Kava Bruce R
Rev Urol. 2005;7 Suppl 2(Suppl 2):S39-50.
Phosphodiesterase type-5 (PDE-5) inhibitors have revolutionized the treatment of post-radical prostatectomy erectile dysfunction. For those patients who undergo a non-nerve-sparing radical prostatectomy or whose condition fails to respond to PDE-5 inhibitors, alternative treatment with intracavernous injection therapy, transurethral alprostadil, vacuum erection devices, and recently described combination therapy is available. The goals of therapy are to provide the patient with a means of obtaining an erection so that the patient and his partner may resume sexual relations as soon as possible following radical prostatectomy. There is evidence that early institution of treatment may promote improvement in the return of spontaneous erections in patients who have undergone nerve preservation. In patients who undergo non-nerve-sparing procedures, therapy may improve penile rigidity. Intracavernous injection therapy, transurethral alprostadil, and vacuum devices are highly effective in the management of post-prostatectomy erectile dysfunction. High dropout rates, which are not related to adverse effects, have been described with all 3 modalities. Pre- and postoperative counseling may improve patient and partner satisfaction.
5型磷酸二酯酶（PDE - 5）抑制剂彻底改变了根治性前列腺切除术后勃起功能障碍的治疗方法。对于那些接受非保留神经的根治性前列腺切除术或对PDE - 5抑制剂治疗无效的患者，可以采用海绵体内注射疗法、经尿道前列地尔、真空勃起装置以及最近描述的联合疗法等替代治疗方法。治疗的目标是为患者提供一种获得勃起的方法，以便患者及其伴侣在根治性前列腺切除术后尽快恢复性关系。有证据表明，早期开始治疗可能会促进接受神经保留手术患者的自发性勃起恢复。在接受非保留神经手术的患者中，治疗可能会改善阴茎硬度。海绵体内注射疗法、经尿道前列地尔和真空装置在前列腺切除术后勃起功能障碍的管理中非常有效。所有这三种治疗方式都存在较高的退出率，且这些退出率与不良反应无关。术前和术后咨询可能会提高患者及其伴侣的满意度。
