Doctor’s Guide ranks this as the top-read abstract about prostate cancer for the week of March 23, 2006. The stretch of one statistical finding in this study is remarkable - “The recovery of potency following radical prostatectomy varies from 16% to 86%.” This finding is in line with a review a couple of years ago in Greece which found:

Although low incidences of incontinence and erectile dysfunction after radical prostatectomy have been reported in the hands of experienced surgeons, the literature review revealed a great variety, with incontinence rates ranging from 0.3-65.6% and potency rates ranging from 11-87%. Several factors contribute to this wide difference, the most important being the application of a meticulous surgical technique.

Whether even the best surgeon will be able to spare either one or both sets of erectile nerves has to depend on what he finds when he eyeballs the prostate and seen the exact location and extent of the tumor. If you choose surgery, do not put yourself in inexpert hands. Find yourself an artist.

Drugs Aging. 2006;23(2):101-17.
Erectile dysfunction following radical retropubic prostatectomy : epidemiology, pathophysiology and pharmacological management.
Nandipati KC, Raina R, Agarwal A, Zippe CD.
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.

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