Role of penile vascular injury in erectile dysfunction after radical prostatectomy.
OBJECTIVE
To investigate the cause of erectile dysfunction after nerve-sparing radical prostatectomy for clinically localized adenocarcinoma of the prostate (stage A or B).


METHODS
Erectile function was evaluated in 20 patients, mean age 65 years (range 44-74), both pre-operatively and 1 year after surgery by intracavernosal injection of a vasoactive agent (papaverine hydrochloride or prostaglandin E1) and pulsed Doppler ultrasonography. The degree of erection, the size of the cavernosal artery and penile arterial blood flow velocity were assessed.


RESULTS
Results revealed that the decreased response to intracavernosal injection of a vasoactive agent was associated with a significant reduction in both the diameter and velocity of blood flow within cavernosal arteries in 40% of patients after surgery. The pathological stage of the tumour did not correlate with the degree of vascular injury.


CONCLUSIONS
We conclude that post-prostatectomy impotence is multifactorial but vascular injury plays a substantial role.
Aboseif
S
S
Department of Urology, University of California School of Medicine, San Francisco.
Shinohara
K
K
Breza
J
J
Benard
F
F
Narayan
P
P
D000230:Adenocarcinoma / Q000601:surgery; D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D007172:Erectile Dysfunction / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000187:drug effects / Q000502:physiology*; D010413:Penis / Q000098:blood supply* / Q000000981:diagnostic imaging; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000601:surgery; D013997:Time Factors; D014463:Ultrasonography; D014662:Vasoconstrictor Agents / Q000494:pharmacology
D014662:Vasoconstrictor Agents