ERECTILE DYSFUNCTION FOLLOWING RADICAL PROSTATECTOMY


Authors: MUDr. Miroslav Záleský;  Doc. MUDr. Roman Zachoval, Ph.D.;  MUDr. Petr Nencka;  MUDr. Viktor Vik;  MUDr. Vladislav Klemenc
Authors‘ workplace: Urologické oddělení FTN
Published in: Urol List 2007; 5(3): 62-68

Overview

The growing rate of detection of prostate cancer in its localised stage has resulted in a growing number of radical prostatectomies performed and in a growing relevance of subsequent complications affecting the patients' quality of life. Erectile dysfunction is one of the most frequent complications of radical prostat­ectomy (ED). The objective of this overview is to summarise information concerning the incidence, causes, prevention and treatment of erectile dysfunction following radical prostatectomy (RP).

References to key words ”erectile dysfunction, radical prostatectomy“ were searched in the Medline database. Information obtained from the respective sources was used as a basis for this work.

The incidence of ED following RP primarily depends on the age, pre-surgical condition of the patient's erection and the surgical technique applied. The cause of ED following RP is damage or temporary neurapraxy of nervous filaments in the neurovascular bundles (NVB) passing laterodorsally in close vicinity of the prostate. Protracted neurapraxy provokes changes in the cavernous bodies, which causes further deterioration in ED. The incidence of ED following RP can be influenced by the application of nerve-saving surgical techniques and by different measures taken prior to and after the surgery. Among the treatment options for ED following RP is oral treatment with 5-phpsphpdiesterase inhibitors, intracavernous injection therapy, vacuum pump therapy and intraurethral alprostadil therapy. Penile implant surgery is the method of choice for ED following RP to which the above therapies cannot be applied.

Bilateral or unilateral nerve-saving surgery is the basis for prevention of erectile dysfunction following RP. Recently published works on ED following RP point out prophylactic measures reducing the incidence of ED, and the need for early initiation of therapy that may prevent ED from developing into its final stage involving cavernous body fibrosis.

Key words:
prostate carcinoma, radical prostatectomy, erectile dysfunction


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