Addressing and Managing Erectile Dysfunction after Prostatectomy For Prostate Cancer

Jeffrey A. Albaugh, PhD, APRN, CUCNS


Urol Nurs. 2010;30(3):167-177,166. 

In This Article

Erectile Dysfunction after Prostate Removal in Men with Prostate Cancer

Removal of the prostate continues to be a gold standard treatment option for prostate cancer against which all other treatment options are measured (Zippe et al., 2001). The etiology involved in erectile dysfunction is multifactorial. Not only can nerve conduction be compromised from the dissection of these nerves away from the prostate, but nitric oxide synthesis may also be diminished (the cavernosal nerve is a source of synthesis for nitric oxide) (Carrier et al., 1995). Nitric oxide is the primary chemical that mediates smooth muscle relaxation and vasodilatation. In an effort to minimize postprostatectomy erectile problems, nerve-sparing techniques have been developed (Walsh & Mostwin, 1984). Despite these nerve-sparing techniques, erectile dysfunction remains a problem for the majority of men after radical prostatectomy (Penson et al., 2005; Walsh, Marschke, Ricker, & Burnett, 2000). The quest continues to find better techniques to improve erectile function after radical prostatectomy.

Efforts to improve outcomes and reduce recovery time after prostate removal include the use of robotics for radical prostatectomy. Robotic-assisted prostatectomy is a minimally invasive surgical technique that uses a laparoscope and approximately 5 to 6 small ports of entry to remove the prostate rather than the traditional open retropubic or perineal method of prostatectomy (El-Hakim & Tewari, 2004). The surgeon sits at the control counsel and uses hand controls that allow each of his movements to be translated into movements with the robotic instruments while simultaneously filtering tremors, scaling movement to size, and providing full range of motion and ergonomy. The cameras in the scope provide a three-dimensional magnified image for the surgeon. In terms of erectile function, the hope is that the robotic-assisted method will provide a more precise surgical technique, less manipulation, and better visualization of the nerves for erectile function during prostate removal.

Initial reports of erectile function are varied. No conclusive evidence has been reported to determine if potency rates are better with robotic prostatectomy versus open prostatectomy. Menon and associates (2007) reported that of patients with normal erectile function before surgery, successful intercourse was achieved by 70% to 100% of men who had undergone nerve-sparing techniques, although only half of those men reported a return to the normal Sexual Health Inventory for Men (SHIM) score without the use of medication. Madeb and associates (2007) reported that 62.2% of patients who had bilateral nerve-sparing robotic-assisted prostatectomy had mild or no erectile problems. Still another report from Tewari and colleagues (2008) stated that 87% of previously potent men regained potency after surgery within one year. Further research directly comparing traditional open radical prostatectomy methods to robotic-assisted prostatectomy methods needs to done to determine whether potency rates are better with the newer technique.


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