Post Radical Prostatectomy Erectile Dysfunction. A Single Centre Experience

Abstract

Introduction: This study aims to determine the effects of radical retropubic prostatectomy on post-operative erectile function.Materials & Methods: A total of 50 patients were included in this study, diagnosed with localized prostate cancer, and underwent nerve-sparing radical retropubic prostatectomy. All patients completed the International Index of Erectile Function (IIEF-5) questionnaire pre-operatively and on the third, sixth, and twelfth post-operative month and completed a self-reporting of their satisfaction with their sexual performance. Patients with a history of severe heart disease, were on erectile dysfunction medication, or had a score of 7 or less on the IIEF-5 questionnaire, were excluded from the study.Results: Pre-operatively it was observed that the lower the IIEF-5 score, the higher the biopsy Gleason score. Post-operatively, 16 patients stated that erectile function had returned to the pre-operative IIEF-5 category. In contrast, only 13 of them stated they were happy with their sexual performance on the self-reporting scale. The rest reported dissatisfaction despite returning to their pre-operative erectile function status. IIEF-5 scores were also different when compared amongst the four age groups, with scores indicating that younger age is related to higher IIEF-5 scores. At the 3-month follow-up, no statistically significant difference was observed between age groups. Finally, patients younger than 64 reported significantly less deterioration in post-operative erectile function.Conclusion: Post-radical prostatectomy erectile dysfunction remains one of the most pressing issues in prostate cancer therapy. A higher Gleason score has a more significant impact on pre-operative ED, and at the same time, the best post-operative ED results are observed in younger patients. Finally, patients need extensive follow-up, therapy, and pre-and post-operative psychological support to have the best possible erectile function.

Comorbidities Associated with Erectile Dysfunction Following Radical Prostatectomy at a University Hospital

“…This lends strength to the findings for scores 7 and 9 as well as the hypothesis that higher Gleason scores imply a higher ED index in the prognosis, as expected based on the literature. 5 Smoking was not significantly correlated with any of variable of PDE5 inhibitor use. Thus, there were no relevant statistical differences among smokers, ex-smokers and non-smokers for ED following RP in this study.…”

“…However, the rate was close to that found in the recent literature, which reported the prevalence of ED following RP to be 82.6%, without describing the time of the postoperative period or severity of ED 15 . Rates of severe dysfunction six months after the procedure were 74% and 57.3% in two studies, 5,11 whereas other studies reported the prevalence to be 76 to 87% at six months after the procedure, depending on the preservation of local nerves. 2 The daily use of tadalafil in the first three months following RP was significantly correlated with the Gleason score (p = 0.001).…”

“…Thus, the increase in the Gleason score was accompanied by greater use of tadalafil and a greater occurrence of ED in the prognosis of the patients, especially in the first three months. In a study conducted in March 2023, Konstantinos et al 5 also found greater ED severity following RP with the increase in the Gleason score. In the present investigation, however, this same tendency was not found for score 8, likely due to the smaller N as a limiting factor: tadalafil use rate of 56.66% for 8 (3+5) (9 of 16 patients), 66.66% for 8 (4+4) (20 of 30 patients) and 100% for 8 (5+3) (5 of 5 patients).…”

“…Adjunct therapy in PC is used in cases of greater disease aggressivity and ED is one of the complications of such therapy. 5,19 In the literature, RT alone for the treatment of low-risk PC increased the rate of impotence by 32% in patients who previously did not have ED and by 42% one year after treatment. 5,19 Thus, patients having undergone trimodal treatment are expected to be more prone to impotence as well as the cessation of medications due to persistent ED and the ineffectiveness of PDE5 inhibitors in these patients.…”

“…The best treatment depends on the stage and prognostic factors of the clinical evolution in each patient. 3 Radical prostatectomy (RP) is the gold standard in treatable cases 2,4 .This procedure can be performed through the perineal route, laparoscopy (robotassisted or not) or the retropubic route 1,4,5 .Erectile dysfunction (ED) is common in the postoperative period and is defined as an imbalance between contraction and relaxation of the smooth musculature of the corpus cavernosum. 4,6 The risk of ED is greater if RP compromises the nerve cells that innervate the penis.…”