Rehabilitation of the Impotent Patient: An Update

Erectile dysfunction (ED) affects as many as 90% of patients after treatment for prostate cancer. Denervation appears to be the primary mechanism after either surgery or radiation; venooclusion or smooth-muscle dysfunction may follow. There may also be a vasculogenic component. Changes in surgical technique and pharmacologic prophylaxis may reduce the likelihood of ED. In men who desire reversal of ED, a stepwise approach beginning with oral sildenafil and, if that drug is ineffective, moving to intraurethral or intracavernous therapy and, finally, to a surgical approach is advisable.