Center for Reproductive Medicine

Glickman Urological & Kidney Institute and Ob-Gyn & Women's Health Institute
Cleveland Clinic Foundation

bladder cancer&   erectile dysfunction
Our Center is actively conducting basic science and clinical research in the areas of male and female infertility and sexual function. Some of the important highlights of our research program are:
 

Current Thrust Areas

Our focus is to obtain expert knowledge in the incidence and prevalence of bladder cancer in specific patient populations and implement screening tests to evaluate the predictive value of these tests.

Review of efficacy and long-term compliance of multiple treatments (intracavernous injections, vacuum constriction devices, MUSE- transurethral insertion of alprostatdil and sildenafil citrate) used to treat erectile dysfunction following radical surgeries. Our recent study is focused on early treatment program following radical prostatectomy, a strategy used to help promote early nerve recovery and regeneration following radical surgery.

Our Center is among the first to conduct novel study to address sexual dysfunction in subset of patients (both male and female) undergoing radical cystectomy. We reported sexual function data in a contemporary radical cystectomy series by using the SHIM (IIEF-5) for males and a modified IFSF for females.

Our ongoing studies are focused on cutting edge issues in the management of erectile dysfunction. We are investigating the role of sildenafil citrate in salvaging erectile function following radical prostatectomy and factors predicting its response [e.g., type of surgical procedure (nerve sparing or non-nerve sparing), age, and preoperative sexual status].

Future plans

We are interested in investigating the potential use of vascular endothelial growth factor gene therapy to stimulate cavernous nerve regeneration after nerve sparing and non-nerve sparing radical prostatectomy and enhance the return of natural erections sufficient for sexual intercourse.

To continue our ongoing research on assessment of sexual dysfunction in male and females patients who have undergone radical cystectomy.

To assess erectile function after I-125 seed radiation therapy for prostate cancer (T1-2) and the role of sildenafil citrate.


bladder cancer

Our research interests in bladder cancer are comprehensive, from screening and early detection to monitoring the treatment response of bladder cancer to BCG, to nerve sparing radical cystectomy, and to continent diversion for invasive and metastatic disease. Our laboratory has been at the forefront of clinical research in the area of urinary tumor markers and their role in screening or early detection of bladder cancer.

We have a large bladder cancer database, which is maintained prospectively. This database identifies patients who have been screened for bladder cancer, have been treated with intravesical chemotherapy, and have undergone radical surgery with continent diversion. The laboratory is interested in comparing the efficacy and durability of various types of continent reservoirs.

Our basic science research includes studies on the immunologic response to BCG and whether this response can be augmented with various interferons. In future, we would like to examine the relationship between levels of reactive oxygen species and the progression of superficial bladder cancer after intravesical therapy.

We are studying the ability of targeted multicolor fluorescence in situ hybridization (FISH) to identify malignant cells in cytological equivocal cases where morphology alone does not allow definitive diagnosis.

We are conducting an open comparative within patient controlled phase 3 multicenter Study of Hexvix fluorescence cystoscopy and standard cystoscopy in the detection of carcinoma in situ in patients with bladder cancer. Hexvix contains hexyl-5-aminolevulinate which are precursors of photoactive porphyrins preferentially taken up by bladder cancer cells, which can be utilized for identification and treatment guidance of malignant and pre-malignant lesions.

Our focus is to expand on this solid foundation and to obtain expert knowledge in the incidence and prevalence of bladder cancer in specific populations and implement screening tests, evaluate the predictive values of these tests, and determine the diagnostic algorithm for early detection of bladder cancer.


erectile dysfunction

Erectile Dysfunction after Radical Prostatectomy

The research laboratory is interested in the treatment of localized prostate cancer with radical prostatectomy and the associated complications of incontinence and erectile dysfunction (ED). Our interests in this field have been on surgical margin status and the effect of nerve-sparing surgery on incontinence and erectile function. We are involved in studies to assess the results of sildenafil citrate in salvaging erectile function in postprostatectomy patients.

Our clinical research includes the treatment of localized prostate cancer with radical prostatectomy, the associated complications of incontinence and ED, and quality of life issues in urological practice. Our research also involves a review of efficacy and long-term compliance of multiple treatments (intracavernous injections, vacuum constriction devices, MUSE- transurethral insertion of alprostatdil and sildenafil citrate) used to treat ED following radical surgeries. We are involved in studies to assess the results of sildenafil citrate in management of ED following radical prostatectomy. We were among the first to investigate the effects of this new oral medication in patients following radical prostatectomy and to study the impact of the presence or absence of the neurovascular bundles. We have recently assessed long-term follow-up compliance with sildenafil citrate therapy following radical prostatectomy. We are focusing on early treatment program after radical prostatectomy, a strategy used to help promote early nerve recovery and regeneration following radical surgery.

