Prospective comprehensive assessment of sexual function after retropubic non nerve sparing radical prostatectomy for localized prostate cancer

Abstract

Objectives: This prospective study was undertaken to assess sexual function according to a multidisciplinary comprehensive approach in patients with localized prostate cancer who were treated with radical prostatectomy.

Materials and methods: Patients with localized prostate cancer scheduled to undergo retropubic radical non nerve sparing prostatectomy participated to the study. International Index of Erectile Function (IIEF) and Self-rating Depression Scale (SDS) questionnaires were administered and patients were interviewed by a psychologist about their sexual function before and 1 month and 3 months after surgery and underwent nocturnal penile tumescence (NPT) monitoring for 3 nights before and 3 months after radical prostatectomy. After surgery patients were offered sexual counselling and were encouraged to experiment with oral treatment for erectile dysfunction. At 24 month follow up patients were interviewed asking for information PSA value, continence and sexual status.

Results: At basal IIEF score showed erectile dysfunction at various degree in 40%, SDS score demonstrated a mild depression in 10% and NPT tests showed a number or erectile episodes less than 3 in 30%, a total time of erection less than 60 minutes in 43% and a degree of rigidity less than 70% in 66%. IIEF scores were inversely related to SDS scores (r = -0.43, p < 0.012) and SDS scores were inversely related to time of erection at NPT (r = -0.44, p = 0.016). The mean basal IIEF score was significantly higher than the 1-month IIEF (p = 0.000) and 3-month IIEF score (p = 0.001) and the mean basal SDS score was significantly higher than the 3-month SDS score (p = 0.011). The mean degree of erections (p = 0.000), total time of erection (p = 0.004) and degree of erection (p = 0.003) at basal were significantly higher than at 3-month follow up. At 24 month follow up five patients replied that they were not able to achieve any erection (group A), 4 were able to achieve an erection only after intracorporeal injection of prostaglandins (group B), 3 were able to achieve erection after oral treatment with sildenafil and only one stated to be able to achieve spontaneously an erection sufficient to sexual intercourse (group C). The mean values of basal IIEF and SDS score at basal and the degree of erection at basal were not significantly different in the three groups whereas the mean number of erections and the mean total time of erection at basal NPT tests were significantly higher in group C than in group A and B.

Conclusion: Severe erectile dysfunction was observed in most patients after retropubic radical non nerve sparing prostatectomy, but 50% of candidates for radical treatment presents with abnormal erectile function before surgery when appropriately studied. Patients who will recover erectile function could be identified by NPT test before surgery. Depression associated with the fear for intervention is related with erectile dysfunction measured by IIEF scores before surgery, but depression index scores improve after surgery showing that the role of depression in the maintenance of erectile dysfunction is marginal. Sexual counselling and oral treatment facilitate recovery after surgery in patients with optimal erectile function before treatment.