Erectile Dysfunction After Prostate Surgery: What You NEED To Know

Reducing the risk of impotence after prostatectomy involves a combination of preoperative planning, surgical techniques, and postoperative management. Below is a summarized approach based on the information provided:

1. Preoperative Planning
Patient Counseling: The patient should be informed about the risks of impotence, particularly in relation to nerve-sparing (NS) procedures. The risk of impotence is approximately 50% for unilateral NS and over 60% for bilateral NS.
mpMRI: Multiparametric MRI, interpreted by an experienced radiologist, can help surgeons decide if nerve preservation is feasible.
NeuroSAFE Technique: Some centers use intraoperative fresh frozen sections to guide nerve preservation decisions.
2. Surgical Considerations
Nerve-Sparing Radical Prostatectomy (NS-RP): If oncologically safe, attempts should be made to preserve the neurovascular bundles, either bilaterally or unilaterally.
Contraindications to NS-RP:
Palpable disease
Apical tumor extension
High-risk Gleason score (8 or more)
3. Postoperative Management
Early Use of PDE5 Inhibitors:
Starting a PDE5 inhibitor (e.g., sildenafil, tadalafil) at the first postoperative visit (6 weeks) is recommended.
Some evidence suggests starting PDE5 inhibitors preoperatively may yield better results.
Alternative Therapies:
Prostaglandin E1: Administered intraurethrally or intracavernosally for patients who do not respond to PDE5 inhibitors.
Vacuum Pump Devices: These can help maintain penile length and prevent shrinkage while waiting for the return of natural erectile function.
Specialist Follow-Up:
Regular follow-up in a clinic specializing in erectile dysfunction is essential for tailored treatment and support.
Emerging Techniques and Research
NeuroSAFE Technique: Ongoing evaluations suggest that intraoperative histological analysis may help optimize nerve-sparing decisions without compromising oncological outcomes.
In conclusion, a multidisciplinary approach integrating advanced imaging, careful surgical planning, early pharmacological intervention, and access to specialized follow-up care can help reduce the risk of impotence following prostatectomy. However, patients should be counseled about the inherent risks and limitations of these interventions.