ERECTILE DYSFUNCTION AFTER RADICAL PROSTATECTOMY: HEMODYNAMIC PROFILES AND THEIR CORRELATION WITH THE RECOVERY OF ERECTILE FUNCTION

In men undergoing radical treatment for prostate cancer, erectile function is one of the most important health-related quality-of-life outcomes influencing patient choice in treatment. Penile rehabilitation has emerged as a therapeutic measure to prevent erectile dysfunction and expedite return of erectile function after radical prostatectomy. Penile rehabilitation involves a program designed to increase the likelihood of return to baseline-level erectile function, as opposed to treatment, which implies the therapeutic treatment of symptoms, a key component of post–radical prostatectomy management. Several pathological theories form the basis for rehabilitation, and a plethora of treatments are currently in widespread use. However, whilst there is some evidence supporting the concept of penile rehabilitation from animal studies, randomised controlled trials are contradictory in outcomes. Similarly, urological guidelines are conflicted in terms of recommendations. Furthermore, it is clear that in spite of the lack of evidence for the role of penile rehabilitation, many urologists continue to employ some form of rehabilitation in their patients after radical prostatectomy. This is a significant burden to health resources in public-funded health economies, and no effective cost-benefit analysis has been undertaken to support this practice. Thus, further research is warranted to provide both scientific and clinical evidence for this contemporary practice and the development of preventative strategies in treating erectile dysfunction after radical prostatectomy.

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1421: Glial Cell Derived Neurotrophic Factor (GDNF) Improves Erectile Function in a Model of Post Radical Prostatectomy Erectile Dysfunction

The Journal of Urology ◽

10.1016/s0022-5347(18)38646-4 ◽

2004 ◽

Vol 171 (4S) ◽

pp. 374-374

Author(s):

Jang H. Kim ◽

Yong Tae Kim ◽

Brandon S. Minnery ◽

Nelson E. Bennett ◽

Darren Wolfe ◽

...

Keyword(s):

Erectile Dysfunction ◽

Radical Prostatectomy ◽

Glial Cell ◽

Neurotrophic Factor ◽

Erectile Function

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SINGLE STEP IMPLANTATION OF AN ARTIFICIAL SPHINCTER OF THE BLADDER AND PENILE PROSTHESIS AS A METHOD OF CORRECTING OF ERECTILE DYSFUNCTION AND URINARY INCONTINENCE

Research n Practical Medicine Journal ◽

10.17709/2409-2231-2017-4-2-10 ◽

2017 ◽

Vol 4 (2) ◽

pp. 75-79

Author(s):

P. S. Kyzlasov ◽

M. M. Sokol’shchik ◽

N. A. Goncharov ◽

S. V. Porowski ◽

V. P. Sergeev ◽

...

Keyword(s):

Prostate Cancer ◽

Urinary Incontinence ◽

Erectile Dysfunction ◽

Radical Prostatectomy ◽

Erectile Function ◽

Single Step ◽

Optimal Method ◽

Acceptable Result ◽

Simultaneous Treatment ◽

Artificial Sphincter

This article provides a clinical example of the simultaneous implantation of an artificial sphincter of the bladder and a triple-component prosthesis of the penis, which allows almost completely to rehabilitate a patient with total incontinence and erectile dysfunction after laparoscopic radical prostatectom y for prostate cancer. The urgency of writing this article was a high incidence of prostate cancer, which has no tendency to decrease.It should be noted that when choosing the optimal method for treating prostate cancer, it is necessary to take into account the stage of the disease development, the patient’s age, concomitant diseases, possible complications, test results, and the wishes of the patient. In the stages of prostate cancer T1T2, radical prostatectomy in any of its embodiments, openly laparoscopically or with the help of a robot is a routine operation, at stage T3, in order to achieve an acceptable result, it is necessary not only sufficient surgical technique, but the correct preoperative preparation (the use of hormone therapy).One of the frequent complications of radical prostatectomy at stage T3 is urinary incontinence and erectile dysfunction, which is caused by the need for more “aggressive” techniques, the frequency of which reaches, in the opinion of different authors, 30 to 90%. With incontinence after a radical prostatectomy of moderate and severe degree, the implantation of an artificial urethral sphincter remains the preferred method of treatment. Artificial sphincter allows you to fully control the process of retention of urine and urination. Note that the restoration of potency after surgery is a very difficult problem. After the operation, one of the methods of preserving the erectile function is the early administration of 5fosofodiesterase inhibitors, but their reception does not always allow to maintain the erectile function, in this case, patients can be rehabilitated by penile implantation. The installation of a three-component phalloprosthesis or artificial sphincter separately is already a routine operation, but simultaneous treatment of two com plications and sim ultaneous im plantation of two prostheses is a rarity.

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When should the evaluation of erectile function be done before radical prostatectomy?

Urologia Journal ◽

10.1177/0391560319842956 ◽

2019 ◽

Vol 86 (3) ◽

pp. 148-151

Author(s):

Ali Yıldız ◽

Kaan Karamık ◽

Yasin Aktaş ◽

Hakan Anıl ◽

Ekrem İslamoğlu ◽

...

