Prevention and management of erectile dysfunction following radical prostatectomy

Erectile dysfunction (ED) remains the most common morbidity after radical retropubic prostatectomy (RRP), approaching 90% in some series. Etiologic factors are both nonsurgical and surgical. Age, time from surgery, preoperative sexual function, psychological issues, and surgical technique all play a role in postoperative erectile function. The recovery of erectile function is a slow process, requiring as many as 2 years. The treatment of post RRP ED is highly successful and includes, in increasing order of effectiveness, MUSE, sildenafil, intracorporal injection therapy, vacuum erection devices, and penile prostheses. Current areas of research include the early intervention clinical protocols as well as animal studies in the use of nerve and vascular growth factors to selectively encourage early nerve regeneration.