1. ¹Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, USA
2. ²Department of Internal Medicine and Pediatrics, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA

Correspondence: Dr CD Zippe, Glickman Urological Institute, Cleveland Clinic, 12000 McCracken Road, Suite 451, Garfield Heights, Cleveland, OH 44125, USA. E-mail: verdir@ccf.org

Received 19 December 2006; Revised 2 April 2007; Accepted 15 April 2007; Published online 9 August 2007.

Abstract

Erectile dysfunction is one of the most important quality of life issues following radical prostatectomy. The potency rates reported following nerve-sparing technique varies between 40 and 86%, and the time period required for complete recovery of erectile function varies from 6 to 24 months. The literature evidence suggests that lack of natural erections during this period of time produces cavernosal hypoxia. Prolonged periods of cavernosal hypoxia induce fibrosis, which later increases the incidence of venous leak. Recently, there is a growing interest among the physicians to interrupt these events by preventing cavernosal hypoxia during the period of neuropraxia. Initial studies using intracavernosal injection appears to be beneficial. In this article, we reviewed the pathophysiology of cavernosal hypoxia following radical prostatectomy with currently available evidence for the interventions to promote the nerve recovery and regeneration.