Proerectile pharmacological prophylaxis following nerve-sparing radical prostatectomy (NSRP)

Gontero, Paolo; Kirby, Roger

doi:10.1038/sj.pcan.4500737

Cited by 26 publications

(16 citation statements)

References 29 publications

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“…68,69 The combination of nerve damage with decreased arterial inflow may cause penile tissue hypoxia leading to apoptosis and collagen deposition, which ultimately results in venous leak, which in turn, has been linked to the pathophysiology of ED after RP. [70][71][72][73][74][75][76][77][78][79] As nerve recovery requires time, it is hypothesized that VED may bypass the neuropraxic period by directly dilating the cavernosal arteries, therefore, overcoming hypoxia and preventing apoptosis and fibrosis before the functional recovery of the cavernous nerve.…”

Section: 48-52mentioning

confidence: 99%

Vacuum therapy in erectile dysfunction—science and clinical evidence

et al. 2010

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Vacuum therapy (VT) utilizes negative pressure to distend the corporal sinusoids and to increase the blood inflow to the penis. Depending on its purpose, VT could be used as vacuum constriction device (VCD), with the aid of an external constricting ring which is placed at the base of penis to prevent blood outflow, maintaining the erection for sexual intercourse. Also, as a vacuum erectile device (VED), without the application of a constriction ring, just increases blood oxygenation to the corpora cavernosa and for other purposes. The emerging of phosphodiesterase 5 inhibitors (PDE 5 I) for the treatment of erectile dysfunction (ED) eclipsed VCD as therapeutic choice for ED; however, widespread usage of VED as part of penile rehabilitation after radical prostatectomy and other purposes rekindle the interest for VT. The underlying hypothesis is that the artificial induction of erections shortly after surgery facilitates tissue oxygenation, reducing cavernosal fibrosis in the absence of nocturnal erections, and potentially increases the likelihood of preserving erectile function. Due to its ability to draw blood into the penis regardless of nerve disturbance, VED has become the centerpiece of penile rehabilitation protocols. Herein, we reviewed the history, mechanism, application, side effects and future direction of VT in ED.

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Section: 48-52mentioning

confidence: 99%

Vacuum therapy in erectile dysfunction—science and clinical evidence

et al. 2010

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“…Furthermore, they had a significantly greater risk of developing venous leak within 6 months after RP (75% vs. 7% with BNS surgery), their erectile function as reflected by their IIEF-EF score failed to improve over time when compared at 6 and 18 months and, finally, their chance to recover natural erections or to respond to PDE5i was remarkably poor, 7% and 12%, respectively. Gontero and Kirby reviewed the literature on erectogenic pharmacotherapy after RP and suggested that since PDE5i response is poor and intracavernosal injection therapy is highly effective following NNS RP, intracavernosal injection therapy is the treatment of choice in the early postoperative period in these patients [23]. Gontero et al studied the association between PGE1 intracavernosal injections response, hemodynamic profile, and time elapsed from surgery over a time period of 1-12 months, among men who had NNS RP, and found that response rates decline over time: 82%, 63%, 57%, and 35% at 1, 2-3, 4-6, and 7-12 months, respectively.…”

Section: Discussionmentioning

confidence: 99%

Persistent Erectile Dysfunction Following Radical Prostatectomy: The Association between Nerve-Sparing Status and the Prevalence and Chronology of Venous Leak

Tal

Valenzuela

Aviv

et al. 2009

The Journal of Sexual Medicine

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Introduction Failure to recover erectile function after radical prostatectomy (RP) may result from venous leak as a sequela of neuropraxia-induced erectile tissue damage. Venous leak portends a poor prognosis for erections recovery as well as phosphodiesterase type 5 inhibitor (PDE5i) response. Aims To define the impact of RP nerve-sparing status on venous leak prevalence and chronology. Methods Study population: men who underwent RP for localized prostate cancer, had functional erections prior to RP, developed postoperative erectile dysfunction (ED), had a Doppler ultrasonography within 6 months of RP, and did not receive any ED treatment for the first 6 months after RP other than on-demand PDE5i. Main Outcome Measures Venous leak prevalence and erectile function recovery at different time-points. Results Data on 142 patients were analyzed, mean age: 58 ± 16 years. Sixty percent had bilateral nerve-sparing (BNS) surgery, 20% unilateral nerve-sparing (UNS) surgery, and 20% non-nerve-sparing (NNS) surgery. Eleven percent and 21% had venous leak by 3 and 6 months, respectively. Venous leak prevalence by 6 months was 7%, 11%, and 75% for BNS, UNS, and NNS surgery (P < 0.001). Mean end-diastolic velocity was 1.8, 2.1, and 7.2 cm/second for the three groups (P < 0.01). The only patients developing venous leak prior to 3 months were NNS patients, one-third of NNS-associated venous leak occurring before this time-point. At 18 months, the proportion of men having return of unassisted erections was 49%, 42%, and 7% with mean erectile function domain scores of 21, 18, and 12, and PDE5i response rates were 72%, 64%, and 12% for the three groups, respectively. Conclusions Nerve-sparing status impacts heavily upon the prevalence and the chronology of venous leak development post-RP. NNS RP is associated with early development of venous leak, increased prevalence of venous leak, and reduction in return of natural erections.

