Erectile function after cystectomy with neurovascular preservation

Abstract

ObjectivesTo study the utility of neurovascular preservation for postoperative erection in radical cystectomy. Materials and methodsRetrospective analysis of 44 cystectomies performed at our center between January 2006 and December 2009 in men <65 years. In 11 cases a neurovascular preservation was done. We analyzed age, BMI, indication for surgery, urinary diversion, use of i-PDE5 or alprostadil, and daytime and nighttime continence. Erection Hardness Score (EHS) was used to assess erectile function. ResultsSpontaneous postoperative erectile function in preservation group was 44.4% EHS 4, 33.3% EHS 3 and 22.3% EHS 1 (achieving EHS 3 or 4 with alprostadil). In the non preservation group, 4.5% achieved EHS 4 spontaneously. The other 95.5% had EHS 0 (4.5% achieved EHS 3 with tadalafil 20mg and 9% with intracavernous injections). Variables age (p=0.001) and nerve-sparing surgery (p<0.001) were related to postoperative erectile function recovery. In the multivariate analysis, nerve-sparing surgery remained statistically significant. ConclusionsThe functional results in preserving cystectomy are promising. The preservation should be considered in young patients without erectile dysfunction.