Damage to the erectile function following radical pelvic surgery: prevalence of veno-occlusive dysfunction

A retrospective study was carried out to investigate the prevalence of venoocclusive dysfunction (VOD) in 44 patients who developed impotence following radical cystectomy (24 patients, 55%) and radical prostatectomy (20 patients, 45%) for invasive cancer, performed using a non nerve-sparing technique. Patient evaluation included sexual history, hormone profile, intracavernosal injection test and, in the nonresponders to the test, dynamic infusion cavernosometry and cavernosography (DICC). The follow-up period investigated ranged from 6 months to 9 years and 5 months (average 2.5 years). Our data indicate a 11% prevalence (5 patients) of postsurgical VOD with impotence following radical cystectomy and a 5% prevalence (2 patients) of impotence following radical prostatectomy. In the 7 patients (5 after cystectomy and 2 after prostatectomy) who underwent DICC, cavernosal artery insufficiency was detected. No correlation was found between VOD and the time from surgery (from 6 months to 9 years, average 4.4 years), in both the post-cystectomy and post-prostatectomy groups. Our data indicate that there are not only neurogenic causes of impotence following radical pelvic surgery, VOD and cavernosal artery insufficiency can also be partly responsible. Furthermore, it was shown that erectile inactivity, even in the long-term, does not affect the possible return of drug-induced sexual potency.