Erectile dysfunction following radical prostatectomy

Author(s): I. Pearce - Pages: 35–40

Abstract

Erectile dysfunction following radical prostatectomy for malignancy is a common and debilitating side effect of the procedure. This condition can have a significant negative impact on the quality of life of both the patient and his partner. Ideally, patients should be seen and counselled prior to their surgery, where possible, so that early conservative measures (e.g. weight loss, exercise and pelvic floor muscle training) can be instituted before or immediately after the operation. A full assessment is required in order to identify potentially reversible or modifiable concomitant risk factors, and management should follow a stepwise progression. Penile rehabilitation therapy with early daily phosphodiesterase type 5 inhibitors is gaining increasing acceptance because these drugs reduce penile fibrosis and loss of length, and also improve the response to treatment. Phosphodiesterase type 5 inhibitors, either daily or on demand, are the first-line therapy for erectile dysfunction, and have achieved excellent results in patients with good preoperative erectile function who received nerve-sparing surgery. Prostaglandin E1 (alprostadil) therapy and vacuum devices for erection provide avenues for second-line treatment. Penile prosthesis implants provide an excellent third and final line of management that results in extremely high patient and partner satisfaction.

Keywords: erectile dysfunction, management, radical prostatectomy, therapy.