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Erektionsstatus nach nervenerhaltender radikaler Prostatektomie

Nächtliche Früherektion als Parameter der postoperativen organisch-erektilen Integrität

Erectile function after nerve-sparing radical prostatectomy

Nocturnal early erection as a parameter of postoperative organic erectile integrity

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Zusammenfassung

Der zeitliche Verlauf der Wiedererlangung der Erektionsfähigkeit nach nerverhaltender radikaler Prostatektomie ist bislang noch ungeklärt. Mehrere verschiedene Ansätze zur Pathophysiologie der postoperativen erektilen Funktion werden derzeit diskutiert. In einer prospektiven Studie führten wir nächtliche penile Tumeszenz- und Rigiditätsmessungen (NPTR) in der Akutphase während der 1. Nacht nach Katheterentfernung nach nerverhaltender radikaler Prostatektomie durch, um die organisch-erektile Integrität zu beurteilen.

Bei 18 präoperativ sexuell aktiven Patienten mit lokal begrenztem Prostatakarzinom führten wir eine uni- oder bilaterale nerverhaltende Prostatektomie durch. Die präoperative erektile Funktion aller Patienten wurde mit dem „International Index of Erectile Function-“ (IIEF-)5-Fragebogen evaluiert. Am 14. postoperativen Tag wurde der transurethrale Katheter entfernt und es erfolgte eine NPTR-Messung in der darauf folgenden Nacht mittels Erektometer (Rigi-Scan®).

Alle Patienten wiesen einen präoperativen IIEF-Score >18 auf. Nach Katheterentfernung kam es bei 17 der 18 Patienten (95%) zu einer nächtlichen Rigiditätszunahme >70%, die >10 min anhielt. In einer Kontrollgruppe von 4 nicht nerverhaltend Operierten wies keiner der Patienten eine nächtliche Erektion in der 1. Nacht nach Katheterentfernung auf. Die NPTR-Messung in der Akutphase nach nerverhaltender radikaler Prostatektomie zeigte eine vorhandene erektile Funktion schon in der 1. Nacht nach Katheterentfernung.

Diese Ergebnisse sind von großer Bedeutung für die Wahl der weiteren Pharmakotherapie zur optimalen Wiederherstellung einer zufriedenstellenden Erektion und damit befriedigender Sexualfunktion. Im Falle einer vorliegenden Früherektion kann die supportive Medikation mit einem PDE-5-Inhibitor zur weiteren Organrehabilitation beitragen. Bei ausbleibenden spontanen nächtlichen Früherektionen sollten die penilen Injektionsverfahren erwogen werden.

Abstract

The time lapse before recovery of erectile function after nerve-sparing radical prostatectomy is still under debate. Several pathophysiologies are postulated for postoperative erectile function rehabilitation. In prospective studies we measured nocturnal penile tumescence (NPTR) in the acute phase during the first night after catheter removal subsequent to nerve-sparing radical prostatectomy to assess the neuronal organic erectile integrity.

Eighteen sexually active patients suffering from local prostate cancer underwent bilateral and unilateral nerve-sparing retropubic radical prostatectomy. All patients completed an IIEF-5 questionnaire concerning erectile function preoperatively. The transurethral catheter was removed 14 days after surgery, and nocturnal penile tumescence was measured with an erectometer (Rigi-Scan®) in each patient during the following night. None of these patients received any comedication interacting with erectile function.

The preoperative IIEF score was >18 in all patients. After catheter removal, 17 of 18 patients (95%) had nocturnal penile radial rigidity >70% that persisted for >10 min during one night. In a control of four patients without a nerve-sparing procedure, no nocturnal erections were recorded.

The measurement of NPTR in the acute phase after nerve-sparing radical prostatectomy showed retained erectile function even during the “first” night after catheter removal. Our findings are important for an appropriate choice of pharmacotherapy for optimal recovery of erectile function. In cases of early penile erections, the cavernous nerve had been well preserved during surgery providing good neuronal integrity, and PDE-5 inhibitors can support organic rehabilitation of the corpus cavernosum. In the absence of early penile erections, the neuronal integrity of the cavernous nerve is presumed to be impaired. In this case, additional injection therapy should be chosen to support recovery of spontaneous erectile function.

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  1. Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel

    A. Bannowsky, H. Schulze, C. van der Horst, J. H. Stübinger, F. J. Martinez Portillo & K. P. Jünemann

  2. Klinik für Urologie und Kinderurologie, Universitätskliniken Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 7, 24105, Kiel

    A. Bannowsky

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  1. A. Bannowsky
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  2. H. Schulze
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  3. C. van der Horst
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  4. J. H. Stübinger
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  6. K. P. Jünemann
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Correspondence to A. Bannowsky.

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Bannowsky, A., Schulze, H., van der Horst, C. et al. Erektionsstatus nach nervenerhaltender radikaler Prostatektomie. Urologe [A] 44, 521–526 (2005). https://doi.org/10.1007/s00120-005-0781-0

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  • DOI: https://doi.org/10.1007/s00120-005-0781-0

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