Erectile dysfunction following radical prostatectomy in a preoperative sexually active population: Cleveland clinic series

Abstract

Objective: To determine the erectile status, treatment options, and outcomes of patients following radical prostatectomy.Design: Prospective study.Materials/Methods: A review of a single surgical series (1997–2000) identified 176 sexually active patients who underwent nerve sparing (NS) or non-nerve-sparing (non-NS) radical prostatectomy (RP). All patients were indexed at least twelve months after their surgery. The patients received regular follow-up at 6 to 9 month intervals. The patients were questioned regarding their erectile status at each visit and standard treatment options like vacuum constriction device (VCD), intracavernous injection (IC) or medicated urethral system for erections (MUSE) were offered. Since its introduction, sildenafil citrate has been offered to all patients regardless of their previous therapy of erectile status. At each visit, therapy for erectile dysfunction (ED) was modulated to achieve the maximum patient satisfaction.Results: A sexually active population of 176 patients, of mean age 63 years, underwent NS 112/176 (63.6%) and 64/176 non-NS (36.3%) RP. Though 18% (32 of 176) patients regained spontaneous erections (34% NS, 4% non-NS) sufficient for successful vaginal intercourse after surgery, 78% (25 of 32) patients were dissatisfied with the quality of erections and sought adjuvant treatment. ED after RP was observed in 82% (138 of 176) patients. Though 43% (59 of 138) of the ED patients postoperatively attempted standard treatments (IC penile injections, MUSE, and VCD), no adjuvant therapy was sought by 57% (79 of 138) patients. With the introduction of oral therapy with sildenafil citrate, 42% (33 of 79) of the patients in the no-treatment subgroup tried treatments for ED for the first time. In the patients who were already taking standard treatments, 57.6% (34 of 59) patients switched to sildenafil citrate when it was offered as an option.Conclusions: While 18% of the patients regain erectile function after RP, nearly three-fourths seek adjuvant treatments to enhance their quality of erections. Though sexually active preoperatively, nearly 57% of these patients with ED after RP did not seek any treatment. However, with the introduction of sildenafil citrate, one-third of these patients were encouraged to try treatment for the first time. Therefore, oral therapy should be offered as a first treatment option for ED following RP.Supported by: None. Objective: To determine the erectile status, treatment options, and outcomes of patients following radical prostatectomy. Design: Prospective study. Materials/Methods: A review of a single surgical series (1997–2000) identified 176 sexually active patients who underwent nerve sparing (NS) or non-nerve-sparing (non-NS) radical prostatectomy (RP). All patients were indexed at least twelve months after their surgery. The patients received regular follow-up at 6 to 9 month intervals. The patients were questioned regarding their erectile status at each visit and standard treatment options like vacuum constriction device (VCD), intracavernous injection (IC) or medicated urethral system for erections (MUSE) were offered. Since its introduction, sildenafil citrate has been offered to all patients regardless of their previous therapy of erectile status. At each visit, therapy for erectile dysfunction (ED) was modulated to achieve the maximum patient satisfaction. Results: A sexually active population of 176 patients, of mean age 63 years, underwent NS 112/176 (63.6%) and 64/176 non-NS (36.3%) RP. Though 18% (32 of 176) patients regained spontaneous erections (34% NS, 4% non-NS) sufficient for successful vaginal intercourse after surgery, 78% (25 of 32) patients were dissatisfied with the quality of erections and sought adjuvant treatment. ED after RP was observed in 82% (138 of 176) patients. Though 43% (59 of 138) of the ED patients postoperatively attempted standard treatments (IC penile injections, MUSE, and VCD), no adjuvant therapy was sought by 57% (79 of 138) patients. With the introduction of oral therapy with sildenafil citrate, 42% (33 of 79) of the patients in the no-treatment subgroup tried treatments for ED for the first time. In the patients who were already taking standard treatments, 57.6% (34 of 59) patients switched to sildenafil citrate when it was offered as an option. Conclusions: While 18% of the patients regain erectile function after RP, nearly three-fourths seek adjuvant treatments to enhance their quality of erections. Though sexually active preoperatively, nearly 57% of these patients with ED after RP did not seek any treatment. However, with the introduction of sildenafil citrate, one-third of these patients were encouraged to try treatment for the first time. Therefore, oral therapy should be offered as a first treatment option for ED following RP. Supported by: None.