Erectile dysfunction after radical prostatectomy: value of preoperative programming of intracavernous injections.

Objectives : Vasoactive drugs used for self-administered intra-cavernous in jections are currently the reference treatments for erectile dysfunction af ter radical prostatectomy. The acceptability of and compliance with this tr eatment often limit their use. This study analysed these two parameters as a function of the type of andrological management decided before radical pr ostatectomy. Material and Method : From January 1996 to January 1997, 45 sexually active patients, aged 52 to 69 years, requiring radical prostatectomy without pre servation of the nervi erigentes, for localized prostate cancer, were inclu ded in this prospective study. Before the operation all 45 patients were in formed about the high risk of erectile dysfunction following radical prosta tectomy. Fifteen patients (group I) did not receive any particular advice concerning the management of erectile dysfunction after radical prostatectomy, but we re possibly referred for an andrology consultation depending on their compl aints. Fifteen patients (group 2) were systematically referred for an andrology co nsultation three months after radical prostatectomy for information about t he available treatment options. For 15 patients (group 3), the andrology consultation (3 months after the o peration) had been planned before radical prostatectomy to perform a test i njection of prostaglandin El. The injections, started before the operation in this group 3, therefore constituted an integral part of the global manag ement of prostate cancer. All these patients were followed for at least I year in the urology departm ent. Results : Only 7 of the 15 patients of group I consulted an andrologist. Fi ve of these patients received a test intracavernous injection versus 14 in group 2 and 15 in group 3. The 5 patients of group I who received an intrac avernous injection accepted this modality as treatment versus 8 in group 2 and 12 in group 3. After one year 4, 5 and 9 patients in groups I, 2 and 3, respectively continued intracavernous injections. Conclusion : The management of erectile dysfunction after radical prostatec tomy must start with the decision to operate. Systematic encouragement to u se intracavernous injections after radical prostatectomy helps to improve a ccess to this treatment for impotence. The acceptability and especially the compliance, appear to be better in patients in whom intracavernous injecti ons were integrated into the global management of their prostate cancer.