[Sexual dysfunction in men after surgery of colorectal carcinoma. New developments in prevention and therapy]

Current procedures in the treatment of rectal carcinoma respect preservation quality of life. Development of sexual dysfunction (SD) in men after iatrogenic damage to neurovascular structures has been reported in 21-38% and significantly decreases quality of life. The author summarizes new developments in the area of surgical anatomy of Denonvilliers' fascia, occurrence of accessory pudendal arteries (APA), and neural anatomy. Introduction of robotic nerve-sparing surgery along with application of new diagnostic perioperative methods such as Doppler diagnostics and Optical Coherence Tomography will allow precise perioperative identification of neurovascular structures. New approaches in the treatment of erectile dysfunction prevent cavernosal hypoxia after neurovascular damage. Decrease of pO2 leads to fibrosis of penile structures and development of venous leak. Early administration of phosfodiesterasis-5 (PDE5) inhibitors forms the basis of treatment. Besides inducing erection in spite of decreased pO2, inhibitors PDE5 also have protective effect on the smooth muscles and endothelia of the penis. Combination with intracavernously applied prostaglandin PGE1 or with statins (Atorvastatin) increases efficacy. Currently, there is no standardized procedure in penile rehabilitation. Early start of therapy is recommended. In case of permanent medication support, the dosage for achieving erection is lower than in non-rehabilitated patients. Complex sexologiceal care is essential. It is necessary to initiate educational campaign of sexologists, surgeons, oncologists and patients themselves. Patients must be well informed and referred to a sexologist prior the treatment of carcinoma. Late start of rehabilitation leads to irreversible structural changes that require increased doses of drug therapy.