Management of Erectile Dysfunction Following Radical Prostatectomy

Abstract

Prostate cancer is the most commonly diagnosed and treated solid tumor in American men. In 1999, approx 180,000 new cases of prostate cancer were diagnosed, whereas more than 37,000 men died of the disease (1). Treatment options for prostate cancer include radical prostatectomy, external beam radiation, hormonal ablation, and brachytherapy. Each of these modalities is associated to some degree with erectile dysfunction (ED) as a potential consequence of treatment. Radical prostatectomy continues to be the treatment of choice in the majority of cases of organ-confined prostate cancer. Careful extirpation of the prostate gland in these patients offers a hope for cure. Although rates of tumor eradication with this procedure are excellent, radical prostatectomy is not without morbidity. Sexual and voiding dysfunction are the most frequent complications of radical prostatectomy (2). The recently published Prostate Cancer Outcomes study reported that at 18 mo following radical prostatectomy, 8.4% of men were incontinent for urine, whereas 59.9% of men were impotent (3). These patients may also exhibit other sexual dysfunctions such as ejaculatory failure, shortening of the penis, fibrotic changes in the penis, and orgasmic dysfunction.