Erectile dysfunction after radical prostatectomy

Hemodynamic profiles and their correlation with the recovery of erectile function

John P. Mulhall, Ron Slovick, James Hotaling, Nadid Aviv, Rolando Valenzuela, W Waters, Robert C. Flanigan

Research output: Contribution to journalArticle

186 Citations (Scopus)

Abstract

Purpose: Despite the advent of nerve sparing radical prostatectomy some men experience erectile dysfunction. Many of these men have vasculogenic erectile impairment in the form of arterial insufficiency or venous leakage. Recent data imply that early postoperative injection therapy may decrease the rate of erectile dysfunction. We defined hemodynamic patterns in patients who underwent bilateral nerve sparing radical prostatectomy to assess the chronology of venous leakage development and explore the correlation of hemodynamic profiles with the return of functional erection 12 months postoperatively. Materials and Methods: Patients with excellent preoperative erectile function who underwent bilateral nerve sparing surgery and had no pharmacological support for erectile dysfunction in the initial 12 months after surgery received vascular evaluation at presentation. Vascular evaluation involved cavernosometry or penile ultrasonography. Patients were then interviewed again at least 12 months postoperatively to assess the ability to achieve sexual intercourse. Results: Our study group comprised 96 men with a mean age plus or minus standard deviation of 54 ± 12 years who met all inclusion criteria. All patients had pathologically proved organ confined disease. Mean time to the initial postoperative presentation was 6 ± 5 months. Patients were divided into 4 groups according to the time of vascular studies postoperatively, namely less than 4 to 8, 9 to 12 and greater than 12 months. Normal vascular status, arterial insufficiency and venous leakage were diagnosed in 35%, 59% and 26% of the group, respectively. No difference in the incidence of arterial insufficiency was noted in the 4 time groups. Time postoperatively was significantly associated with the incidence of venous leakage (14% at less than 4 months and 35% at between 9 and 12). In regard to the correlation of the vascular diagnosis with the return to functional erection 47% of the normal, 31% of the arteriogenic and 9% of the venous leakage group achieved sexual intercourse 12 months postoperatively. Conclusions: These data imply that the longer the duration of erectile dysfunction after radical prostatectomy, the greater the risk of venous leakage. Furthermore, it appears that the prognosis for the return of functional erection is worst when venous leakage is present.

Original languageEnglish (US)
Pages (from-to)1371-1375
Number of pages5
JournalJournal of Urology
Volume167
Issue number3
DOIs
StatePublished - Jan 1 2002
Externally publishedYes

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Recovery of Function
Erectile Dysfunction
Prostatectomy
Blood Vessels
Hemodynamics
Venous Insufficiency
Coitus
Chronology
Aptitude
Incidence
Ultrasonography
Pharmacology
Injections

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Erectile dysfunction after radical prostatectomy : Hemodynamic profiles and their correlation with the recovery of erectile function. / Mulhall, John P.; Slovick, Ron; Hotaling, James; Aviv, Nadid; Valenzuela, Rolando; Waters, W; Flanigan, Robert C.

In: Journal of Urology, Vol. 167, No. 3, 01.01.2002, p. 1371-1375.

Research output: Contribution to journalArticle

Mulhall, John P. ; Slovick, Ron ; Hotaling, James ; Aviv, Nadid ; Valenzuela, Rolando ; Waters, W ; Flanigan, Robert C. / Erectile dysfunction after radical prostatectomy : Hemodynamic profiles and their correlation with the recovery of erectile function. In: Journal of Urology. 2002 ; Vol. 167, No. 3. pp. 1371-1375.
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abstract = "Purpose: Despite the advent of nerve sparing radical prostatectomy some men experience erectile dysfunction. Many of these men have vasculogenic erectile impairment in the form of arterial insufficiency or venous leakage. Recent data imply that early postoperative injection therapy may decrease the rate of erectile dysfunction. We defined hemodynamic patterns in patients who underwent bilateral nerve sparing radical prostatectomy to assess the chronology of venous leakage development and explore the correlation of hemodynamic profiles with the return of functional erection 12 months postoperatively. Materials and Methods: Patients with excellent preoperative erectile function who underwent bilateral nerve sparing surgery and had no pharmacological support for erectile dysfunction in the initial 12 months after surgery received vascular evaluation at presentation. Vascular evaluation involved cavernosometry or penile ultrasonography. Patients were then interviewed again at least 12 months postoperatively to assess the ability to achieve sexual intercourse. Results: Our study group comprised 96 men with a mean age plus or minus standard deviation of 54 ± 12 years who met all inclusion criteria. All patients had pathologically proved organ confined disease. Mean time to the initial postoperative presentation was 6 ± 5 months. Patients were divided into 4 groups according to the time of vascular studies postoperatively, namely less than 4 to 8, 9 to 12 and greater than 12 months. Normal vascular status, arterial insufficiency and venous leakage were diagnosed in 35{\%}, 59{\%} and 26{\%} of the group, respectively. No difference in the incidence of arterial insufficiency was noted in the 4 time groups. Time postoperatively was significantly associated with the incidence of venous leakage (14{\%} at less than 4 months and 35{\%} at between 9 and 12). In regard to the correlation of the vascular diagnosis with the return to functional erection 47{\%} of the normal, 31{\%} of the arteriogenic and 9{\%} of the venous leakage group achieved sexual intercourse 12 months postoperatively. Conclusions: These data imply that the longer the duration of erectile dysfunction after radical prostatectomy, the greater the risk of venous leakage. Furthermore, it appears that the prognosis for the return of functional erection is worst when venous leakage is present.",
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