Nocturnal Tumescence: A Parameter for Postoperative Erectile Integrity After Nerve Sparing Radical Prostatectomy

Abstract

NPTR recording during the acute phase after nerve sparing radical prostatectomy showed residual erectile function as early as the first night after catheter removal. These results are significant for selecting adequate pharmacological treatment for optimal therapy and rehabilitation of satisfactory erections and sexual function. In cases of early nocturnal tumescence, application of a PDE5 inhibitor can support successive organ rehabilitation. However, if tumescence does not occur, penile injection therapy is recommended.

Current state of penile rehabilitation after radical prostatectomy

“…This study is the first to present objective data in the human population that early pharmacologic intervention can modify the natural history of postprostatectomy erectile dysfunction [25 ,26]. This study also demonstrates the profound loss of erectile function 4 weeks postoperatively noted by NPT studies in contrast to relatively preserved erectile function (95%) demonstrated through NPT studies at 1 week postoperatively by Bannowsky et al [27] This stark difference certainly underscores that immediately postoperatively there is still preserved nervous and structural potency, and that much of the pathogenesis of postprostatectomy erectile dysfunction is related more to nonacute neural and structural alterations in bilateral nerve sparing surgery, and that we may have a window of opportunity to intervene. Criticisms of the Padma-Nathan et al study include a small sample size which can be attributed at least in part to the early termination of the study, and nondisclosure of the number of surgeons involved in the subgroup of evaluable patients.…”

Nervenerhaltende radikale Prostatektomie mit niedrig dosiertem Sildenafil

“…Alle Patienten wiesen einen präoperativen IIEF-Score >16 (16)(17)(18)(19)(20)(21)(22)(23)(24)(25) Bezüglich des endgültigen Tumorstadiums ergab sich kein signifikanter Unterschied der Anzahl der nächtlichen Erektionen und der Rigidität (p=0,331). Ein Vergleich zum präoperativen nächtlichen Erektionsstatus war innerhalb dieses Studienkonzepts aufgrund der sedativen Prämedikation am Abend vor Prostatektomie nicht möglich.…”

“…[17] konnten zeigen, dass bei ED-Patienten unterschiedlicher Genese 100 mg Sildenafil täglich zur Nacht eingenommen im Vergleich zu Placebo die Qualität und Anzahl der nächt-lichen Erektionen mittels NPTR-Messung signifikant gesteigert werden konnte. Eigene Untersuchungen konnten bei nervenerhaltend operierten Männern in der akuten postoperativen Phase nach Entfernung des transurethralen Dauerkatheters ebenfalls eine spontane nächtliche erektile Aktivität in der NPTR-Messung zeigen und damit die potentielle Wirksamkeit einer abendlichen PDE-5-Hemmereinnahme nachweisen [18].…”

Penile rehabilitation following treatment for prostate cancer: an analysis of the current state of the art

“…18 Nocturnal penile tumescence that occurs during the rapid eye movement sleep phase in men with normal erections has been identified as an important component in preserving normal erectile function through tissue oxygenation, a phenomenon which is lost during the period of neurapraxia. [19][20][21] The chronic low oxygen tensions within the postoperative penis are believed to initiate severe fibrotic changes in the cavernosal tissue, which ultimately lead to venoocclusive dysfunction. 22 A penile hemodynamic study among patients who underwent NSRP who had no pharmacological support in the initial year after surgery revealed a progressive incidence of venous leakage, varying from 14% at 4 months to 50% at later than 12 months.…”