Sexual dysfunction after radical prostatectomy

Abstract

Sexual dysfunction associated with radical retropubic prostatectomy (RRP) may start before the surgery. Men undergoing RRP frequently have some degree of sexual dysfunction. In addition to the psychological stress of the diagnosis, the biopsy may itself have a detrimental effect. After surgery, all men will experience loss of ejaculate, because the organ responsible for ejaculate has been removed. Orgasm quality is adversely affected in many men. Erectile dysfunction is immediate and recovery from it is slow. Initially, phosphodiesterase (PDE)-5 inhibitors do not work, and they take up to 18 months for their effect to be maximized. Younger men who have had bilateral nerve-sparing procedures respond the best. Combination treatment with prostaglandin E1 or high-dose PDE-5 inhibitors may provide salvage therapy when initial PDE-5 inhibitor therapy has failed.

Figure 1

(A) Preoperative and (B) 1 month postoperative scans showing nocturnal penile tumescence (tum). The profound loss of nocturnal erections after radical prostatectomy is demonstrated. Rig, rigidity.

Figure 2

(A) Nocturnal erection rigidity among study responders and nonresponders and (B) erectile function (EF) domain scores before and after radical prostatectomy. Reprinted with permission from Padma-Nathan et al.