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Non-pharmacologic Erectile Dysfunction Treatments After Prostate Cancer Therapy

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Sexual Function in the Prostate Cancer Patient

Part of the book series: Current Clinical Urology ((CCU))

Abstract

Erectile dysfunction (ED) after treatment for prostate cancer (radical prostatectomy, radiotherapy, or androgen deprivation therapy) is common. Systemic therapy with the PDE5 inhibitors is successful in a lower percentage of these patients than it is in men with ED of other etiologies. Penile injection therapy often results in usable erections in these men but its acceptability may be limited because of pain which is more common in this subset of patients. Vacuum erection device therapy and penile prosthesis implantation are non-pharmacologic options available for the treatment of ED after prostate cancer therapy.

The literature is surveyed for penile prosthesis implantation in men treated for prostate cancer and an overview of the results is presented. Special considerations for penile prosthesis implantation before, after, and during radical prostatectomy are discussed. Some surgeons prefer two-piece inflatable penile prosthesis implantation after radical prostatectomy because of concerns regarding scarring of the lower abdominal fascia and the retropubic space which might complicate reservoir placement. Evidence is presented that three-piece inflatable penile prosthesis implantation can safely be accomplished in these patients.

Penile prosthesis implantation before and after radiation therapy for prostate cancer is reviewed as is penile prosthesis placement after androgen ablation therapy. Vacuum constriction devices remain an option for prostate cancer patients in whom pharmacologic agents are ineffective or contraindicated and who are not interested in or are poor operative candidates for penile prosthesis implantation.

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  1. Cleveland Clinic, Cleveland, OH, USA

    Brian R. Lane

  2. Professor of Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Director, Center for Genitourinary Reconstruction, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

    Drogo K. Montague

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    Lane, B.R., Montague, D.K. (2009). Non-pharmacologic Erectile Dysfunction Treatments After Prostate Cancer Therapy. In: Mulhall, J. (eds) Sexual Function in the Prostate Cancer Patient. Current Clinical Urology. Humana Press. https://doi.org/10.1007/978-1-60327-555-2_14

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