Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Proerectile pharmacological prophylaxis following nerve-sparing radical prostatectomy (NSRP)

Prostate Cancer and Prostatic Diseases volume 7, pages 223–226 (2004)Cite this article

Abstract

The importance of an early pharmacological prophylaxis for erectile function following nerve-sparing radical prostatectomy has been recently stressed by several authors. In spite of that, patient's compliance to erectile rehabilitation protocols seems to be low. The present review is an attempt to define the expected benefits of the currently proposed rehabilitative protocols in terms of cost-efficiency and quality of life. The conclusion is that current scientific evidence in support of an early postoperative use of erectile aids is based mainly on indirect proof of a cavernosal damage that may follow the temporary postoperative ‘erectile silence’. Intracavernosal injections or a vacuum device may represent the best first-line treatment option for the first few months from the procedure as their mechanism of action does not require intact neural tissue for erection. Thereafter oral phosphodiesterase 5 inhibitor therapy may be a reasonable choice for those patients who can achieve at least a partial erection. A phosphodiesterase 5 inhibitor may not be effective when spontaneous erections are absent. It is possible, since the rehabilitation of sexual function aims to prevent cavernosal tissue damage by providing oxygenation to the erectile tissue, the choice of a potentially ineffective treatment may jeopardize the results of a reasonable nerve-sparing procedure.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it

$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

References

  1. Montorsi F et al. Recovery of spontaneous erectile function after nerve-sparing radical retropubic prostatectomy with and without early intracavernous injections of alprostadil: results of a prospective, randomized trial. J Urol 1997; 158: 1408–1410.

    Article  CAS  Google Scholar 

  2. Montorsi F, Burnett AL . Erectile dysfunction after radical prostatectomy. BJU Int 2004; 93: 1–2.

    Article  CAS  Google Scholar 

  3. Raina R et al. Long-term efficacy and compliance of intracorporeal (IC) injection for erectile dysfunction following radical prosatectomy: SHIM (IIEF-5) analysis. Int J Impot Res 2003; 15: 318–322.

    Article  CAS  Google Scholar 

  4. Penson DF et al. Is quality of life different for men with erectile dysfunction and prostate cancer compared to men with erectile dysfunction due to other causes? Results from the exceed data base. J Urol 2003; 169: 1458–1461.

    Article  Google Scholar 

  5. Smith DS et al. Patient preferences for outcomes associated with surgical management of prostate cancer. J Urol 2002; 167: 2117–2122.

    Article  Google Scholar 

  6. Gralnek D, Wessells H, Cui H, Dalkin BL . Differences in sexual function and quality of life after nerve sparing and nonnerve sparing radical retropubic prostatectomy. J Urol 2000; 163: 1166–1170.

    Article  CAS  Google Scholar 

  7. Bokhour BG, Clark JA, Inui TS . Sexuality after treatment for early prostate cancer: exploring the meanings of ‘erectile dysfunction’. J Gen Intern Med 2001; 16: 649–655.

    Article  CAS  Google Scholar 

  8. Penson DF et al. General quality of life 2 years following treatment for prostate cancer: what influences outcomes? Results from the prostate cancer outcome study. J Clin Oncol 2003; 21: 1147–1154.

    Article  Google Scholar 

  9. Rabbani F et al. Factors predicting recovery of erections after radical prostatectomy. J Urol 2000; 164: 1929–1934.

    Article  CAS  Google Scholar 

  10. Walsh PC . Radical prostatectomy for localised prostate cancer provides durable cancer control with excellent quality of life: a structured debate. J Urol 2000; 163: 1802–1807.

    Article  CAS  Google Scholar 

  11. Catalona WJ, Basler JW . Return of erections and urinary continence following nerve sparing radical retropubic prostatectomy. J Urol 1993; 150: 905–909.

    Article  CAS  Google Scholar 

  12. Standford JL et al. Urinary and sexual function after radical prostatectomy for clinically localised prostate cancer: the prostate cancer outcomes study. JAMA 2000; 283: 354–360.

