Recovery of spontaneous erectile function after nerve-sparing radical retropubic prostatectomy with and without early intracavernous injections of alprostadil: results of a prospective, randomized trial.
Level 2 - randomized trial
Individual randomized controlled trial
What was done
Thirty potent men with clinically localized prostate cancer undergoing nerve-sparing radical retropubic prostatectomy were randomized to either postoperative intracavernous alprostadil injections 3 times per week for 12 weeks (group 1, n = 15) or observation without erectogenic treatment (group 2, n = 15). Outcomes were evaluated at 6-month follow-up using sexual history, physical examination, color Doppler sonography of cavernous arteries, and polysomnographic nocturnal erection recording.
What was found
In group 1, 12 of 15 patients (80%) completed the treatment schedule. Spontaneous erections sufficient for satisfactory intercourse were reported by 8 of 12 patients (67%) in group 1 compared with 3 of 15 patients (20%) in group 2 (p < 0.01). Objective tests confirmed normal hemodynamics and nocturnal erections in nearly all successfully recovering patients. Reported treatment failures were attributed to cavernous veno-occlusive dysfunction (17% in group 1 vs. 53% in group 2) and cavernous nerve injury (17% in group 1 vs. 20% in group 2). Alprostadil complications included 2 cases (13%) of penile nodule and 1 case (6%) of prolonged erection.
Why it matters
This trial provided early evidence supporting penile rehabilitation protocols, suggesting that early vasoactive therapy improves cavernous oxygenation and enhances spontaneous erectile function recovery after nerve-sparing prostatectomy.
Limits
The sample size was very small (30 randomized, 27 evaluated), follow-up was limited to 6 months, and the unblinded observation control lacked a sham/placebo injection comparison.
Cited by
- supports A lack of regular erections leads to reduced blood flow and progressive shrinkage of penile or clitoral tissue over time.