Erectile dysfunction following radical retropubic prostatectomy :
epidemiology, pathophysiology and pharmacological management.

Glickman Urological Institute and Department of Obstetrics and
Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.

Radical prostatectomy has been the time-honoured and standard treatment
option for prostate cancer. Erectile dysfunction (ED) is one of the
common quality-of-life issues following radical prostatectomy. The
recovery of potency following radical prostatectomy varies from 16% to
86%. Although major modifications in surgical technique appear to be
promising, the reported ED rates are still high. The time period
required for the recovery of erectile function after surgery varies from
6 to 24 months. During this period of neuropraxia lack of natural
erections produces cavernosal hypoxia.

This cavernosal hypoxia has been implicated as one of the most important
factors in the pathophysiology of ED. Cavernosal hypoxia predisposes to
cavernosal fibrosis, ultimately producing venous leak and long-term ED.

Interruption of this cascade of events has been the major challenge for
physicians.

Physicians have several options available for the treatment of ED.
However, oral treatment options have quickly become established as
first-line treatment options. Sildenafil has been most extensively
studied in the radical prostatectomy population. In patients who do not
respond to oral therapy alone, standard treatment options
(intracavernosal injections, vacuum constriction devices and
intraurethral alprostadil) are useful.

Use of penile prostheses is one of the oldest treatment options
available for the treatment of ED but is used only as a last resort.
Initial attempts to promote the earlier recovery of erectile function
appear to be promising. However, further confirmatory studies are
essential. The roles of gene transfer and growth factors are still in
experimental stages. In this review we discuss the epidemiology,
pathophysiology and treatment options available for ED following radical
prostatectomy.

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
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