Surgery and erectile dysfunction

Erectile Dysfunction (ED) is one of the most negatively impacting complications associated with pelvic surgery. To date, several technical approaches and therapeutics options are available to limit the impact of pelvic surgical treatment on sexual health. The present article focuses on the short and long term outcomes of pelvic surgery in terms of erectile dysfunction.

A Medline search was conducted to identify original and review articles as well as editorials addressing the functional outcome after surgery. Keywords included radical prostatectomy, radical cystectomy, rectal cancer and erectile dysfunction.

Erectile function impairment represents the most significant complication of pelvic surgery, negatively impacting the overall sexual health. The rates of ED range from 25-100%of patients, according to the extension of the pelvic dissection, the conservation of the neurovascular structures, as well as in consideration of the preoperative erectile function of the patients. Recent advances in the knowledge of pelvic anatomy resulted in an increase in the rates of erectile function recovery, especially in patients subjected to radical prostatectomy. The use of pro-erectile drugs significantly improves the outcomes of patients treated with nerve-sparing approach. Radical cystectomy for muscle-invasive bladder cancer is still associated with a high rate of erectile dysfunction. Similarly, pelvic surgery for rectal cancer is often a cause of ED in patients surviving to cancer treatment. Presence of urinary or faecal diversions surely represent a limitation to sexual activity in men.

Recent advances in surgical technique and in the awareness of pelvic anatomy led to a better comprehension of the structures responsible for erectile function in pelvic surgery. New strategies are necessary in order to further reduce the rates of ED after this frequent surgical approach.