ROLE OF PENILE VASCULAR INJURY IN ERECTILE DYSFUNCTION AFTER RADICAL PROSTATECTOMY

Objective To investigate the cause of erectile dysfunction after nerve -sparing radical prostatectomy for clinically localized adenocarcinoma of the prostate (stage A or B). Patients and methods Erectile functio n was evaluated in 20 patients, mean age 65 years (range 44-74), both pre-operatively and 1 year after surgery by intracavernosal injection of a vasoactive agent (papaverine hydrochloride or prostaglandin E1) a nd pulsed Doppler ultrasonography. The degree of erection, the size of the cavernosal artery and penile arterial blood flow velocity were as sessed Results Results revealed that the decreased response to intraca vernosal injection of a vasoactive agent was associated with a signifi cant reduction in both the diameter and velocity of blood flow within cavernosal arteries in 40% of patients after surgery. The pathological stage of the tumour did not correlate with the degree of vascular inj ury. Conclusion We conclude that post-prostatectomy impotence is multi factorial but vascular injury plays a substantial role.