Pharmacological treatment of erectile dysfunction after radical prostatectomy

The potential for potency after radical retropubic prostatectomy has improved considerably since the anatomical description of the neurovascular bundles to the penis and a technique whereby these nerves may be spared from injury. However, impotence remains an unavoidable complication in some patients. It is in such patients that we have chosen to evaluate the technique of intracavernosal injection of a papaverine/phentolamine mixture to obtain erections. After classical radical prostatectomy potency was restored by the injection technique in 12 of 14 patients (85 per cent). Three patients who failed to attain erections initially had successful results with larger doses. Two patients who failed to achieve erections had the lowest penile brachial index values and 1 in whom priapism developed had the highest value, indicating that this may be a useful technique to determine the initial dosage of the injection.