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Grand Rounds
Clinician's Corner
June 1, 2005

Erectile Dysfunction Following Radical Prostatectomy

Author Affiliations

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.

JAMA. 2005;293(21):2648-2653. doi:10.1001/jama.293.21.2648

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.