Department of Urology, Montefiore Medical Center, Bronx, NY 10467, USA.
J Sex Med. 2010 Dec;7(12):3984-90. doi: 10.1111/j.1743-6109.2010.01969.x. Epub 2010 Aug 16.
Given the paucity of literature on the time course of recovery of erectile function (EF) after radical prostatectomy (RP), many publications have led patients and clinicians to believe that erections are unlikely to recover beyond 2 years after RP.
We sought to determine the time course of recovery of EF beyond 2 years after bilateral nerve sparing (BNS) RP and to determine factors predictive of continued improved recovery beyond 2 years.
EF was assessed prospectively on a 5-point scale: (i) full erections; (ii) diminished erections routinely sufficient for intercourse; (iii) partial erections occasionally satisfactory for intercourse; (iv) partial erections unsatisfactory for intercourse; and (v) no erections. From 01/1999 to 01/2007, 136 preoperatively potent (levels 1-2) men who underwent BNS RP without prior treatment and who had not recovered consistently functional erections (levels 1-2) at 24 months had further follow-up regarding EF. Median follow-up after the 2-year visit was 36.0 months.
Recovery of improved erections at a later date: recovery of EF level 1-2 in those with level 3 EF at 2 years and recovery of EF level 1-3 in those with level 4-5 EF at 2 years.
The actuarial rates of further improved recovery of EF to level 1-2 in those with level 3 EF at 2 years and to level 1-3 in those with level 4-5 EF at 2 years were 8%, 20%, and 23% at 3, 4, and 5 years postoperatively, and 5%, 17%, and 21% at 3, 4, and 5 years postoperatively, respectively. Younger age was predictive of greater likelihood of recovery beyond 2 years.
There is continued improvement in EF beyond 2 years after BNS RP. Discussion of this prolonged time course of recovery may allow patients to have a more realistic expectation.
由于关于根治性前列腺切除术（RP）后勃起功能（EF）恢复时间过程的文献很少，许多出版物使患者和临床医生相信，RP 后 2 年以上勃起功能不太可能恢复。
我们旨在确定双侧神经保留（BNS）RP 后 2 年以上 EF 的恢复时间过程，并确定 2 年以上持续改善恢复的预测因素。
EF 通过 5 分制进行前瞻性评估：（i）完全勃起；（ii）减少勃起，常规足以进行性交；（iii）部分勃起偶尔足以进行性交；（iv）部分勃起不足以进行性交；和（v）无勃起。从 1999 年 1 月至 2007 年 1 月，136 名术前有勃起功能（1-2 级）的男性接受了 BNS RP 治疗，并且在 24 个月时没有恢复一致的功能性勃起（1-2 级），他们进一步随访了 EF。在 2 年就诊后中位随访时间为 36.0 个月。
更晚日期改善勃起的恢复：在 2 年时 EF 为 3 级的患者中恢复 EF 1-2 级，在 2 年时 EF 为 4-5 级的患者中恢复 EF 1-3 级。
在 2 年时 EF 为 3 级的患者中进一步改善恢复至 EF 1-2 级的患者，以及在 2 年时 EF 为 4-5 级的患者中恢复至 EF 1-3 级的患者，在术后 3、4 和 5 年的累积率分别为 8%、20%和 23%，分别为 5%、17%和 21%。年龄较轻是 2 年以上恢复的更大可能性的预测因素。
在 BNS RP 后 2 年以上 EF 持续改善。讨论这种延长的恢复时间过程可能使患者有更现实的期望。
