RECOVERY OF SPONTANEOUS ERECTILE FUNCTION AFTER NERVE-SPARING RADICALRETROPUBIC PROSTATECTOMY WITH AND WITHOUT EARLY INTRACAVERNOUS INJECTIONS OF ALPROSTADIL - RESULTS OF A PROSPECTIVE, RANDOMIZED TRIAL

Purpose: This study was aimed at assessing prospectively the effect of postoperative intracavernous injections of alprostadil on the recover y of spontaneous erectile function after nerve-sparing radical retropu bic prostatectomy. Materials and Methods: A total of 30 potent patient s 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 erectogeni c treatment (group 2, 15 patients). Patients were assessed at the 6-mo nth followup by sexual history, physical examination, color Doppler so nography of the cavernous arteries and polisomnographic recording of n octurnal erections. Results: In group 1, 12 patients (80%) completed t he entire treatment schedule and were evaluated at the long-term follo wup. Eight patients in this group (67%) reported the recovery of spont aneous erection sufficient for satisfactory sexual intercourse, compar ed with 3 patients (20%) in group 2. The difference between the 2 grou ps was statistically significant (p < 0.01). In group 1, all but 1 pat ient reporting normal postoperative erections also showed normal erect ions at nocturnal testing, whereas color Doppler sonography demonstrat ed normal penile hemodynamics in all of them. In these patients, failu res were the result of cavernous veno-occlusive dysfunction (2 cases, 17%) and cavernous nerve injury (2 cases, 17%). In group 2, patients w ith normal erections showed both normal nocturnal testing and penile h emodynamics, whereas failures were the result of cavernous veno-occlus ive dysfunction (8 cases, 53%), cavernous arterial insufficiency (2 ca ses, 13%) or cavernous nerve injury (3 cases, 20%). Complications in p atients treated with alprostadil injections accounted for 2 cases (13% ) of a penile nodule and 1 further case (6%) of prolonged penile erect ion. Complications were not seen in group 2 patients. Conclusions: Ear ly postoperative administration of alprostadil injections significantl y increases the recovery rate of spontaneous erections after nerve-spa ring radical retropubic prostatectomy. It is our belief that programme d vasoactive injections improve cavernous oxygenation, thereby limitin g the development of hypoxia-induced tissue damage. The potential comp lications related to the use of intracavernous injections must be clea rly explained to patients.