Most post-radical prostatectomy erectile dysfunction cases have non-neurogenic etiology

January 1, 2012

The advent of nerve-sparing radical prostatectomy and its outcomes has focused attention on the etiology of erectile dysfunction following all forms of prostate cancer intervention.

Key Points

Jacksonville, FL-The advent of nerve-sparing radical prostatectomy and its outcomes has focused attention on the etiology of erectile dysfunction following all forms of prostate cancer intervention. A study by urologists at Mayo Clinic, Jacksonville, FL, suggests that only 13.3% of cases of ED following radical prostatectomy have a primarily neurogenic etiology and that 9.1% of cases following radiation therapies have neurogenic origins.

"Nerve-sparing prostatectomy is a major step forward in the treatment of prostate cancer, and it appears from this data that it is effective at avoiding neurogenic impotence. However, vascular concerns must be considered," first author Ryan Hutchinson, MD, told Urology Times.

"The data contained both non-nerve-sparing and nerve-sparing procedures; however, the vast majority of these were nerve sparing," Dr. Hutchinson said.

Incidence of neurogenic etiology low

Analysis found that among surgical patients, 48.3% had refractory ED associated with cavernous veno-occlusive disease, 36.7% had ED associated with arterial insufficiency, and 13.3% had ED associated with neurogenic origins. Among those with ED following radiation therapy, more than half (54.5%) evidenced arterial insufficiency, 36.4% evidenced cavernous veno-occlusive disease, and 9.1% evidenced neurogenic etiology for their ED.

The study also found that diabetics had the lowest Erection Hardness Scores (p=.025) and that these men also exhibited lower peak systolic velocity and a lower resistive index during Doppler penile blood flow testing.

"These findings speak to the value of a good pre-operation counseling session," Dr. Hutchinson said. "Patients should be told that a successful nerve-sparing procedure does not mean that their erectile function will be exactly the same after the procedure as it was before. Many men will experience some decline in erectile function and may require ED therapy. That said, it appears that the neurologic function is well preserved using the techniques of modern retropubic and robotic prostatectomy."

He said that this study is probably the first of a number of such studies, some of which will examine the relationship of diabetes, hypertension, and coronary artery disease to ED.