Erectile Dysfunction after radical Prostatectomy

In the age of nerve-sparing radical prostatectomy, rates of postoperative erectile dysfunction (ED) have significantly decreased. However, on comparing open retropubic, laparoscopic and robot-assisted procedures, none of these techniques seem to show specific advantages in this respect. PDE5 inhibitors are considered to be the gold standard in the first-line therapy of postoperative ED, as far as relevant contraindications can be excluded. Intraurethral and intracavernosal injections with prostaglandin E1 represent the second-line treatment. Implantation of penile prostheses still remains as the third-line and ultima ratio. Meanwhile, the administration of PDE5 inhibitors has been proven to be most effective. When applying this therapy regimen, these substances are highly useful when they are administered early after the intervention. After curative treatment of prostate cancer, testosterone substitution can be an efficient way to reduce hypogonadal symptoms in patients with manifest testosterone deficiency. It may even contribute to the improvement of post- interventional erectile disorders. According to the recent literature, testosterone substitution therapy is safe and does not show any additional risk of recurrence when there is a well considered indication and when patients are carefully selected.