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Role of penile vascular injury in erectile dysfunction after radical prostatectomy
S Aboseif1, K Shinohara, J Breza
1Department of Urology, University of California School of Medicine, San Francisco.
Objective:
To investigate the cause of erectile dysfunction after nerve-sparing radical prostatectomy for clinically localized adenocarcinoma of the prostate (stage A or B).
Patients And Methods:
Erectile function was evaluated in 20 patients, mean age 65 years (range 44-74), both pre-operatively and 1 year after surgery by intracavernosal injection of a vasoactive agent (papaverine hydrochloride or prostaglandin E1) and pulsed Doppler ultrasonography. The degree of erection, the size of the cavernosal artery and penile arterial blood flow velocity were assessed.
Results:
Results revealed that the decreased response to intracavernosal injection of a vasoactive agent was associated with a significant reduction in both the diameter and velocity of blood flow within cavernosal arteries in 40% of patients after surgery. The pathological stage of the tumour did not correlate with the degree of vascular injury.
Conclusion:
We conclude that post-prostatectomy impotence is multifactorial but vascular injury plays a substantial role.