    Article  Google Scholar 

  13. Talcott JA et al. Patient-reported impotence and incontinence after nerve-sparing radical prostatectomy. J Natl Cancer Inst 1997; 89: 1117–1123.

    Article  CAS  Google Scholar 

  14. Hara I et al. Comparison of quality of life following laparoscopic and open prostatectomy for prostate cancer. J Urol 2003; 169: 2045–2048.

    Article  Google Scholar 

  15. Katz R et al. Patient reported sexual function following laparoscopic radical prostatectomy. J Urol 2002; 168: 2078–2082.

    Article  Google Scholar 

  16. Padma-Nathan H et al. Postoperative nightly administration of sildenafil citrate significantly improves the return of normal spontaneous erectile function after bilateral nerve-sparing radical prostatectomy. J Urol 2003; 169 (Suppl): 1402.

    Google Scholar 

  17. McCullough AR . Prevention and management of erectile dysfunction following radical prostatectomy. Urol Clin North Am 2001; 28: 613–627.

    Article  CAS  Google Scholar 

  18. Leungwattanakij S et al. Cavernous neurotomy causes hypoxia and fibrosis in rat corpus cavernosum. J Androl 2003; 24: 239–245.

    Article  Google Scholar 

  19. User HM et al. Penile weight and cell subtype specific changes in a post-radical prostatectomy model of erectile dysfunction. J Urol 2003; 169: 1175–1179.

    Article  Google Scholar 

  20. Savoie M, Kim SS, Soloway MS . A prospective study measuring penile length in men treated with radical prostatectomy for prostate cancer. J Urol 2003; 169: 1462–1464.

    Article  Google Scholar 

  21. Mulhall JP et al. Erectile dysfunction after radical prostatectomy: hemodynamic profiles and their correlation with the recovery of erectile function. J Urol 2002; 167: 1371–1375.

    Article  Google Scholar 

  22. Schwarts EJ, Wong P, Graydon RJ . Sildenafil preserves intracorporeal smooth muscle after radical retropubic prostatectomy. J Urol 2004; 171: 771–774.

    Article  Google Scholar 

  23. Aboseif S et al. Role of penile vascular injury in erectile dysfunction after radical prostatectomy. BJU Int 1994; 73: 75–80.

    Article  CAS  Google Scholar 

  24. Fraiman MC, Lepor H, McCullough AR . Nocturnal penile tumescence activity in 81 patients presentino with erectile dysfunction (ED) after nerve sparing radical prostatectomy. J Urol 1999; 161 (Suppl 4S): 179.

    Article  Google Scholar 

  25. Zagaja GP, Mhoon DA, Aikens JE, Brendler CB . Sildenafil in the treatment of erectile dysfunction after radical prostatectomy. Urology 2000; 56: 631–634.

    Article  CAS  Google Scholar 

  26. Montorsi F et al. The subsequent use of I.C. alprostadil and oral sildenafil is more efficacious than sildenafil alone in nerve sparing radical prostatectomy. J Urol 2002; 167 (Suppl): 279.

    Google Scholar 

  27. Soderdahl DW, Thrasher JB, Hansberry KL . Intracavernosal drug-induced erection therapy versus external vacuum devices in the treatment of erectile dysfunction. BJU Int 1997; 79: 952–957.

    Article  CAS  Google Scholar 

Download references

Author information

Author notes

  1. P Gontero

    Present address: Clinica Urologica, Dipartimento Scienze Mediche, Universita' Piemonte Orientale, Via Solaroli, 17, 28100, Novara, Italy

Authors and Affiliations

  1. St George's Hospital, London, UK

    P Gontero & R Kirby

Authors
  1. P Gontero
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R Kirby
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P Gontero.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Gontero, P., Kirby, R. Proerectile pharmacological prophylaxis following nerve-sparing radical prostatectomy (NSRP). Prostate Cancer Prostatic Dis 7, 223–226 (2004). https://doi.org/10.1038/sj.pcan.4500737

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.pcan.4500737

Keywords

  • radical prostatectomy
  • nerve-sparing
  • erectile dysfunction
  • treatment
  • rehabilitation

This article is cited by

Search

Advanced search

Quick links