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


Cancer Control. 2006;13(3):179-187. 

In This Article

Conclusions and Future Approaches

The high prevalence of sexual dysfunction after surgical treatment for prostate or bladder cancer has increased efforts to seek effective methods to prevent the damage from surgery and to restore normal sexual function. Montorsi et al[74] prospectively assessed the effect of postoperative intracavernous injections of alprostadil on the recovery of spontaneous erectile function after nerve-sparing radical retropubic prostatectomy. They concluded that early postoperative administration of injections increases the recovery rate of spontaneous erections after nerve-sparing radical retropubic prostatectomy. However, the optimal formula for penile rehabilitation, before and/or after radical prostatectomy, remains unclear. There is no consensus to clearly define which agents and which time points are most effective. Some clinicians believe that in the early postoperative period, intracavernosal injection therapy and VED are indicated, with the subsequent addition of a PDE-5 inhibitor once the patient obtains spontaneous erections.[89] Others believe that the concept of prophylaxis for conditioning of the vasculature of the penis is critical. Mancini et al[90,91] studied Doppler duplex sonographic changes to compare alprostadil, sildenafil citrate, and placebo using chronic dosing for arterial conditioning. They demonstrated improvement in Doppler duplex sonographic peak systolic velocity by 30% with alprostadil and 39% with sildenafil.

The international multidisciplinary consensus panel on female sexual dysfunction in 19991 cited the lack of adequate experimental or clinical trial data and recognized the broad need for basic and applied research in this area. The report emphasized deficits in areas such as epidemiologic research, anatomic studies, biologic mechanisms of sexual arousal and orgasm, effects of aging and menopause, development of reproducible measurement devices, and instruments for evaluating physiologic parameters of the female sexual response in the clinical setting. Current efforts to obtain further data concerning female sexual dysfunction and the continued research in male erectile dysfunction should lead to new tools and management options that will minimize the risk of sexual dysfunction after local surgical therapy for prostate or bladder cancer.

CME Information

The print version of this article was originally certified for CME credit. For accreditation details, contact the publisher. H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612. Telephone: (813) 632-1349. Fax: (813) 903-4950. Email: .


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