Data point to need for better counseling on post-radical prostatectomy erectile dysfunction

May 15, 2011

Research suggests that urologists should be more candid with patients about the potential aftereffects of radical prostatectomy and other prostate interventions.

Key Points

In one study, researchers found that without using erectile dysfunction medications, less than one-fifth of men returned to baseline erectile function after RP.

"The myth is that there can be good potency preservation after RP," said John Mulcahy, MD, PhD, a urologist in private practice in Huntsville, AL.

Another study underscores the most common reasons for refractory ED after RP or other interventions. Here, investigators used pharmacologic testing and color duplex Doppler ultrasound to assess why men who had undergone treatments including RP, radiation therapy, brachytherapy, or transurethral resection of the prostate had failed oral phosphodiesterase type-5 inhibitor therapies.

"The vast majority of these patients had vascular etiologies rather than neurological etiologies, which is what we've always thought," Dr. Mulcahy said.

Other AUA abstracts spotlight concerns for penile length after RP, and in the context of Peyronie's disease. Specifically, one abstract shows that penile shortening after RP tends to last up to 12 months.

For patients with Peyronie's disease, Dr. Mulcahy said, two abstracts show that traction therapy (TT) can provide modest benefits if used faithfully. In particular, a prospective pilot study shows that for patients with acute Peyronie's, a penile extender device appears safe and efficacious for reducing penile curvature and pain and increasing penile length.

Similarly, a retrospective analysis suggests that TT can at least preserve stretched penile length, and often increase it slightly, in patients with Peyronie's who have undergone tunica albuginea plication or partial excision and grafting.

Although neither therapy appears to provide major length increases, he said, "This is the trend. Patients seem to be happy with a longer penis." Other strategies urologists can employ to that end include performing ventral phalloplasty, increasing the size of penile implants, and using length-extending implantable cylinders, said Dr. Mulcahy.

Another abstract documents how commonly urologists find penile curvature when performing penile prosthesis implantation for patients with post-RP ED.

"The gist of this paper is that we should tell patients that there might be some curvature after RP," Dr. Mulcahy said. Urologists commonly caution patients considering RP that they might experience urine leakage and ED, he said, but frequently they fail to mention possible curvature.