The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, 1800 Orleans Street, Baltimore, Maryland 21287, USA.
Department of Urology, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Baltimore, Maryland 21287-2411, USA.
Nat Rev Urol. 2016 Apr;13(4):216-25. doi: 10.1038/nrurol.2016.47. Epub 2016 Mar 15.
Despite continued advances in urological surgery, erectile dysfunction (ED) remains a serious adverse effect of radical prostatectomy. In this setting, ED is predominantly caused by injury to the neurovascular bundles, which lie alongside the prostate and are responsible for initiating and maintaining the erectile response. Most men will experience some degree of ED after radical prostatectomy, although erectile function outcomes have already remarkably improved since the development of nerve-sparing surgical techniques. To further improve outcomes, erection rehabilitation strategies are being investigated, which emphasize early treatment regimens with the aim of preventing adverse remodelling after surgery and preserving erectile function. Strategies include pharmacological therapy, mechanical therapy and psychosocial support. In addition, novel therapeutic approaches involving new targets for small-molecule treatments and regenerative medicine therapies are being developed to aid in restoring erectile function. Although ED treatments can be effective following radical prostatectomy, no specific erection rehabilitation regimen has currently been shown to be superior to other investigated rehabilitation regimens. Nevertheless, the different strategies rightfully remain an area of intensive research, as preservation of erectile function is a critical part of providing comprehensive care for men with prostate cancer to ensure their overall well-being, in contrast to just treating a patient's tumour.
尽管泌尿外科手术不断取得进展，但勃起功能障碍（ED）仍然是根治性前列腺切除术的严重不良反应。在这种情况下，ED 主要是由于神经血管束损伤引起的，这些神经血管束位于前列腺旁边，负责启动和维持勃起反应。大多数接受根治性前列腺切除术的男性都会经历一定程度的 ED，尽管自神经保留手术技术发展以来，勃起功能的结果已经显著改善。为了进一步改善结果，正在研究勃起康复策略，这些策略强调早期治疗方案，旨在预防手术后的不良重塑并保持勃起功能。策略包括药物治疗、机械治疗和社会心理支持。此外，还开发了涉及小分子治疗和再生医学治疗新靶点的新型治疗方法，以帮助恢复勃起功能。尽管 ED 治疗在根治性前列腺切除术后可能有效，但目前还没有特定的勃起康复方案被证明优于其他研究中的康复方案。然而，不同的策略仍然是一个密集研究的领域，因为保留勃起功能是为前列腺癌患者提供全面护理的关键部分，以确保他们的整体健康，而不仅仅是治疗患者的肿瘤。
