Significant erectile dysfunction after prostate surgery despite modern methods

Radical removal of the prostate leads to erectile dysfunction in a significant percentage of patients, even during nerve-preserving surgery. Despite improvements in surgical techniques and the use of robots, current studies show no higher potency rates after prostate surgery, according to the conclusion drawn at the congress of the European Association of Urology (EAU) in March 2019 in Barcelona. 

If men with localized prostate cancer are operated on, they will have to reckon with considerable losses in their potency. According to a large-scale study by Barmer GEK, 70 percent of those who underwent surgery complained about erection problems and 53 percent about sexual disinterest.  "Reliable statements on the frequency of erectile dysfunction after radical surgery vary greatly," says Dr. Pedram Derakhshani, urologist at the West German Prostate Center. The data from scientific studies are between 26 and 100 percent. 

No uniform definition of potency

Often there is already a lack of a uniform definition of potency. Prof. Dr. Suks Minhas of University College London even assumes that this has been systematically softened in order to relieve the horror of radical prostatectomy. Thus, the high potency rates reported with robot-assisted prostate removal should also be treated with caution, emphasises the urologist at the EAU's annual congress. 

No improvement in sexual function after surgery in the last 10 years

Meanwhile, scientists at the Memorial Sloan Kettering Cancer Center in New York systematically investigated the question of whether an improvement in erectile dysfunction after radical prostatectomy could be achieved in recent years. For this purpose, they examined more than 2,000 patients who underwent nerve-sparing surgery between 2008 and 2015 and determined data on potency after surgery using standardized questionnaires. However, the results are sobering: the probability of maintaining potency after surgery for prostate cancer has not improved in the last ten years despite great progress in surgical and postoperative care.  According to the study results, this also applies to the modern robot-assisted DaVinci operation.

"Losses in sexual function as a result of the operation are all the more serious since many men with prostate cancer are still undergoing unnecessary surgery," Dr. Derakhshani comments on the current results. According to the recommendation of the guidelines, it could often be sufficient to monitor the tumour closely (active surveillance) or to treat it curatively (healing) by means of focused radiation (brachytherapy) in men who have a low-risk prostate carcinoma. If treatment is necessary, the aim of the therapy should always be to achieve optimal healing rates with minimal side effects, according to the Cologne urologist. 

Capogrosso P et al.: Are We Improving Erectile Function Recovery After Radical Prostatectomy? Analysis of Patients Treated over the Last Decade. Eur Urol. 2019 Feb; 75(2): 221–22

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