Keyword(s):

Erectile Dysfunction ◽

Surgical Treatment ◽

Radical Prostatectomy ◽

Prostate Biopsy ◽

Erectile Function ◽

Transrectal Ultrasound ◽

Before And After

The aim of this study is to assess the erectile function of patients before and after transrectal ultrasound prostate biopsy comparatively in order to determine the appropriate time to evaluate erectile function before radical prostatectomy. A total of 44 patients underwent transrectal ultrasound biopsy. We used the International Index of Erectile Function-5 questionnaire to assess all the patients. In total, 44 volunteered patients were included in this study. All patients were evaluated with the International Index of Erectile Function-5 questionnaire before the biopsy and at 4 weeks after the transrectal ultrasound biopsy. A total of 50% of patients were potent before the biopsy was done. A month after the biopsies, erectile dysfunction was reported by 29 of 44 patients (66%) as mild in 10 (22.7%), as mild-moderate in 14 (31.8%), as moderate in 4 (9.1%), and severe in 1 (2.3%). The differences were statistically significant in the first month of the biopsy ( p < 0.05). The effect of prostate biopsy upon the erectile function is non-negligible. However, this situation is temporary and transient. Therefore, it is recommended that the International Index of Erectile Function-5 questionnaire is to be administered prior to prostate biopsy rather than before surgical treatment.

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Ultrasonido Doppler de pene en la evaluación posterior a prostatectomía radical. Revisión bibliográfica y recomendaciones

Revista Mexicana de Urología ◽

10.48193/rmu.v78i4.97 ◽

2018 ◽

Vol 78 (4) ◽

Author(s):

Juan Fernando Uribe ◽

Luis Javier Aluma

Keyword(s):

Prostate Cancer ◽

Erectile Dysfunction ◽

Radical Prostatectomy ◽

Sexual Function ◽

Doppler Ultrasound ◽

Erectile Function ◽

Current Evidence ◽

Sexual Medicine ◽

Sexual Rehabilitation ◽

Complex Process

Changes in sexual function are common in patients following radical prostatectomy for prostate cancer. Sexual rehabilitation after radical prostatectomy requires a complex process in which the diagnosis is refined, and an accurate treatment program is chosen. Penile Doppler ultrasound is a commonly used method for diagnosing erectile dysfunction and it is very useful in certain cases after surgery to improve the assessment of arterial evaluation, venous leaks, and quality of the cavernous tissue and fascia. A literature search was conducted using the databases from Google and PubMed to identify original and review articles that examined the uses of penile Doppler ultrasound in post-radical prostatectomy evaluation or post-surgery rehabilitation. Search terms included: Erectile dysfunction post radical prostatectomy, sexual function post radical prostatectomy, Penile evaluation post-prostatectomy, Diagnosis of erectile function after radical surgery, Penile Doppler ultrasound AND prostatectomy, Penile Doppler ultrasound AND sexual rehabilitation. The initial search resulted in 415 articles. After applying additional filters, 46 studies were included in the present review. Backgrounds of the most relevant guidelines were cited: Standard practice in sexual medicine, Standard operating procedure in sexual medicine, International Consultation on Sexual Medicine, and the EAU and AUA guidelines. Information on the use of penile Doppler ultrasound before surgery is extremely inconsistent in the literature. The recommendations for a successful evaluation of post-radical prostatectomy patients were included. Sexual rehabilitation after radical prostatectomy requires a complex process. There is great inconsistency in the literature with respect to the definition of what is considered normal erectile function before surgery and what may be considered normal erection after radical prostatectomy. The cost of penile Doppler ultrasound is a modest component of the penile post-radical prostatectomy rehabilitation process. Current evidence does not support the systematic use of penile Doppler ultrasound, but it must be included in the management algorithm of the patient undergoing radical prostate surgery so that erectile function can be properly evaluated. KEYWORDS: Prostate cancer; Sexual Dysfunction; Erectile dysfunction; Sexual rehabilitation; Penile Doppler ultrasound; Radical Prostatectomy.

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Preclinical Evidence for the Benefits of Penile Rehabilitation Therapy following Nerve-Sparing Radical Prostatectomy

Advances in Urology ◽

10.1155/2008/594868 ◽

2008 ◽

Vol 2008 ◽

pp. 1-10 ◽

Cited By ~ 9

Author(s):

M. Albersen ◽

S. Joniau ◽

H. Claes ◽

H. Van Poppel

Keyword(s):

Erectile Dysfunction ◽

Radical Prostatectomy ◽

Erectile Function ◽

Nerve Fibers ◽

Nerve Sparing ◽

Pde5 Inhibitors ◽

Rehabilitation Therapy ◽

Erectile Tissue ◽

Vasoactive Substances ◽

Penile Rehabilitation

Erectile dysfunction following radical prostatectomy remains a frequent problem despite the development of nerve-sparing techniques. This erectile dysfunction is believed to be neurogenic, enhanced by hypoxia-induced structural changes which result in additional veno-occlusive dysfunction. Recently, daily use of intracavernous vasoactive substances and oral use of PDE5-inhibitors have been clinically studied for treatment of postprostatectomy erectile dysfunction. Since these studies showed benefits of “penile rehabilitation therapy,” these effects have been studied in a preclinical setting. We reviewed experimental literature on erectile tissue preserving and neuroregenerative treatment strategies, and found that preservation of the erectile tissue by the use of intracavernous nitric oxide donors or vasoactive substances, oral PDE5-inhibitors, and hyperbaric oxygen therapy improved erectile function by antifibrotic effects and preservation of smooth muscle. Furthermore, neuroregenerative strategies using neuroimmunophilin ligands, neurotrophins, growth factors, and stem cell therapy show improved erectile function by preservation of NOS-containing nerve fibers.

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