Ultrasonido Doppler de pene en la evaluación posterior a prostatectomía radical. Revisión bibliográfica y recomendaciones

Abstract

Changes in sexual function are common in patients following radical prostatectomy for prostate cancer. Sexual rehabilitation after radical prostatectomy requires a complex process in which the diagnosis is refined, and an accurate treatment program is chosen. Penile Doppler ultrasound is a commonly used method for diagnosing erectile dysfunction and it is very useful in certain cases after surgery to improve the assessment of arterial evaluation, venous leaks, and quality of the cavernous tissue and fascia. A literature search was conducted using the databases from Google and PubMed to identify original and review articles that examined the uses of penile Doppler ultrasound in post-radical prostatectomy evaluation or post-surgery rehabilitation. Search terms included: Erectile dysfunction post radical prostatectomy, sexual function post radical prostatectomy, Penile evaluation post-prostatectomy, Diagnosis of erectile function after radical surgery, Penile Doppler ultrasound AND prostatectomy, Penile Doppler ultrasound AND sexual rehabilitation. The initial search resulted in 415 articles. After applying additional filters, 46 studies were included in the present review. Backgrounds of the most relevant guidelines were cited: Standard practice in sexual medicine, Standard operating procedure in sexual medicine, International Consultation on Sexual Medicine, and the EAU and AUA guidelines. Information on the use of penile Doppler ultrasound before surgery is extremely inconsistent in the literature. The recommendations for a successful evaluation of post-radical prostatectomy patients were included. Sexual rehabilitation after radical prostatectomy requires a complex process. There is great inconsistency in the literature with respect to the definition of what is considered normal erectile function before surgery and what may be considered normal erection after radical prostatectomy. The cost of penile Doppler ultrasound is a modest component of the penile post-radical prostatectomy rehabilitation process. Current evidence does not support the systematic use of penile Doppler ultrasound, but it must be included in the management algorithm of the patient undergoing radical prostate surgery so that erectile function can be properly evaluated. KEYWORDS: Prostate cancer; Sexual Dysfunction; Erectile dysfunction; Sexual rehabilitation; Penile Doppler ultrasound; Radical Prostatectomy.