RECOVERY OF SPONTANEOUS ERECTILE FUNCTION AFTER NERVE-SPARING RADICAL RETROPUBIC PROSTATECTOMY WITH AND WITHOUT EARLY INTRACAVERNOUS INJECTIONS OF ALPROSTADIL: RESULTS OF A PROSPECTIVE, RANDOMIZED TRIAL

No AccessJournal of UrologyClinical Urology: Original Articles1 Oct 1997RECOVERY OF SPONTANEOUS ERECTILE FUNCTION AFTER NERVE-SPARING RADICAL RETROPUBIC PROSTATECTOMY WITH AND WITHOUT EARLY INTRACAVERNOUS INJECTIONS OF ALPROSTADIL: RESULTS OF A PROSPECTIVE, RANDOMIZED TRIAL Francesco Montorsi, Giorgio Guazzoni Luigi, Luigi Ferini Strambi, Luigi F. Da Pozzo, Luciano Nava, Luigi Barbieri, Patrizio Rigatti, Giuliano Pizzini, and Alberto Miani Francesco MontorsiFrancesco Montorsi , Giorgio Guazzoni LuigiGiorgio Guazzoni Luigi , Luigi Ferini StrambiLuigi Ferini Strambi , Luigi F. Da PozzoLuigi F. Da Pozzo , Luciano NavaLuciano Nava , Luigi BarbieriLuigi Barbieri , Patrizio RigattiPatrizio Rigatti , Giuliano PizziniGiuliano Pizzini , and Alberto MianiAlberto Miani View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)64227-7AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: This study was aimed at assessing prospectively the effect of postoperative intracavernous injections of alprostadil on the recovery of spontaneous erectile function after nervesparing radical retropubic prostatectomy. Materials and Methods: A total of 30 potent patients with clinically localized prostate cancer (clinical stage B1 or B2, Gleason sum 7 or greater, prostatic specific antigen less than 20 ng./ml.) underwent nerve-sparing radical retropubic prostatectomy and was subsequently randomized to alprostadil injections 3 times per week for 12 weeks (group 1, 15 patients) or observation without any erectogenic treatment (group 2, 15 patients). Patients were assessed at the 6-month followup by sexual history, physical examination, color Doppler sonography of the cavernous arteries and polisomnographic recording of nocturnal erections. Results: In group 1, 12 patients (80%) completed the entire treatment schedule and were evaluated at the long-term followup. Eight patients in this group (67%) reported the recovery of spontaneous erection sufficient for satisfactory sexual intercourse, compared with 3 patients (20%) in group 2. The difference between the 2 group was statistically significant (p <0.01). In group 1, all but 1 patient reporting normal postoperative erections also showed normal erections at nocturnal testing, whereas color Doppler sonography demonstrated normal penile hemodynamics in all of them. In these patients, failures were the result of cavernous veno-occlusive dysfunction (2 cases, 17%) and cavernous nerve injury (2 cases, 17%). In group 2, patients with normal erections showed both normal nocturnal testing and penile hemodynamics, whereas failures were the result of cavernous veno-occlusive dysfunction (8 cases, 53%), cavernous arteries insufficiency (2 cases, 13%) or cavernous nerve injury (3 cases, 20%). Complications in patients treated with alprostadil injections accounted for 2 cases (13%) of a penile nodule and 1 further case (6%) of prolonged penile erection. Complications were not seen in group 2 patients. Conclusions: Early postoperative administration of alprostadil injections significantly increases the recovery rate of spontaneous erections after nerve-sparing radical retropubic prostatectomy. It is our belief that programmed vasoactive injections cavernous oxygenation, thereby limiting the development of hypoxia-induced tissue damage. The potential complications related to the use of intracavernous injections must be clearly explained to patients. References 1 : Impotence following radical prostatectomy: insight into etiology and prevention.. J. Urol.1982; 128: 492. Abstract, Google Scholar 2 : Precise localization of the autonomic nerves from the pelvic plexus to the corpora cavernosa: a detailed anatomical study of the adult male pelvis.. J. Urol.1985; 133: 207. Abstract, Google Scholar 3 : Patient-reported complications and follow-up treatment after radical prostatectomy. The National Medicare Experience: 1988-1990 (updated June 1993).. Urology1993; 42: 622. 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Volume 158Issue 4October 1997Page: 1408-1410 Advertisement Copyright & Permissions© 1997 by American Urological Association, Inc.MetricsAuthor Information Francesco Montorsi More articles by this author Giorgio Guazzoni Luigi More articles by this author Luigi Ferini Strambi More articles by this author Luigi F. Da Pozzo More articles by this author Luciano Nava More articles by this author Luigi Barbieri More articles by this author Patrizio Rigatti More articles by this author Giuliano Pizzini More articles by this author Alberto Miani More articles by this author Expand All Advertisement PDF downloadLoading ...