Prevention and management of erectile dysfunction following radical prostatectomy

Most studies indicate general satisfaction rates of greater than 80% after radical retropubic prostatectomy. Nonetheless, erectile dysfunction remains the most common problem postoperatively, with rates ranging from 100% to 10% depending on the experience of the surgeon, the frequency with which he or she performs the surgery, the nerve-sparing nature of the procedure, the stage of the disease, and the age and preoperative potency of the patient. The natural recovery of erection function takes as long as 24 months and can be expedited by early treatment with intracorporal injection therapy. The treatment of erectile dysfunction after radical retropubic prostatectomy is highly successful despite the finding that fewer than 50% of patients seek treatment. Sildenafil does not seem to be effective early in the recovery phase but increases in efficacy as the nerves recover from intraoperative injury. Other modalities in the early recovery phase in the order of increasing effectiveness are intraurethral prostaglandin, the vacuum erection device, and intracorporal injection therapy. After 2 years from surgery, the recovery of natural function and improved sildenafil responsiveness are unlikely, and the implantation of a prosthesis is reasonable if other modalities are ineffective or unacceptable for the patient. Animal studies and human trials are underway to examine ways to expedite and maximize the return of erectile function.