Sexual Function After Surgery for Prostate or Bladder Cancer

Alejandro J. Miranda-Sousa, MD; Hugo H. Davila, MD; Jorge L. Lockhart, MD; Raul C. Ordorica, MD; Rafael E. Carrion, MD

Disclosures

Cancer Control. 2006;13(3):179-187. 

In This Article

Local Surgical Treatment of Prostate Cancer

Radical prostatectomy has an immediate and significant impact on erectile function. It can affect nocturnal, morning, and psychogenic erections. Bilateral nervesparing procedures do not guarantee preservation of sexual potency. Moreover, a significant proportion of men undergoing radical prostatectomy fail to recover to the preoperative levels of erectile function. Reported rates of recovery of erectile function after prostate surgery vary widely, ranging from 9% to 86%.[26,27,28,29,30,31,32,33,34,35] This wide range of outcomes may be due to differences in assessments used to evaluate erectile function status or may be the result of the extent and precision of the nervesparing surgical techniques used in different institutions.

Several factors are involved in the etiology of erectile dysfunction after radical prostatectomy, even when a nerve-sparing technique is used. Direct neurogenic injury is the most obvious effect. In addition, blunt nerve damage can play an important but often overlooked role in the risk for erectile dysfunction. This category of blunt, indirect injury to the nerve can include stretch, thermal, and ischemic injuries. Also, nonneurogenic causes such as advanced age and vascular and psychologic factors can result in erectile dysfunction.[34,36]

Iatrogenic vascular injury has been related to erectile dysfunction after radical prostatectomy.[37] Inadvertent injury to internal and accessory pudendal arteries that provide blood supply to the penis has been described in up to 85% of patients.[38,39]

Atrophic and fibrotic changes of the penis occur in men who have undergone radical prostatectomy.[40,41] Degeneration of nerve terminations occurs within the erectile tissue, as well as corporeal smooth-muscle deterioration and infiltration of the erectile tissue with collagen.[36,42] This type of tissue destruction alters the tunical compliance needed for the maintenance of an erection and predisposes to the development of venoocclusive erectile dysfunction. The mechanisms involved in these changes are consistent with pathways known to occur with hypoxemic injury. Apoptosis is one mechanism involved in erectile tissue degeneration following penile denervation in rats.[43]

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