Iatrogenic Erectile Dysfunction after Pelvic Surgery: Prostatectomy, Colonic and Rectal Surgery

IATROGENIC ERECTILE DYSFUNCTION AFTER PELVIC SURGERY: PROSTATECTOMY, COLONIC AND RECTAL SURGERY (ABSTRACT): Radical pelvic surgery: radical prostatectomy, colonic and rectal surgery are iatrogenic causes of erectile dysfunction with major impact on healthrelated quality of life. The major cause of erectile dysfunction in such surgical procedures is cavernous nerve injury that leads to apoptosis of cavernous smooth muscle, fibrosis and venooclusive disease. After radical nerve-sparing prostatectomy up to 50 % of patients may develop erectile dysfunction and recover rate varies from 16%to 86 % in 6-12 month. The prevalence of erectile dysfunction after rectal surgery varies largely according to the technique used, nerve dissection, associated irradiation and chemotherapy from 33 % to 95 %. Laparoscopic and robotic-assisted surgery allows a better autonomic nerve preservation and a better postoperative sexual function. Rehabilitation programs in patients with iatrogenic erectile dysfunction must start as soon as possible in order to provide blood supply, good oxygenation and to prevent smooth muscle loss and fibrosis. Best candidates for this program are young patients with normal sexual function before surgery. First line therapy in rehabilitation programs are phosphodiesterase type 5 inhibitors, followed by intracavernosal erectogenic drugs injections and vacuum constriction devices. Rehabilitation programs are efficient in 14%-81% of patients with bilateral nervesparing prostatectomy and in 43%-93% of patients following robotic-assisted laparoscopic surgery.