Zippe C D, Raina R, Thukral M, Lakin M M, Klein E A, Agarwal A
Andrology-Urology Research Laboratory, Urological Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A100, Cleveland, OH 44195, USA.
Curr Urol Rep. 2001 Dec;2(6):495-503. doi: 10.1007/s11934-001-0045-5.
Radical prostatectomy is the standard treatment for organ/specimen-confined prostate cancer, yet erectile dysfunction in selected series is still reported as high as 90% after this procedure. Thus, most men need adjuvant treatments to be sexually active following radical prostatectomy. These include vacuum constriction devices, intracorporeal injections of vasoactive drugs, and transurethral dilators, all of which have reported response rates of 50% to 70%. Unfortunately, long-term compliance is suboptimal, with a discontinuation rate of nearly 50% at one year. These non-oral options should be offered on an individual basis to patients who have failed oral therapy since efficacy and compliance vary. Also, these options should be considered in the early postoperative period to enhance sexual activity and penile oxygenation, which may prevent corporeal fibrosis. Early penile rehabilitation with intracavernosal injections or vacuum constriction devices should be encouraged to increase chances for recovery of rigid erections. In patients with some preservation of nerve tissue, oral sildenafil may be effective in promoting an earlier return of erectile function. The potential impact of sildenafil and other new oral therapies should encourage urologists to continue to perform and perfect the nerve-sparing approach.
根治性前列腺切除术是器官/标本局限性前列腺癌的标准治疗方法，但在某些系列报道中，该手术后勃起功能障碍的发生率仍高达90%。因此，大多数男性在根治性前列腺切除术后需要辅助治疗以恢复性功能。这些治疗方法包括真空缩窄装置、阴茎海绵体内注射血管活性药物和经尿道扩张器，据报道，所有这些方法的有效率为50%至70%。不幸的是，长期依从性并不理想，一年的停药率接近50%。由于疗效和依从性各不相同，对于口服治疗无效的患者，应根据个体情况提供这些非口服治疗方法。此外，在术后早期应考虑这些方法，以增强性功能和阴茎氧合，这可能预防海绵体纤维化。应鼓励早期使用阴茎海绵体内注射或真空缩窄装置进行阴茎康复治疗，以增加恢复坚挺勃起的机会。对于保留了部分神经组织的患者，口服西地那非可能有效促进勃起功能的早日恢复。西地那非和其他新型口服治疗方法的潜在影响应促使泌尿外科医生继续实施并完善保留神经的手术方法。
