Post-prostatectomy erectile dysfunction: contemporary approaches from a US perspective

Abstract

Success of cancer surgery often leads to life-changing side effects, and surgical treatment for malignant urologic disease often results in erectile dysfunction (ED). Patients that undergo surgical prostatectomy or cystoprostatectomy will often experience impairment of erections due to disruption of blood and nerve supply. Surgical technique, nerve sparing status, patient age, comorbid conditions, and pretreatment potency status all have an effect on post-surgical ED. Regardless of surgical technique, prostatectomy results in disruption of normal anatomy and nerve supply to the penis, which governs the functional aspects of erection. A variety of different treatment options are available for men who develop ED after prostatectomy, including vacuum erection device, oral phosphodiesterase 5 inhibitors (PDE5I), intracorporal injections, and penile prosthesis. The vacuum erection device creates an artificial erection by forming a vacuum via suction of air to draw blood into the penis. The majority of men using the vacuum erection device daily after prostatectomy, regardless of nerve-sparing status, have erections sufficient for intercourse. Phosphodiesterase 5 inhibitors remain a common treatment option for post-surgical ED and are the mainstay of therapy. They work through cyclic adenosine monophosphate and cyclic guanine monophosphate pathways and are recommended in all forms of ED. Intracorporal injections or intraurethral use of vasoactive substances may be a good second-line therapy in men who do not experience improvement with oral medications. Surgical placement of a penile prosthesis is typically the treatment strategy of choice after other options have failed. Semi-rigid and inflatable devices are available with high satisfaction rates. With careful patient counseling and proper treatment selection, patient satisfaction and improved erectile function can be achieved. We advise that patients use a vacuum erection device daily in the early postoperative period in combination with an oral PDE5I. For patients who do not respond to a vacuum erection device or PDE5I, consideration should be given to intraurethral alprostadil, intracorporal injections, or a penile prosthesis.

Atuação da Fisioterapia Frente ás Disfunções Sexuais Masculinas: disfunção erétil e ejaculação precoce

“…Os autores relatam que cada paciente é único e que as técnicas escolhidas devem ser de acordo com a causa da disfunção sexual e a individualidade biológica de cada homem. Sendo assim, Hamilton & Mirza (2014) corroboram com Martin et al (2016), pois, eles relatam que há uma variedade de opções de tratamentos para homens que apresentam disfunção erétil, e, entre eles, estão dispositivos de ereção a vácuo, terapia medicamentosa, injeções intracavernosas e uso da prótese peniana, ressaltando que o uso dependerá da avaliação realizada. Porém, os recursos elencados são eficazes no tratamento da disfunção erétil e da ejaculação precoce.…”

Erectile Dysfunction: Treatments, Advances and New Therapeutic Strategies

“…Sural nerve grafts and/or neurorrhaphy have been used to reinstate lesioned nerve function at the cavernous level after pelvic trauma and after radical prostatectomy [262][263][264][265][266], which remains one of the major causes of ED in spite of the use of robot-assisted nerve sparing surgery compared to conventional surgical laparoscopy/open surgery methods. In fact, irrespective of the surgical technique used, prostatectomy causes disruption of normal pelvic anatomy and alters both the nerve and vascular supply to the penis [267,268]. Additionally, in this case, few studies are available, and the number of patients is very low.…”

Effects of Biofeedback in Preventing Urinary Incontinence and Erectile Dysfunction after Radical Prostatectomy

“…The prostate is an organ that is exclusive to the male gender, and which is located on the basis of the bladder and below the rectum, with the first region of the urethra traversing its volume. The prostate tissues include smooth muscles and fiber tissues, besides glands that produce part of the seminal fluid responsible for feeding the sperms ( 7 , 8 ).…”

“…The surgery can cause resection of the internal sphincter as well as a lesion in part of the external sphincter. This injury frequently results in complications, such as the urinary incontinence ( 3 , 9 , 10 ) and the erectile dysfunction ( 3 , 7 , 8 , 10 – 12 ).…”

“…In erectile dysfunction (ED), the vascular reflex mechanism is not able to pump blood with enough pressure toward the cavernous body of the penis, and consequently the penis erection cannot be maintained ( 5 ). Also, studies suggest that after prostatectomy the ischiocavernosus muscle, which is responsible for the rigidity phase of the erection, becomes weakened by the use of the bladder catheter, and that this weakening may also contribute to ED ( 4 , 7 , 8 , 12 ).…”