Montorsi F, Guazzoni G, Strambi L F, Da Pozzo L F, Nava L, Barbieri L, Rigatti P, Pizzini G, Miani A
Institute of Human Anatomy, University of Milan School of Medicine and Division of Urology, Scientific Institute H. San Raffaele, Italy.
J Urol. 1997 Oct;158(4):1408-10.
This study was aimed at assessing prospectively the effect of postoperative intracavernous injections of alprostadil on the recovery of spontaneous erectile function after nerve-sparing radical retropubic prostatectomy.
A total of 30 potent patients with clinically localized prostate cancer (clinical stage B1 or B2, Gleason sum 7 or greater, prostatic specific antigen less than 20 ng./ml.) underwent nerve-sparing radical retropubic prostatectomy and was subsequently randomized to alprostadil injections 3 times per week for 12 weeks (group 1, 15 patients) or observation without any erectogenic treatment (group 2, 15 patients). Patients were assessed at the 6-month followup by sexual history, physical examination, color Doppler sonography of the cavernous arteries and polisomnographic recording of nocturnal erections.
In group 1, 12 patients (80%) completed the entire treatment schedule and were evaluated at the long-term followup. Eight patients in this group (67%) reported the recovery of spontaneous erection sufficient for satisfactory sexual intercourse, compared with 3 patients (20%) in group 2. The difference between the 2 groups was statistically significant (p <0.01). In group 1, all but 1 patient reporting normal postoperative erections also showed normal erections at nocturnal testing, whereas color Doppler sonography demonstrated normal penile hemodynamics in all of them. In these patients, failures were the result of cavernous veno-occlusive dysfunction (2 cases, 17%) and cavernous nerve injury (2 cases, 17%). In group 2, patients with normal erections showed both normal nocturnal testing and penile hemodynamics, whereas failures were the result of cavernous veno-occlusive dysfunction (8 cases, 53%), cavernous arterial insufficiency (2 cases, 13%) or cavernous nerve injury (3 cases, 20%). Complications in patients treated with alprostadil injections accounted for 2 cases (13%) of a penile nodule and 1 further case (6%) of prolonged penile erection. Complications were not seen in group 2 patients.
Early postoperative administration of alprostadil injections significantly increases the recovery rate of spontaneous erections after nerve-sparing radical retropubic prostatectomy. It is our belief that programmed vasoactive injections improve cavernous oxygenation, thereby limiting the development of hypoxia-induced tissue damage. The potential complications related to the use of intracavernous injections must be clearly explained to patients.
本研究旨在前瞻性评估术后海绵体内注射前列地尔对保留神经的耻骨后根治性前列腺切除术后自发性勃起功能恢复的影响。
共有30例有性能力的临床局限性前列腺癌患者（临床分期B1或B2，Gleason评分7分及以上，前列腺特异性抗原低于20 ng/ml）接受了保留神经的耻骨后根治性前列腺切除术，随后被随机分为两组，一组每周注射前列地尔3次，共12周（第1组，15例患者），另一组不进行任何促勃起治疗，仅观察（第2组，15例患者）。在6个月的随访中，通过性病史、体格检查、海绵体动脉彩色多普勒超声检查以及夜间勃起的多导睡眠图记录对患者进行评估。
第1组中，12例患者（80%）完成了整个治疗方案并接受了长期随访。该组中有8例患者（67%）报告自发性勃起恢复到足以进行满意的性交，而第2组中只有3例患者（20%）。两组之间的差异具有统计学意义（p<0.01）。在第1组中，除1例报告术后勃起正常的患者外，其余患者夜间测试时勃起也正常，而彩色多普勒超声显示他们所有人的阴茎血流动力学均正常。在这些患者中，勃起功能障碍的原因是海绵体静脉闭塞功能障碍（2例，17%）和海绵体神经损伤（2例，17%）。在第2组中，勃起正常的患者夜间测试和阴茎血流动力学均正常，而勃起功能障碍的原因是海绵体静脉闭塞功能障碍（8例，53%）、海绵体动脉供血不足（2例，13%）或海绵体神经损伤（3例，20%）。接受前列地尔注射治疗的患者出现2例（13%）阴茎结节并发症和1例（6%）阴茎异常勃起时间延长并发症。第2组患者未出现并发症。
术后早期注射前列地尔可显著提高保留神经的耻骨后根治性前列腺切除术后自发性勃起的恢复率。我们认为，程序性血管活性药物注射可改善海绵体氧合，从而限制缺氧诱导的组织损伤的发生。必须向患者清楚解释与海绵体内注射相关的潜在并发症。
