Persistent erectile dysfunction following radical prostatectomy: The association between nerve-sparing status and the prevalence and chronology of venous leak Journal Article
| Authors: | Tal, R.; Valenzuela, R.; Aviv, N.; Parker, M.; Waters, W. B.; Flanigan, R. C.; Mulhall, J. P. |
| Article Title: | Persistent erectile dysfunction following radical prostatectomy: The association between nerve-sparing status and the prevalence and chronology of venous leak |
| Abstract: | Introduction: Failure to recover erectile function after radical prostatectomy (RP) may result from venous leak as a sequela of neuropraxia-induced erectile tissue damage. Venous leak portends a poor prognosis for erections recovery as well as phosphodiesterase type 5 inhibitor (PDE5i) response. Aims: To define the impact of RP nerve-sparing status on venous leak prevalence and chronology. Methods: Study population: men who underwent RP for localized prostate cancer, had functional erections prior to RP, developed postoperative erectile dysfunction (ED), had a Doppler ultrasonography within 6 months of RP, and did not receive any ED treatment for the first 6 months after RP other than on-demand PDE5i. Main Outcome Measures: Venous leak prevalence and erectile function recovery at different time-points. Results: Data on 142 patients were analyzed, mean age: 58 ± 16 years. Sixty percent had bilateral nerve-sparing (BNS) surgery, 20% unilateral nerve-sparing (UNS) surgery, and 20% non-nerve-sparing (NNS) surgery. Eleven percent and 21% had venous leak by 3 and 6 months, respectively. Venous leak prevalence by 6 months was 7%, 11%, and 75% for BNS, UNS, and NNS surgery (P < 0.001). Mean end-diastolic velocity was 1.8, 2.1, and 7.2 cm/second for the three groups (P < 0.01). The only patients developing venous leak prior to 3 months were NNS patients, one-third of NNS-associated venous leak occurring before this time-point. At 18 months, the proportion of men having return of unassisted erections was 49%, 42%, and 7% with mean erectile function domain scores of 21, 18, and 12, and PDE5i response rates were 72%, 64%, and 12% for the three groups, respectively. Conclusions: Nerve-sparing status impacts heavily upon the prevalence and the chronology of venous leak development post-RP. NNS RP is associated with early development of venous leak, increased prevalence of venous leak, and reduction in return of natural erections. © 2009 International Society for Sexual Medicine. |
| Keywords: | adult; treatment response; middle aged; surgical technique; major clinical study; united states; prospective studies; prevalence; risk factors; doppler echography; time factors; prostate cancer; postoperative complication; prostatic neoplasms; prostatectomy; urologic surgery; radical prostatectomy; age distribution; new york; erectile dysfunction; penile erection; phosphodiesterase v inhibitor; hemodynamics; health status indicators; impotence, vasculogenic; penis; nerve sparing surgery; corporal veno-occlusive dysfunction; venous leak; venous leakage |
| Journal Title: | Journal of Sexual Medicine |
| Volume: | 6 |
| Issue: | 10 |
| ISSN: | 1743-6095 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2009-10-01 |
| Start Page: | 2813 |
| End Page: | 2819 |
| Language: | English |
| DOI: | 10.1111/j.1743-6109.2009.01437.x |
| PUBMED: | 19686421 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 5" - "Export Date: 30 November 2010" - "Source: Scopus" |
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