title: Persistent erectile dysfunction following radical prostatectomy: the association between nerve-sparing status and the prevalence and chronology of venous leak.
abstract: BACKGROUND
  . Failure to recover erectile function after radical prostatectomy (RP) may result from venous leak as a sequela of neuropraxia-induced erectile tissue damage. Venous leak portends a poor prognosis for erections recovery as well as phosphodiesterase type 5 inhibitor (PDE5i) response.
  
  
  OBJECTIVE
  To define the impact of RP nerve-sparing status on venous leak prevalence and chronology.
  
  
  METHODS
  
  
  
  METHODS
  men who underwent RP for localized prostate cancer, had functional erections prior to RP, developed postoperative erectile dysfunction (ED), had a Doppler ultrasonography within 6 months of RP, and did not receive any ED treatment for the first 6 months after RP other than on-demand PDE5i.
  
  
  METHODS
  Venous leak prevalence and erectile function recovery at different time-points.
  
  
  RESULTS
  Data on 142 patients were analyzed, mean age: 58 +/- 16 years. Sixty percent had bilateral nerve-sparing (BNS) surgery, 20% unilateral nerve-sparing (UNS) surgery, and 20% non-nerve-sparing (NNS) surgery. Eleven percent and 21% had venous leak by 3 and 6 months, respectively. Venous leak prevalence by 6 months was 7%, 11%, and 75% for BNS, UNS, and NNS surgery (P < 0.001). Mean end-diastolic velocity was 1.8, 2.1, and 7.2 cm/second for the three groups (P < 0.01). The only patients developing venous leak prior to 3 months were NNS patients, one-third of NNS-associated venous leak occurring before this time-point. At 18 months, the proportion of men having return of unassisted erections was 49%, 42%, and 7% with mean erectile function domain scores of 21, 18, and 12, and PDE5i response rates were 72%, 64%, and 12% for the three groups, respectively.
  
  
  CONCLUSIONS
  Nerve-sparing status impacts heavily upon the prevalence and the chronology of venous leak development post-RP. NNS RP is associated with early development of venous leak, increased prevalence of venous leak, and reduction in return of natural erections.
authors.affiliation: Sexual & Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York 10065, NY, USA.
authors.forename: Raanan
authors.initials: R
authors.lastname: Tal
authors.forename: Rolando
authors.initials: R
authors.lastname: Valenzuela
authors.forename: Nadid
authors.initials: N
authors.lastname: Aviv
authors.forename: Marilyn
authors.initials: M
authors.lastname: Parker
authors.forename: W Bedford
authors.initials: WB
authors.lastname: Waters
authors.forename: Robert C
authors.initials: RC
authors.lastname: Flanigan
authors.forename: John P
authors.initials: JP
authors.lastname: Mulhall
mesh_terms: D006305:Health Status Indicators; D006439:Hemodynamics; D006801:Humans; D018783:Impotence, Vasculogenic / Q000150:complications* / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D010410:Penile Erection / Q000502:physiology; D010413:Penis / Q000098:blood supply* / Q000293:injuries* / Q000294:innervation; D015995:Prevalence; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000601:surgery; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology