Persistent erectile dysfunction following radical prostatectomy: The association between nerve-sparing status and the prevalence and chronology of venous leak

Raanan Tal, Rolando Valenzuela, Nadid Aviv, Marilyn Parker, W Waters, Robert C. Flanigan, John P. Mulhall

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Introduction: 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. Aims: To define the impact of RP nerve-sparing status on venous leak prevalence and chronology. Methods: Study population: 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. Main Outcome Measures: 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.

Original languageEnglish (US)
Pages (from-to)2813-2819
Number of pages7
JournalJournal of Sexual Medicine
Volume6
Issue number10
DOIs
StatePublished - Jan 1 2009
Externally publishedYes

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Chronology
Erectile Dysfunction
Prostatectomy
Phosphodiesterase 5 Inhibitors
Doppler Ultrasonography
Recovery of Function
Prostatic Neoplasms
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Reproductive Medicine
  • Obstetrics and Gynecology
  • Urology

Cite this

Persistent erectile dysfunction following radical prostatectomy : The association between nerve-sparing status and the prevalence and chronology of venous leak. / Tal, Raanan; Valenzuela, Rolando; Aviv, Nadid; Parker, Marilyn; Waters, W; Flanigan, Robert C.; Mulhall, John P.

In: Journal of Sexual Medicine, Vol. 6, No. 10, 01.01.2009, p. 2813-2819.

Research output: Contribution to journalArticle

Tal, Raanan ; Valenzuela, Rolando ; Aviv, Nadid ; Parker, Marilyn ; Waters, W ; Flanigan, Robert C. ; Mulhall, John P. / Persistent erectile dysfunction following radical prostatectomy : The association between nerve-sparing status and the prevalence and chronology of venous leak. In: Journal of Sexual Medicine. 2009 ; Vol. 6, No. 10. pp. 2813-2819.
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abstract = "Introduction: 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. Aims: To define the impact of RP nerve-sparing status on venous leak prevalence and chronology. Methods: Study population: 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. Main Outcome Measures: 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.",
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T1 - Persistent erectile dysfunction following radical prostatectomy

T2 - The association between nerve-sparing status and the prevalence and chronology of venous leak

AU - Tal, Raanan

AU - Valenzuela, Rolando

AU - Aviv, Nadid

AU - Parker, Marilyn

AU - Waters, W

AU - Flanigan, Robert C.

AU - Mulhall, John P.

PY - 2009/1/1

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N2 - Introduction: 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. Aims: To define the impact of RP nerve-sparing status on venous leak prevalence and chronology. Methods: Study population: 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. Main Outcome Measures: 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.

AB - Introduction: 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. Aims: To define the impact of RP nerve-sparing status on venous leak prevalence and chronology. Methods: Study population: 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. Main Outcome Measures: 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.

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