedure in IPP patients that may result in greater uroflowmetry flow rate compared to the general ED population&#46; No preoperative clinical characteristics were predictive of postoperative outcomes&#46; Urinary retention was the only complication after Rez&#363;m&#8482;&#44; which only occurred in 2 patients without an IPP&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Overall&#44; the results observed in this study are similar to those observed in the randomized controlled study that evaluated Rez&#363;m&#8482;&#46; In the controlled study&#44; 12-month follow-up IPSS was 10&#46;3&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> which is in between the postoperative IPSS of 14&#46;7 in IPP patients and 9&#46;8 in patients without an IPP in this study&#46; The 12-month follow-up Q<span class="elsevierStyleInf">max</span> in the controlled study was 15&#46;5&#8239;mL&#47;s&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> while the postoperative Q<span class="elsevierStyleInf">max</span> was 10&#46;9&#8239;mL&#47;s in IPP patients and 9&#46;8&#8239;mL&#47;s in patients without an IPP&#46; Although these posttreatment flow rates may seem low in comparison&#44; the preoperative flow rates were also substantially lower compared to the controlled study&#46; Baseline Q<span class="elsevierStyleInf">max</span> was 10&#46;0&#8239;mL&#47;s in the controlled study&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> while approximately 8&#46;5&#8239;mL&#47;s in patients with or without an IPP&#46; The absolute change in Q<span class="elsevierStyleInf">max</span> may be substantially less in our cohort&#44; but the proportional change is more similar to the trial data&#46; ED patients appear to have subjective and objective improvements in voiding function after Rez&#363;m&#8482;&#44; which may not be as pronounced in comparison to the general population&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Although uroflowmetry rates improved in all ED patients&#44; IPP patients appeared to have more marked improvements compared to patients without an IPP&#46; There were no significant differences in preoperative Q<span class="elsevierStyleInf">max</span> or Q<span class="elsevierStyleInf">avg</span> between the two patient groups&#59; however&#44; IPP patients had significantly greater postoperative Q<span class="elsevierStyleInf">max</span> and Q<span class="elsevierStyleInf">avg</span>&#46; The Rez&#363;m&#8482; randomized controlled study mean baseline IIEF-EF was 22&#46;7&#44; which indicates the general absence of ED in this cohort&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The mean IIEF-EF did not significantly change until four years postoperatively&#44; which decreased to a mild ED score of 20&#46;8&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Very few patients with ED were included in the Rez&#363;m&#8482; study&#44; which did not specify how many patients would be classified with ED by baseline IIEF-EF score&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> There is little inclusion of ED patients within high quality studies evaluating the efficacy of bladder outlet procedures&#44; making the uroflowmetry observation in IPP patients both novel and difficult to contextualize&#46; The mechanism of increased uroflowmetry after IPP is difficult to propose&#44; since the entirety of the device is located outside of the prostate and urethra&#46; The use of phosphodiesterase-5 inhibitors would likely improve uroflowmetry in patients without an IPP&#44; rather than patients with an IPP&#46; Overall&#44; this uroflowmetry difference is unlikely to be clinically significant&#44; but should be evaluated in future studies that include large ED patient populations with and without IPPs&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">While this is one of the first studies to compare the efficacy of a bladder outlet procedure in ED patients with and without IPPs&#44; this study has several limitations&#46; The absence of any objective assessment of prostate volume suggests that some patients that did not respond well to the treatment may not have been properly selected for this procedure&#46; There was also an insufficient number of patients and complications to identify patient demographics or clinical characteristics that were associated with complications&#46; Although Rez&#363;m&#8482; is just one of many bladder outlet procedures&#44; the Rez&#363;m&#8482; needle is substantially smaller than the prostatic urethral lift needle&#44; so perforation of the IPP reservoir is probably less likely&#46; However&#44; direct comparisons of Rez&#363;m&#8482; with other bladder outlet procedures are needed to adequately compare safety and efficacy&#46; Nevertheless&#44; the number of general ED and IPP patients who undergo Rez&#363;m&#8482; should continue to grow&#44; which will allow for the continued surveillance of IPP device safety&#46; Future studies should focus on identifying factors associated with complications and greater subjective&#47;objective treatment response in ED patients with and without IPPs&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0070" class="elsevierStylePara elsevierViewall">Rez&#363;m&#8482; is a safe and effective procedure to perform in ED patients&#44; particularly those with an IPP&#46; Objective and subjective improvement in LUTS are observed in patients with and without an IPP&#46; IPP patients may experience greater increase in uroflowmetry rate compared to ED patients without an IPP&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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            0 => "Erectile dysfunction"
            1 => "Inflatable penile prosthesis"
            2 => "Bladder outlet obstruction"
            3 => "Benign prostatic hyperplasia"
            4 => "Rez&#363;m&#8482;"
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          "palabras" => array:5 [
            0 => "Disfunci&#243;n er&#233;ctil"
            1 => "Pr&#243;tesis peneana inflable"
            2 => "Obstrucci&#243;n de la salida de la vejiga"
            3 => "Hiperplasia prost&#225;tica benigna"
