Erectile dysfunction after surgical treatment

REVIEW

Erectile dysfunction after surgical treatment*

VINCENZO MIRONE,CIRO IMBIMBO,ALESSANDRO PALMIERI,NICOLA LONGO and FERDINANDO FUSCO

Urologic Clinic,University ÔFederico II Õ,Naples,Italy

Summary

Erectile dysfunction is a recognized complication of prostate and bladder radical surgery,although there is significant variation in the reported risk,much of this

variability is related to the retrospective nature of most previous studies.Undoubtedly,the quality of life of bladder and prostate cancer patients would be much improved if both normal micturition and potency are preserved,which is the subject of this article.Quality of life studies can delineate sexual function after radical prostatectomy,including the use of sexual aids.Penile erection is a neurovascular event modulated by

neurotransmitters and hormonal status.The penis is innervated by autonomic and somatic nerves.Both surgery and radiation therapy appear to affect such a mechanism.Radiation is thought to produce Erectile Dysfunction (ED)by accelerating microvascular angiopathy causing cavernosal fibrosis or stenosis of the pelvic arteries and by accelerating existing arteriosclerosis,leading to vascular impotence.Years may elapse before clinically significant ED occurs.Criteria that influence recovery of erections after surgery include younger patient age,stronger erections before operation,preservation of the neurovas-cular bundles,and attention to fine details in the surgical technique.Recovery of

erections occurs in 68%of preoperatively potent men treated with bilateral nerve-sparing surgery and in 47%of those treated with unilateral nerve-sparing surgery.Keywords:Cancer,Erectile Preservation,Treatment for Erectile Dysfunction

Introduction

Penile erection is a neurovascular event modulated by neurotransmitters and hormonal status.The penis is inner-vated by autonomic and somatic nerves.In the pelvis,the sympathetic and parasympathetic nerves merge to form the cavernous nerves,which enter the corpora cavernosa to regulate blood flow during erection and detumescence.The parasympathetic visceral efferent fibres arise from sacral roots 2–4to supply the pelvic plexus located on the lateral wall of the rectum.The cavernous nerves leave the pelvic plexus and travel in the lateral pelvic fascia on the posterolateral surface of the prostate gland to supply the corpora cavernosa

of the penis.The somatic component,the pudendal nerve,is

responsible for penile sensation.Autonomic denervation followed by blunt pelvic or perineal trauma,radical pelvic surgeries (e.g.for colon or prostate cancer)affect poor smooth muscle relaxation,arterial insufficiency and venous abnormalities,thus preventing adequate erection (Lue,2000).Both surgery and radiation therapy appear to affect this plications of prostate cancer therapy and radical cystectomy,include erectile dysfunction,which can be significant incontinence and bowel dysfunction.These complications may significantly diminish quality of life.Of patients receiving therapy,45%list the maintenance of quality of life as a principal concern when selecting prostate cancer therapy (Zippe et al .,1998).Treatment selection is often made after consideration of related side-effects and subsequent quality of life.Erectile

dysfunction

Correspondence:Alessandro Palmieri M.D.,via Morghen,18180129,Naples,Italy

*This is a review article for the 2nd European Congress of Andrology in Malmo ¨,Sweden.

international journal of andrology,26:137–140(2003)

Ó2003Blackwell Publishing Ltd.