Recoverability of erectile function in post-radical cystectomy patients: subjective and objective evaluations.
BACKGROUND
Literature regarding both subjective and objective evaluations of erectile function following radical cystectomy is deficient.


OBJECTIVE
To study the recoverability of erectile function in post-radical cystectomy patients on subjective and objective bases.


METHODS
Between March 2003 and March 2005, 45 male patients with organ-confined invasive bladder cancer were prospectively enrolled in this study.


METHODS
Radical cystectomy and urinary diversion were offered to all patients (21 patients underwent a nerve-sparing [NS] surgical technique, and 24 patients underwent a non-nerve-sparing [NNS] surgical technique).


METHODS
Patients were evaluated preoperatively using the International Index of Erectile Function (IIEF) questionnaire and using penile Doppler ultrasound (PDU). Patients were followed up regularly at 2 mo, 6 mo, and 12 mo using the same parameters.


CONCLUSIONS
Among patients in the NS group, 17 patients (78.8%) were potent postoperatively: 12 patients (57.8%) with spontaneous complete tumescence and 5 patients (21%) with partial tumescence using phosphodiesterase type 5 inhibitor (PDE5-I) as erectogenic aid; 4 patients needed intracorporeal prostaglandin E1 injections. In contrast, no patients in the NNS group showed spontaneous erection, and they did not improve with sildenafil; all of them needed prostaglandins as an erectogenic aid. The comparison between preoperative and postoperative IIEF domains showed that postoperatively the erectile function and overall satisfaction domains deteriorated initially, but in the NS group they gradually improved with time (p<0.0001). Corresponding PDU findings were comparable in peak systolic velocity during the course of follow-up in both groups. Although the end diastolic velocity was significantly more deteriorated postoperatively than preoperatively in both groups, gradual improvement in patients in the NS group was more evident 12 mo after surgery.


CONCLUSIONS
The return of erectile function was better in the NS group on subjective and objective bases. The most significant change was in veno-occlusive function, which improved rapidly and progressively in the NS group during 1 yr of follow-up.
Hekal
Ihab A
IA
Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. eahekal@yahoo.com
El-Bahnasawy
Magdy S
MS
Mosbah
Ahmed
A
El-Assmy
Ahmed
A
Shaaban
Atallah
A
D015653:Cystectomy / Q000009:adverse effects*; D007172:Erectile Dysfunction / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D018783:Impotence, Vasculogenic / Q000209:etiology / Q000517:prevention & control; D007989:Libido; D008297:Male; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010410:Penile Erection / Q000502:physiology*; D010413:Penis / Q000000981:diagnostic imaging / Q000294:innervation / Q000503:physiopathology; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods; D011795:Surveys and Questionnaires; D014463:Ultrasonography; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*