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    "resumen" => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Purpose</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This study evaluates the safety and efficacy of Rez&#363;m&#8482; in erectile dysfunction &#40;ED&#41; patients with and without an inflatable penile prosthesis &#40;IPP&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and Methods</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This was a retrospective review of ED patients who underwent Rez&#363;m&#8482; by a single surgeon over 12 months&#46; Patient age&#44; presence of IPP&#44; number of benign prostatic hyperplasia medications&#44; International Prostate Symptom Score &#40;IPSS&#41;&#44; IPSS Quality of Life Index &#40;QOL&#41;&#44; uroflowmetry maximum flow rate &#40;Q<span class="elsevierStyleInf">max</span>&#41;&#44; and uroflowmetry average flow rate &#40;Q<span class="elsevierStyleInf">avg</span>&#41; before and after Rez&#363;m&#8482; were obtained&#46; Independent two-sample T-tests were used to compare preoperative and postoperative characteristics between patients with and without an IPP&#46; Linear regression was performed to identify factors associated with postoperative Q<span class="elsevierStyleInf">max</span> or Q<span class="elsevierStyleInf">avg</span>&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A total of 17 patients with ED who underwent Rez&#363;m&#8482; were identified&#44; including 11 patients with an IPP&#46; The median follow-up after Rez&#363;m&#8482; was 65 days&#46; There were no significant differences in baseline demographics and clinical characteristics between patients with and without an IPP&#46; Postoperative Q<span class="elsevierStyleInf">max</span> &#40;10&#46;9&#8239;mL&#47;s vs 9&#46;8&#8239;mL&#47;s&#44; p&#8239;&#61;&#8239;0&#46;04&#41; and Q<span class="elsevierStyleInf">avg</span> &#40;7&#46;5&#8239;mL&#47;s vs 6&#46;0&#8239;mL&#47;s&#44; p&#8239;&#61;&#8239;0&#46;03&#41; were significantly higher in patients with an IPP compared to patients without an IPP&#46; There were no factors associated with postoperative Q<span class="elsevierStyleInf">max</span> or Q<span class="elsevierStyleInf">avg</span> on linear regression&#46; Two patients without an IPP went into urinary retention&#44; while no complications occurred in IPP patients&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Rez&#363;m&#8482; is a safe and effective procedure to perform in ED patients&#44; particularly those with an IPP&#46; IPP patients may experience greater increase in uroflowmetry rate compared to ED patients without an IPP&#46;</p></span>"
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            "titulo" => "Materials and Methods"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Este estudio eval&#250;a la seguridad y eficacia del sistema Rez&#363;m&#174; en pacientes con disfunci&#243;n er&#233;ctil &#40;DE&#41; con y sin pr&#243;tesis peneana inflable &#40;PPI&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se trata de una revisi&#243;n retrospectiva de los pacientes con disfunci&#243;n er&#233;ctil tratados con Rez&#363;m&#174; por un &#250;nico cirujano durante 12 meses&#46; De cada paciente se obtuvo la edad&#44; la presencia de PPI&#44; el n&#250;mero de medicamentos para la hiperplasia prost&#225;tica benigna&#44; la puntuaci&#243;n internacional de s&#237;ntomas prost&#225;ticos &#40;IPSS&#41;&#44; el &#237;ndice de calidad de vida &#40;QOL&#41; de la IPSS&#44; la tasa de flujo m&#225;ximo &#40;Q<span class="elsevierStyleInf">max</span>&#41; en la uroflujometr&#237;a y la tasa de flujo promedio &#40;Q<span class="elsevierStyleInf">avg</span>&#41; en la uroflujometr&#237;a antes y despu&#233;s del tratamiento con Rez&#363;m&#174;&#46; Se utilizaron pruebas T para dos muestras independientes para comparar las caracter&#237;sticas preoperatorias y postoperatorias entre los pacientes con y sin PPI&#46; Se realiz&#243; una regresi&#243;n lineal para identificar los factores asociados con el Q<span class="elsevierStyleInf">max</span> o Q<span class="elsevierStyleInf">avg</span> postoperatorio&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se identificaron un total de 17 pacientes con disfunci&#243;n er&#233;ctil sometidos al sistema Rez&#363;m&#174;&#44; incluyendo 11 pacientes con una PPI&#46; La mediana de seguimiento tras el tratamiento con Rez&#363;m&#174; fue de 65 d&#237;as&#46; No hubo diferencias significativas en cuanto a los datos demogr&#225;ficos y las caracter&#237;sticas cl&#237;nicas basales entre los pacientes con y sin PPI&#46; El Q<span class="elsevierStyleInf">max</span> postoperatorio &#40;10&#44;9&#8239;mL&#47;s frente a 9&#44;8&#8239;mL&#47;s&#44; p&#8239;&#61;&#8239;0&#44;04&#41; y el Q<span class="elsevierStyleInf">avg</span> &#40;7&#44;5&#8239;mL&#47;s frente a 6&#44;0&#8239;mL&#47;s&#44; p&#8239;&#61;&#8239;0&#44;03&#41; fueron significativamente mayores en los pacientes con PPI en comparaci&#243;n con los pacientes sin PPI&#46; No hubo factores asociados con el Q<span class="elsevierStyleInf">max</span> o el Q<span class="elsevierStyleInf">avg</span> postoperatorio en la regresi&#243;n lineal&#46; Dos pacientes sin PPI resultaron en retenci&#243;n urinaria&#44; mientras que en los pacientes con PPI no se produjeron complicaciones&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Rez&#363;m&#174; es un procedimiento seguro y eficaz para realizar en pacientes con DE&#44; especialmente en aquellos con una PPI&#46; Los pacientes con PPI pueden experimentar un incremento mayor en los par&#225;metros de uroflujometr&#237;a en comparaci&#243;n con los pacientes con DE sin PPI&#46;</p></span>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">IPP Present&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Age&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">68&#46;0 &#40;10&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                      "doi" => "10.1038/sj.ijir.3900622"
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                        "tituloSerie" => "Int J Impot Res"
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