Erectile dysfunction after radical prostatectomy: hemodynamic profiles and their correlation with the recovery of erectile function.
OBJECTIVE
Despite the advent of nerve sparing radical prostatectomy some men experience erectile dysfunction. Many of these men have vasculogenic erectile impairment in the form of arterial insufficiency or venous leakage. Recent data imply that early postoperative injection therapy may decrease the rate of erectile dysfunction. We defined hemodynamic patterns in patients who underwent bilateral nerve sparing radical prostatectomy to assess the chronology of venous leakage development and explore the correlation of hemodynamic profiles with the return of functional erection 12 months postoperatively.


METHODS
Patients with excellent preoperative erectile function who underwent bilateral nerve sparing surgery and had no pharmacological support for erectile dysfunction in the initial 12 months after surgery received vascular evaluation at presentation. Vascular evaluation involved cavernosometry or penile ultrasonography. Patients were then interviewed again at least 12 months postoperatively to assess the ability to achieve sexual intercourse.


RESULTS
Our study group comprised 96 men with a mean age plus or minus standard deviation of 54 +/- 12 years who met all inclusion criteria. All patients had pathologically proved organ confined disease. Mean time to the initial postoperative presentation was 6 +/- 5 months. Patients were divided into 4 groups according to the time of vascular studies postoperatively, namely less than 4 to 8, 9 to 12 and greater than 12 months. Normal vascular status, arterial insufficiency and venous leakage were diagnosed in 35%, 59% and 26% of the group, respectively. No difference in the incidence of arterial insufficiency was noted in the 4 time groups. Time postoperatively was significantly associated with the incidence of venous leakage (14% at less than 4 months and 35% at between 9 and 12). In regard to the correlation of the vascular diagnosis with the return to functional erection 47% of the normal, 31% of the arteriogenic and 9% of the venous leakage group achieved sexual intercourse 12 months postoperatively.


CONCLUSIONS
These data imply that the longer the duration of erectile dysfunction after radical prostatectomy, the greater the risk of venous leakage. Furthermore, it appears that the prognosis for the return of functional erection is worst when venous leakage is present.
Mulhall
John P
JP
Department of Urology, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois, USA.
Slovick
Ron
R
Hotaling
James
J
Aviv
Nadid
N
Valenzuela
Rolando
R
Waters
W Bedford
WB
Flanigan
Robert C
RC
D000293:Adolescent; D000328:Adult; D000818:Animals; D007172:Erectile Dysfunction / Q000209:etiology / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D010410:Penile Erection / Q000502:physiology*; D010413:Penis / Q000098:blood supply; D011184:Postoperative Period; D011379:Prognosis; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000601:surgery; D012039:Regional Blood Flow; D013997:Time Factors; D014652:Vascular Diseases / Q000150:complications / Q000503:physiopathology