title: Is there an optimal time for intracavernous prostaglandin E1 rehabilitation following nonnerve sparing radical prostatectomy? Results from a hemodynamic prospective study.
abstract: OBJECTIVE
  Previous studies have shown that early intracavernous prostaglandin E1 injection may reduce significantly the incidence of veno-occlusive dysfunction before spontaneous erections recover after nerve sparing radical prostatectomy. We identify the more convenient postoperative timing for successful intracavernous injection rehabilitation in a series of patients who underwent nonnerve sparing radical prostatectomy.
  
  
  METHODS
  A total of 73 patients with a normal preoperative International Index of Erectile Function score were randomly allocated to undergo dynamic color Doppler ultrasound study 20 mg. prostaglandin E1 at 1, 2 to 3, 4 to 6 and 7 to 12 months postoperatively, respectively. In all cases the peak systolic velocity, end diastolic velocity and resistance index were evaluated at 5, 10 and 20 minutes after injection.
  
  
  RESULTS
  Of the patients 36 received the intracavernous injection within the first 3 months (group 1) and 37 received it at 4 to 12 months (group 2). A significantly higher proportion of group 1 patients had grade 3 erection compared with group 2. Peak systolic velocity less than 30 cm. per second in at least 1 cavernosal artery was recorded in 22.2% of group 1 patients and 51.3% of group 2 (p >0.05).
  
  
  CONCLUSIONS
  Intracavernous injections after nonnerve sparing radical prostatectomy produce valid erectile responses in a significantly higher proportion of patients when started within month 3 after the operation. Injection given in postoperative month 1 gives the best response rate but with significant complications and poor patient compliance. Arteriogenic and venogenic factors seem to be involved with failure.
authors.affiliation: Clinica Urologica and the Istituto di Igiene, Dipartimento di Scienze Mediche, Università del Piemonte Orientale, Novara, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Gontero
authors.forename: Francesco
authors.initials: F
authors.lastname: Fontana
authors.forename: Andrea
authors.initials: A
authors.lastname: Bagnasacco
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Panella
authors.forename: Ervin
authors.initials: E
authors.lastname: Kocjancic
authors.forename: Giulliano
authors.initials: G
authors.lastname: Pretti
authors.forename: Bruno
authors.initials: B
authors.lastname: Frea
mesh_terms: D000368:Aged; D000527:Alprostadil / Q000008:administration & dosage*; D001783:Blood Flow Velocity; D007172:Erectile Dysfunction / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007267:Injections; D008297:Male; D010413:Penis / Q000098:blood supply; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000601:surgery*; D013997:Time Factors; D018615:Ultrasonography, Doppler, Color
chemical_list: D000527:Alprostadil