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Radical Prostatectomy pp 167–188Cite as

Postoperative Management: Erectile Function

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Abstract

Erectile Dysfunction (ED) is among the most common and feared consequences of radical prostatectomy, irrespective of the surgical modality and approach. It can greatly affect the quality of life of both the patient and his partner and without question influences a man’s decision on if and how his prostate cancer will be treated. Improved understanding of surgical anatomy, physiology, pharmacology and biomedical technology has expanded the available options for treating ED, which currently include oral pills, externally applied penile devices, penile injections and suppositories, and penile prosthetic surgery. A relatively recent concept is that of penile rehabilitation, the attempt to, using available treatment options, restore spontaneous erectile function so that the patient may be independent of erectile aids. The employment of ED treatment and/or rehabilitation should be based on the patient’s goals after a thorough explanation of realistic expectations, risks and consequences of each treatment option. Finally, there are a multitude of possible treatment options still in the research phase which may in the future add to the available armamentarium for post-prostatectomy ED treatment and penile rehabilitation.

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Abbreviations

cGMP:

Cyclic guanosine monophosphate

ED:

Erectile dysfunction

EHS:

Erection hardness score

EPO:

Erythropoietin

ICI:

Intracavernous injection

IIEF:

International index of erectile function

IUA:

Intraurethral alprostadil

MCID:

Minimally clinical important dif-ference

MUSE:

Medicated urethral system for erection

NO:

Nitric oxide

NVB:

Neurovascular bundle

PDE:

5-Phosphodiesterase-5

PFBT:

Pelvic floor biofeedback training

QEQ:

Quality of erection questionnaire

SHIM:

Sexual health inventory for men

VED:

Vacuum erection device

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Authors and Affiliations

  1. Urology Department, Johns Hopkins Hospital, 600 N. Wolfe St., Marburg 409, Baltimore, MD, 21287, USA

    Robert L. Segal M.D., F.R.C.S. (c), Arthur L. Burnett M.D., M.B.A. & Trinity J. Bivalacqua M.D., Ph.D.

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  1. Robert L. Segal M.D., F.R.C.S. (c)
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  2. Arthur L. Burnett M.D., M.B.A.
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  3. Trinity J. Bivalacqua M.D., Ph.D.
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Correspondence to Trinity J. Bivalacqua M.D., Ph.D. .

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  1. Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

    James A. Eastham

  2. Brady Urological Institute, Johns Hopkins Medical Institution, Baltimore, Maryland, USA

    Edward M. Schaeffer

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Segal, R.L., Burnett, A.L., Bivalacqua, T.J. (2014). Postoperative Management: Erectile Function. In: Eastham, J., Schaeffer, E. (eds) Radical Prostatectomy. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8693-0_11

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