Erectile Dysfunction following Radical Prostatectomy: A Review

Abstract

Radical prostatectomy remains the gold-standard treatment for localised prostate cancer. Despite the widespread introduction of nerve-sparing techniques, post-operative erectile dysfunction (ED) is still a significant source of morbidity. There are multiple approaches to prevent and treat ED. Recent refinements to surgical technique attempt to minimise disruption to the prostatic neural and arterial supply. A greater understanding of the factors affecting ED has also enabled the first multi-variate risk stratification model, thereby potentially improving awareness of pre-operative risk. Numerous on-demand treatments are available, including phosphodiesterase type 5 inhibitors, intracavernous/transurethral alprostadil, vacuum erection devices and combination therapy with multiple agents. As our understanding of the aetiology improves, attempts to manipulate the molecular mechanisms underpinning ED are also being investigated. In addition, early pharmacological rehabilitation is used to preserve cavernosal smooth muscle function until intra-operative neurapraxia resolves, although the optimum regimen is yet to be defined. Currently, much work is ongoing to improve our understanding and treatment of post-prostatectomy ED. We review the current status and recent advances in this field.