Nandipati Kalyana C, Raina Rupesh, Agarwal Ashok, Zippe Craig D
Glickman Urological Institute and Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Drugs Aging. 2006;23(2):101-17. doi: 10.2165/00002512-200623020-00002.
Radical prostatectomy has been the time-honoured and standard treatment option for prostate cancer. Erectile dysfunction (ED) is one of the common quality-of-life issues following radical prostatectomy. The recovery of potency following radical prostatectomy varies from 16% to 86%. Although major modifications in surgical technique appear to be promising, the reported ED rates are still high. The time period required for the recovery of erectile function after surgery varies from 6 to 24 months. During this period of neuropraxia lack of natural erections produces cavernosal hypoxia. This cavernosal hypoxia has been implicated as one of the most important factors in the pathophysiology of ED. Cavernosal hypoxia predisposes to cavernosal fibrosis, ultimately producing venous leak and long-term ED. Interruption of this cascade of events has been the major challenge for physicians. Physicians have several options available for the treatment of ED. However, oral treatment options have quickly become established as first-line treatment options. Sildenafil has been most extensively studied in the radical prostatectomy population. In patients who do not respond to oral therapy alone, standard treatment options (intracavernosal injections, vacuum constriction devices and intraurethral alprostadil) are useful. Use of penile prostheses is one of the oldest treatment options available for the treatment of ED but is used only as a last resort. Initial attempts to promote the earlier recovery of erectile function appear to be promising. However, further confirmatory studies are essential. The roles of gene transfer and growth factors are still in experimental stages. In this review we discuss the epidemiology, pathophysiology and treatment options available for ED following radical prostatectomy.
根治性前列腺切除术一直是前列腺癌历史悠久的标准治疗选择。勃起功能障碍（ED）是根治性前列腺切除术后常见的生活质量问题之一。根治性前列腺切除术后阴茎勃起功能的恢复率在16%至86%之间。尽管手术技术的重大改进似乎很有前景，但报告的ED发生率仍然很高。术后勃起功能恢复所需的时间为6至24个月。在这段神经失用期，缺乏自然勃起会导致海绵体缺氧。这种海绵体缺氧被认为是ED病理生理学中最重要的因素之一。海绵体缺氧易导致海绵体纤维化，最终导致静脉漏和长期ED。中断这一系列事件一直是医生面临的主要挑战。医生有几种治疗ED的选择。然而，口服治疗选择很快成为一线治疗选择。西地那非在接受根治性前列腺切除术的人群中得到了最广泛的研究。对于仅对口服治疗无反应的患者，标准治疗选择（海绵体内注射、真空收缩装置和尿道内前列地尔）是有效的。阴茎假体的使用是治疗ED最古老的治疗选择之一，但仅作为最后的手段使用。促进勃起功能早期恢复的初步尝试似乎很有前景。然而，进一步的验证性研究至关重要。基因转移和生长因子的作用仍处于实验阶段。在这篇综述中，我们讨论了根治性前列腺切除术后ED的流行病学、病理生理学和治疗选择。