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“…Ereksiyon için potansiyel iyileşme süresi 6-36 ay arasında değişmekle birlikte olguların çoğunda ereksiyon düzeyi 12-24 ay sonra operasyon öncesi seviyeye gelmektedir (22). (27). PDE5i'nin kavernöz sinir travmasına bağlı meydana gelen ED'yi önlemede kullanımı ile ilgili deneysel çalışmalarda PDE5i çeşit-li düzeylerde etkili bulunmuştur (22).…”

Section: Patofizyolojiunclassified

After Radical Prostatectomy Erectile Dysfunction: Approach and Penile Rehabilitation Treatment Modalities

Aydın¹,

Özkan²

2012

JAREM

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ÖZETRadikal prostatektomi, organa sınırlı prostat kanserli olgularda altın standart tedavi olmasının yanında operasyon sonrası görülen erektil disfonksiyon olguların hayat kalitelerini ileri derecede bozmaktadır. Bu derlemede güncel literatür taranarak radikal prostatektomi sonrası görülen erektil disfonksiyon, patofizyoloji, korunma ve kullanılan tedavi modaliteleri değerlendirildi. Uygun hasta, ileri cerrahi teknik operasyon sonrası görülen erektil disfonksiyonun önlenmesinde önemlidir. Erken başlanılan rehabilitasyon programı erektil disfonksiyonun erken dönemde düzelmesini sağlamaktadır. Standart tedavi yöntemleri fosfodiesteraz 5 inhibitörleri, transüretral prostoglandin, intrakavernozal enjeksiyonlar, vakum cihazları ve penil protez implantasyonu gibi birbirleri arasında çeşitli avantaj, dezavantaj ve endikasyon farklılığı bulunan standart tedavi modelleri dışında büyüme faktörleri, immünofilinler, gen ve kök hücrelerle yapılan çalışmalar umut vericidir. (JAREM 2012; 2: 89-95) Anahtar Sözcükler: Radikal prostatektomi, erektil disfonksiyon, penil rehabilitasyon ABSTRACT Although radical prostatectomy is the golden standard treatment for organ confined prostate cancer, postoperative erectile dysfunction which can be seen after operations severely deteriorates the quality of life. In this compilation, by scanning the medical literature, the erectile dysfunction, pathophysiology, prevention and treatments used in post radical prostatectomy are reviewed. An appropriate patient is crucial to prevent erectile dysfunction seen after advanced surgical techniques operations. An early rehabilitation program allows rapid correction of erectile dysfunction . Standard treatment methods such as phosphodiesterase 5 inhibitors, transurethral prostaglandin, intracavernosal injections, vacuum devices and penile prosthesis implantation have many advantages and disadvantages, and standard treatments models have indication differences. The recent studies on growth factors, immunophilines, gene and stem cell treatments are promising. (JAREM 2012; 2: 89-95 GİRİŞRadikal prostatektomi (RP), organa sınırlı prostat kanseri saptanan ve yaşam beklentisi 10 yılın üstünde olan olgularda altın standart tedavi seçeneği olarak giderek artan sayılarla uygulanmaktadır. Tü-mörün tamamen çıkarılması operasyonun birinci amacıdır (1). Prostatektomi sonrası gelişen erektil disfonksiyon (ED) yaşam kalitesini etkileyen önemli sorunlardan biridir. Cerrahi sonrası hastaların %26-100 ünde görüldüğü tahmin edilmektedir (2). Walsh'un anatomik RP'yi tanımlaması ve son 20 yılda prostatın nöroanatomisinin daha iyi anlaşılması RP sonrası cinsel fonksiyonların devamı konusunda önemli aşamaların başındadır. Gelişmeler ne kadar hızlı olsa da yük-sek hasta sayısına sahip ve tecrübeli merkezler dışında RP sonrası sertleşme problemleri %50'lerin üzerinde seyretmektedir (3, 4).Prostatektomi sonrası ED'nin patofizyolojisi ile ilgili bilgilerimizde önemli gelişmeler olmuştur (5, 6). Kavernöz sinirlerin etkilenmesi ile pudental arter kesilerinin kavernöz düz kas ü...

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Proerectile pharmacological prophylaxis following nerve-sparing radical prostatectomy (NSRP)

Cited by 26 publications

References 29 publications

Vacuum therapy in erectile dysfunction—science and clinical evidence

Vacuum therapy in erectile dysfunction—science and clinical evidence

Persistent Erectile Dysfunction Following Radical Prostatectomy: The Association between Nerve-Sparing Status and the Prevalence and Chronology of Venous Leak

After Radical Prostatectomy Erectile Dysfunction: Approach and Penile Rehabilitation Treatment Modalities

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