[Erectile function after nerve-sparing radical prostatectomy. Nocturnal early erection as a parameter of postoperative organic erectile integrity].
The time lapse before recovery of erectile function after nerve-sparing radical prostatectomy is still under debate. Several pathophysiologies are postulated for postoperative erectile function rehabilitation. In prospective studies we measured nocturnal penile tumescence (NPTR) in the acute phase during the first night after catheter removal subsequent to nerve-sparing radical prostatectomy to assess the neuronal organic erectile integrity. Eighteen sexually active patients suffering from local prostate cancer underwent bilateral and unilateral nerve-sparing retropubic radical prostatectomy. All patients completed an IIEF-5 questionnaire concerning erectile function preoperatively. The transurethral catheter was removed 14 days after surgery, and nocturnal penile tumescence was measured with an erectometer (Rigi-Scan) in each patient during the following night. None of these patients received any comedication interacting with erectile function. The preoperative IIEF score was >18 in all patients. After catheter removal, 17 of 18 patients (95%) had nocturnal penile radial rigidity >70% that persisted for >10 min during one night. In a control of four patients without a nerve-sparing procedure, no nocturnal erections were recorded. The measurement of NPTR in the acute phase after nerve-sparing radical prostatectomy showed retained erectile function even during the "first" night after catheter removal. Our findings are important for an appropriate choice of pharmacotherapy for optimal recovery of erectile function. In cases of early penile erections, the cavernous nerve had been well preserved during surgery providing good neuronal integrity, and PDE-5 inhibitors can support organic rehabilitation of the corpus cavernosum. In the absence of early penile erections, the neuronal integrity of the cavernous nerve is presumed to be impaired. In this case, additional injection therapy should be chosen to support recovery of spontaneous erectile function.
Bannowsky
A
A
Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel. abannowsky@urology.uni-kiel.de
Schulze
H
H
van der Horst
C
C
Stübinger
J H
JH
Portillo
F J Martinez
FJ
Jünemann
K P
KP
D000368:Aged; D003258:Consumer Behavior; D007172:Erectile Dysfunction / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D010410:Penile Erection / Q000502:physiology*; D010413:Penis / Q000294:innervation* / Q000503:physiopathology*; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000150:complications / Q000601:surgery*; D011788:Quality of Life; D020127:Recovery of Function / Q000502:physiology*; D012720:Severity of Illness Index; D016896:Treatment Outcome
Urologe A. 2003 Oct;42(10):1351-6
14569384
Cancer. 2003 Apr 1;97(7):1653-62
12655522
Eur Urol. 2003 Feb;43(2):95-101; discussion 101-2
12565764
J Urol. 1997 Oct;158(4):1408-10
9302132
Urology. 2000 Dec 20;56(6):906-11
11113728
Urology. 1998 Dec;52(6):963-6
9836537
Sao Paulo Med J. 2001 Jul 5;119(4):135-7
11500786
Urology. 2000 Oct 1;56(4):631-4
11018620
Int J Impot Res. 1998 Jun;10 (2):113-20
9647948
Eur Urol. 2004 Feb;45(2):123-33
14733995
Med J Aust. 1998 May 18;168(10):477-8
9631668
Actas Urol Esp. 1997 Oct;21(9):909-21
9471875
Curr Opin Urol. 2001 Nov;11(6):611-7
11734698
J Urol. 2000 Dec;164(6):1929-34
11061884
Urol Clin North Am. 2001 Aug;28(3):613-27
11590817
Urologe A. 2003 Apr;42(4):553-8
12715127
J Urol. 2003 Mar;169(3):1175-9
12576876
Urology. 2000 Jan;55(1):58-61
10654895
Urologe A. 2003 Sep;42(9):1196-202
14504752
Eur Urol. 2002 Aug;42(2):118-24
12160581