Grand Rounds at The Johns Hopkins Bayview Medical
Center Section Editors: John H. Stone, MD, MPH, Charles Weiner, MD,
Stephen D. Sisson, MD, The Johns Hopkins Hospital, Baltimore, Md; David S.
Cooper, MD, Contributing Editor, JAMA .
Author Affiliations: Johns Hopkins University
School of Medicine, Department of Urology, The James Buchanan Brady Urological
Institute, The Johns Hopkins Medical Institutions, Baltimore, Md.
Erectile dysfunction following radical prostatectomy for clinically
localized prostate cancer is a known potential complication of the surgery.
Because prostate cancer is diagnosed today more frequently than in the past
and because the diagnosis is made in increasingly younger men, there is an
urgent need to develop effective interventions that preserve erectile function
after surgery. In this presentation, a 51-year-old man with adenocarcinoma
of the prostate underwent a bilateral nerve-sparing radical prostatectomy,
after which he lost natural erectile function for approximately 9 months.
The case highlights the fact that following surgery in which the nerve-sparing
radical prostatectomy technique is used, between 60% to 85% of men eventually
recover erectile function. This constitutes a dramatic improvement over an
earlier era, when postprostatectomy erectile dysfunction was the nearly universal
rule. The case also emphasizes that despite expert application of the nerve-sparing
prostatectomy technique, early recovery of natural erectile function is uncommon.
Many patients experience erectile dysfunction for as long as 2 years after
the procedure, requiring the use of erectile aids for sexual activity during
this period until natural erections recover. Corrective, cause-specific advances
such as neuromodulatory therapy offer valuable adjuncts to this surgery.
Burnett AL. Erectile Dysfunction Following Radical Prostatectomy. JAMA. 2005;293(21):2648-2653. doi:10.1001/jama.293.21.2648