Our ongoing studies are focused on cutting edge issues in the management of ED. For example, we are investigating the role of sildenafil citrate in salvaging erectile function following radical prostatectomy and factors predicting its response [e.g., type of surgical procedure (nerve sparing or non-nerve sparing), age, and preoperative sexual status]. In future we are interested in investigating the potential use of vascular endothelial growth factor gene therapy to stimulate cavernous nerve regeneration after nerve sparing and non-nerve sparing radical prostatectomy and enhance the return of natural erections sufficient for sexual intercourse.

Long Term Potency following I-125 Seed Radiation Therapy For Prostate Cancer (T1-2) and Efficacy of Sildenafil Citrate

Erectile dysfunction is an important morbidity factor after the treatment of localized prostate cancer. In the past, the majority of the patients were elderly, where post-radiation potency was not a major factor in their decision to undergo radiation. A larger percentage of younger patients are choosing radiation therapy in recent years and therefore, the issue of post-radiation potency is becoming a major concern. Potency can be supplemented by the use of an oral adjunctive treatment, sildenafil citrate. Our ongoing study is focused on assessing long-term potency following I-125 seed implantation and efficacy of sildenafil citrate in management of ED following I-125 seed implantation. This study will evaluate the drug's long-term effects after brachytherapy for treatment of localized prostate cancer.

Male and Female Sexual Dysfunction after Radical Cystectomy

Radical cystectomy is the treatment of choice for locally advanced but invasive cancer of the bladder. Outcome data following radical cystectomy with or without orthotopic diversion has focused primarily on cure, urethral recurrence, and continence. We were among the first to conduct this novel study to address sexual dysfunction in subset of patient's (male & female) undergoing radical cystectomy. Using a SHIM (IIEF-5) validated questionnaire for males and a modified IFSF for females, we are assessing sexual function data in a contemporary radical cystectomy series. We are stratifying the sexual response as per orthotopic diversion to assess the efficacy of sildenafil citrate (in male) for salvaging ED following radical cystectomy.

Intracellular Assessment of Apoptotic - Neuropraxia Induced Erectile Dysfunction Following Radical Prostatectomy

We are evaluating corporal cavernosal apoptosis following RP in the canine model. Our hypothesis is that ED following RP may involve neuropraxia-induced apoptosis leading to corporal fibrosis. This study may reflect ongoing apoptosis in the corporal cavernosal tissue and may quantify the degree of neuropraxia following RP.


ApprovedResearchProjects
  • Role of Viagra in the treatment of erectile dysfunction in patients following: 1) radical prostatectomy; 2) radiation therapy, Pfizer Inc., 1999
  • Randomized prospective study of adjuvant androgen ablation in radical prostatectomy patients at high risk for disease recurrence, TAP Holdings Inc., M97-786, 1999
  • Indexing bladder tumor marker, NMP22 with hematuria, atypical cytology, and voided cytology results comparing its screening and monitoring capabilities, Matritech, 2001
  • Phase III diagnostic study of blue light fluorescent cystoscopy with reconstituted hexyl 5-aminolevulinate (hexvix®) versus white light cystoscopy for the detection of carcinoma in situ in patients with bladder cancer, 2002
  • Early use of vacuum constriction device (VCD) following radical prostatectomy (RP) facilitates early sexual activity and potentially earlier return of erectile function. Erec Aid System, Timm Medica, 2002
  • Combination therapy [sildenafil citrate + MUSE (PGE1)] for management of sildenafil citrate following radical prostatectomy, Vivus, 2003
  • Early MUSE treatment following radical prostatectomy to facilitate early sexual activity and potentially an earlier return of erections, Vivus, 2003
  • Role of sildenafil citrate in the management of erectile dysfunction following I-125 seed insertion for localized prostate cancer. Pfizer Inc., 2004
  • Role of sildenafil citrate in management of sexual dysfunction following radical cystectomy. Pfizer, Inc., 2004
  • Radical prostatectomy patients with erectile dysfunction, IRB #7565, 2004
  • Follow-up of carcinoma prostate and bladder patients, IRB #7599, 2004
  • Recovery of spontaneous erectile function after nerve sparing radical prostatectomy with or without intracavernous injections of alprostadil as an add on treatment to sildenafil: prospective study, IRB #7654, 2005.

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Last Update: November 29, 2008
Center for Reproductive Medicine
The Cleveland Clinic
10681 Carnegie Avenue, X11
Cleveland OH 44195
U.S.A.
CRM@ccf.org
 
© The Cleveland Clinic 2008