Abstract and Introduction
Abstract
Erectile dysfunction is the most common side effect after prostatectomy. There are currently five categories of available treatment options for erectile dysfunction for men following radical prostatectomy. The first and most common treatment is oral phosphodiesterase type 5 inhibitors (sildenafil, vardenafil, or tadalafil). Despite their popularity, these medications do not always produce an erection sufficient for intercourse after prostatectomy. The second treatment option is the noninvasive option of either a venous constriction band or the vacuum constriction device. Both treatments use a venous occlusive tension band or ring to maintain erection by retaining blood in the penis. The vacuum constriction device also utilizes external suction pressure to create an erection prior to application of the tension ring. The third treatment option is Muse®, an intraurethral suppository containing alprostadil that dilates the penile blood vessels. The fourth treatment option involves penile injections. The fifth treatment is the penile prosthesis, in which artificial rods are surgically implanted into the corpora cavernosa to provide penile rigidity. Oral agents, the vacuum device, Muse, and injections have been used for penile rehabilitation to encourage spontaneous return of erectile function in men after radical prostatectomy with varied success. Untreated erectile dysfunction after radical prostatectomy has been associated with penile atrophy and further diminished erectile function. Therefore, it is critically important that clinicians provide comprehensive information about the positive and negative aspects of all treatment options and the penile rehabilitation potential of each. This will enable patients to make informed treatment choices about early intervention for erectile dysfunction.
Introduction
Prostate cancer is the most commonly diagnosed non-skin cancer in men, yet five-year survival rates are reported at approximately 99% (American Cancer Society, 2007). Radical prostatectomy has been a treatment of choice for organ-contained prostate cancer for several decades (Zippe et al., 2001). Erectile dysfunction remains the most commonly reported problem following radical prostatectomy (Schover et al., 2002). The National Institutes of Health (NIH) defined erectile dysfunction as the "inability to attain and/or maintain a penile erection sufficient for satisfactory sexual performance" (NIH Consensus Development Panel on Impotence, 1993). This definition has also been accepted by the World Health Organization and the International Consultation on Urologic Disease (Jardin et al., 2000).
Sexual function remains important to men, who often continue to be interested in sex in the final decades of life (Frankel et al., 1998; Mulligan & Moss, 1991). Prevalence of erectile dysfunction in men after prostatectomy has been explored in many studies and has been reported as high as 88% (Korfage et al., 2005). In a study of 1156 post-prostatectomy men, erectile dysfunction was identified as a major problem adversely impacting quality of life (Potosky et al., 2004). Meyer, Gillatt, Lockyer, and Macdonagh (2003) reported that as long as 92 months post-prostatectomy, more than 75% of the men in the study were sad or tearful about the problems related to erectile dysfunction, and over 70% felt quality of life was adversely affected. In light of the high survival rates associated with prostate cancer, issues impacting quality of life, such as erectile dysfunction, need to be addressed and treated.