Post-prostatectomy erectile dysfunction: contemporary approaches from a US perspective
Zachary Hamilton,1 Moben Mirza,2 1Department of Urology, 2Division of Urologic Oncology, Department of Urology, University of Kansas, Kansas City, KS, USA Abstract: Success of cancer surgery often leads to life-changing side effects, and surgical treatment for malignant urologic disease often resul...
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| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2014-05-01
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| Series: | Research and Reports in Urology |
| Online Access: | http://www.dovepress.com/post-prostatectomy-erectile-dysfunction-contemporary-approaches-from-a-a16826 |
| _version_ | 1811248845961560064 |
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| author | Hamilton Z Mirza M |
| author_facet | Hamilton Z Mirza M |
| author_sort | Hamilton Z |
| collection | DOAJ |
| description | Zachary Hamilton,1 Moben Mirza,2 1Department of Urology, 2Division of Urologic Oncology, Department of Urology, University of Kansas, Kansas City, KS, USA Abstract: Success of cancer surgery often leads to life-changing side effects, and surgical treatment for malignant urologic disease often results in erectile dysfunction (ED). Patients that undergo surgical prostatectomy or cystoprostatectomy will often experience impairment of erections due to disruption of blood and nerve supply. Surgical technique, nerve sparing status, patient age, comorbid conditions, and pretreatment potency status all have an effect on post-surgical ED. Regardless of surgical technique, prostatectomy results in disruption of normal anatomy and nerve supply to the penis, which governs the functional aspects of erection. A variety of different treatment options are available for men who develop ED after prostatectomy, including vacuum erection device, oral phosphodiesterase 5 inhibitors (PDE5I), intracorporal injections, and penile prosthesis. The vacuum erection device creates an artificial erection by forming a vacuum via suction of air to draw blood into the penis. The majority of men using the vacuum erection device daily after prostatectomy, regardless of nerve-sparing status, have erections sufficient for intercourse. Phosphodiesterase 5 inhibitors remain a common treatment option for post-surgical ED and are the mainstay of therapy. They work through cyclic adenosine monophosphate and cyclic guanine monophosphate pathways and are recommended in all forms of ED. Intracorporal injections or intraurethral use of vasoactive substances may be a good second-line therapy in men who do not experience improvement with oral medications. Surgical placement of a penile prosthesis is typically the treatment strategy of choice after other options have failed. Semi-rigid and inflatable devices are available with high satisfaction rates. With careful patient counseling and proper treatment selection, patient satisfaction and improved erectile function can be achieved. We advise that patients use a vacuum erection device daily in the early postoperative period in combination with an oral PDE5I. For patients who do not respond to a vacuum erection device or PDE5I, consideration should be given to intraurethral alprostadil, intracorporal injections, or a penile prosthesis. Keywords: vacuum erection device, phosphodiesterase inhibitor, intracorporal injection, penile prosthesis |
| first_indexed | 2024-04-12T15:35:11Z |
| format | Article |
| id | doaj.art-ff16041650834e4c94cf5fb8171ff7fb |
| institution | Directory Open Access Journal |
| issn | 2253-2447 |
| language | English |
| last_indexed | 2024-04-12T15:35:11Z |
| publishDate | 2014-05-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Research and Reports in Urology |
| spelling | doaj.art-ff16041650834e4c94cf5fb8171ff7fb2022-12-22T03:26:58ZengDove Medical PressResearch and Reports in Urology2253-24472014-05-012014default354116826Post-prostatectomy erectile dysfunction: contemporary approaches from a US perspectiveHamilton ZMirza MZachary Hamilton,1 Moben Mirza,2 1Department of Urology, 2Division of Urologic Oncology, Department of Urology, University of Kansas, Kansas City, KS, USA Abstract: Success of cancer surgery often leads to life-changing side effects, and surgical treatment for malignant urologic disease often results in erectile dysfunction (ED). Patients that undergo surgical prostatectomy or cystoprostatectomy will often experience impairment of erections due to disruption of blood and nerve supply. Surgical technique, nerve sparing status, patient age, comorbid conditions, and pretreatment potency status all have an effect on post-surgical ED. Regardless of surgical technique, prostatectomy results in disruption of normal anatomy and nerve supply to the penis, which governs the functional aspects of erection. A variety of different treatment options are available for men who develop ED after prostatectomy, including vacuum erection device, oral phosphodiesterase 5 inhibitors (PDE5I), intracorporal injections, and penile prosthesis. The vacuum erection device creates an artificial erection by forming a vacuum via suction of air to draw blood into the penis. The majority of men using the vacuum erection device daily after prostatectomy, regardless of nerve-sparing status, have erections sufficient for intercourse. Phosphodiesterase 5 inhibitors remain a common treatment option for post-surgical ED and are the mainstay of therapy. They work through cyclic adenosine monophosphate and cyclic guanine monophosphate pathways and are recommended in all forms of ED. Intracorporal injections or intraurethral use of vasoactive substances may be a good second-line therapy in men who do not experience improvement with oral medications. Surgical placement of a penile prosthesis is typically the treatment strategy of choice after other options have failed. Semi-rigid and inflatable devices are available with high satisfaction rates. With careful patient counseling and proper treatment selection, patient satisfaction and improved erectile function can be achieved. We advise that patients use a vacuum erection device daily in the early postoperative period in combination with an oral PDE5I. For patients who do not respond to a vacuum erection device or PDE5I, consideration should be given to intraurethral alprostadil, intracorporal injections, or a penile prosthesis. Keywords: vacuum erection device, phosphodiesterase inhibitor, intracorporal injection, penile prosthesishttp://www.dovepress.com/post-prostatectomy-erectile-dysfunction-contemporary-approaches-from-a-a16826 |
| spellingShingle | Hamilton Z Mirza M Post-prostatectomy erectile dysfunction: contemporary approaches from a US perspective Research and Reports in Urology |
| title | Post-prostatectomy erectile dysfunction: contemporary approaches from a US perspective |
| title_full | Post-prostatectomy erectile dysfunction: contemporary approaches from a US perspective |
| title_fullStr | Post-prostatectomy erectile dysfunction: contemporary approaches from a US perspective |
| title_full_unstemmed | Post-prostatectomy erectile dysfunction: contemporary approaches from a US perspective |
| title_short | Post-prostatectomy erectile dysfunction: contemporary approaches from a US perspective |
| title_sort | post prostatectomy erectile dysfunction contemporary approaches from a us perspective |
| url | http://www.dovepress.com/post-prostatectomy-erectile-dysfunction-contemporary-approaches-from-a-a16826 |
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