Erectile Function Before and After Non-Nerve-Sparing Retropubic Radical Prostatectomy

Objective: To assess the degree of preoperative erectile dysfunction (ED) and postoperative erectile function (EF) following non-nerve-sparing retropubic radical prostatectomy (NNS-RRP).

Material and Methods: Between November 2004 and June 2007, 165 patients with clinically localized adenocarcinoma of the prostate underwent NNS-RRP at our department. In August 2007 all patients still alive were sent questionnaires regarding pre- and post-operative EF including the short version of International Index of Erectile Function (IIEF-5). One hundred and fifty-eight questionnaires were returned with 148 adequately filled in. Median (range) follow-up was 13 (1-33) months.

Results: Twenty-six percent of the patients had no preoperative sexual activity, mainly caused by ED. Five percent used PDE-5 inhibitors or injection therapy to achieve erection. Additional 10 % had an IIEF-5 score of 21 or less suggesting mild or moderate ED. Thus only 59 % of the patients had sexual activity with a normal EF preoperative. Postoperative EF was significantly better in patients with a follow-up of 12 months or more compared to patients with a shorter follow-up. Preserved EF was also more common in patients younger than 60 years and in patients with no preoperative use of PDE-5 inhibitors and/or a preoperative IIEF-5 score of 22 or more. In patients with more than 12 months of follow-up the overall percentages of preserved EF with or without use of medical aid were 45 % and 16 % respectively.

Conclusion: EF is preserved in some patients despite a non-nerve-sparing procedure. Many of the patients may benefit from medical aid.

Keywords: Cancer, Erectile function, Non-nerve-sparing, Prostatectomy, Retropubic, Sexual function.