Effect of radical retropubic prostatectomy on erectile function, evaluated before and after surgery using colour Doppler ultrasonography and nocturnal penile tumescence monitoring

Abstract

Objective To assess the effect of radical retropubic prostatectomy on erectile function, by evaluating objectively patients' erectile function before and after surgery. Patients and methods The study comprised 126 patients with clinically localized prostate cancer who were scheduled to undergo radical retropubic prostatectomy. After giving informed consent for the study, 123 patients underwent intracavernosal injection tests, colour Doppler ultrasonography and nocturnal penile tumescence monitoring before and after surgery. Results From the intracavernosal injection tests and nocturnal penile tumescence monitoring, 21 patients (17%) were evaluated as having normal erectile function before surgery. After radical retropubic prostatectomy, nine (43%) of these 21 potent men had preserved erectile function. In eight patients whose neurovascular bundles were preserved, ®ve were potent after surgery. The cause of erectile function after surgery was a neurogenic disorder in seven and a related vascular disorder in ®ve. Conclusion From objective tests of erectile function on patients scheduled to undergo radical prostatectomy, 17% had normal erectile function. However, even after nerve-sparing radical retropubic prostatectomy, the proportion retaining potency was unsatisfactory. Although a neurological disorder was the main cause of erectile dysfunction after surgery, vascular disorders were also important.

Estimating the risk of long-term erectile, urinary and bowel symptoms resulting from prostate cancer treatment

“…ED is more common in older men 40 and in men who are on certain medications or who have medical illnesses such as coronary artery disease, high blood pressure and/or diabetes. 101 Patients with these risk factors are less likely to regain potency after the trauma of surgery.…”

“…56 Although ED is most commonly defined as the inability to maintain an erection firm enough for intercourse, ED varies from full erections to no penile stiffness and generally improves in the first year following surgery. Finally, it should be noted that the majority of studies are from tertiary care institutions; 17,19,28,35,38,[40][41][42]44,51 several studies are also based on patients who were operated on by a single surgeon. 22,36,[88][89][90][91][92][93] This is important to note because results from high-volume hospitals and/or single surgeons are not always reproducible in community (or population-based) studies (Table 4).…”

Erectile Dysfunction after Radical Prostatectomy and Its Treatment

“…2): A group of randomly selected patients (median age 65 years) scheduled for radical prostatectomy underwent nocturnal tumescence monitoring and color Doppler sonography after injection of prostaglandin E1. Only 17% of them passed for sexually potent according to the specified criteria [39]. The clinical truth lies somewhere inbetween which does not relieve us from the obligation to consider preoperatively as well as postoperatively stringent data only when we talk about potency after radical prostatectomy, i.e.…”

Management of Erectile Dysfunction Secondary to Treatment for Localized Prostate Cancer

“…Full erection recovery is significantly reduced if either one or both bundles are resected. 5,15,17,[20][21][22][23][24][25][26][27] Radical prostatectomy is still associated with significant morbidity. However, further refinements in surgical technique (eg, perioperative testing of the cavernosal nerves, videotape) will pave the way for minimal side effects while preserving efficacy of therapy.…”