Ist eine Rehabilitation der erektilen Funktion nach beckenchirurgischen Eingriffen sinnvoll?

Literaturübersicht vom Sport bis zur PDE-5-Inhibitoren-Gabe

Is rehabilitation of erectile function following pelvic surgery reasonable?

Review of the literature: from sports to PDE5 inhibitors

Zusammenfassung

Immer häufiger stellen sich Patienten mit einer erektilen Dysfunktion (ED) nach beckenchirurgischen Eingriffen in urologischen Praxen vor, wobei es sich in den allermeisten Fällen um Patienten nach radikalen Prostatovesikulektomieoperationen handelt. Trotz Erhaltung des Gefäßnervenbündels tritt in mindestens 50% der Fälle eine ED auf. Dieser Artikel diskutiert die verschiedenen Ursachen und theoretischen Ansätze der Therapie. Dabei werden lebensstilverändernde Maßnahmen, die Unterstützung der Neuroregeneration und die damit verbundene Verhinderung der Apoptose der glatten Muskulatur des Corpus cavernosum und die Verbesserung der Schwellkörpercompliance durch eine verbesserte Oxygenierung angesprochen. Einige dieser Therapieansätze werden in der internationalen Literatur als viel versprechend diskutiert, wobei die frühzeitige Rehabilitation der Erektionsfähigkeit sinnvoll zu sein scheint. Man vermutet, dass die natürliche Wiedererlangung der erektilen Funktion nach beckenchirurgischen Eingriffen häufig bis zu 2 Jahre oder länger dauert, wobei dieser Zeitraum allem Anschein nach durch eine effektive Rehabilitation verkürzt werden kann.

Abstract

Increasingly, urologists are seeing patients with erectile dysfunction after pelvic operations. In most cases, radical prostatectomy is the cause. Even when a nerve-sparing procedure is performed, approximately 50% of the patients suffer from erectile dysfunction. This report discusses the causes and theoretical therapies, including lifestyle changes, strategies for neuroregeneration and the associated prevention of apoptosis of the smooth muscle of the corpus cavernosum and improvement of the corpora cavernosa by increased oxygenation. According to the international literature, many of these agents and lifestyle modifications display promise for treating impotence. Early treatment for patients recovering from pelvic operations seems to be reasonable. It is assumed that the natural recovery of erections may take as long as 18 to 24 months postsurgery or even longer; however, treatment modalities may reduce the time to erectile recovery.

This is a preview of subscription content, access via your institution.

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. 1.

    Burnett AL (2003) Strategies to promote recovery of cavernous nerve function after radical prostatectomy. World J Urol 20: 337–342

    PubMed  Google Scholar 

  2. 2.

    Walsh PC, Donker PJ (1982) Impotence following radical prostatectomy: insight into etiology and prevention. J Urol 128: 492–497

    PubMed  CAS  Google Scholar 

  3. 3.

    Walsh PC (1988) Preservation of sexual function in the surgical treatment of pro staticcancer – an anatomic surgical approach. In: Devita VT, Hellman S, Rosenberg S (eds) Important advances in oncology. Lippincott, Philadelphia, pp 161–170

  4. 4.

    Graefen M, Walz J, Huland H (2006) Open retropubic nerve-sparing radical prostatectomy. Eur Urol 49: 38–48

    PubMed  Article  Google Scholar 

  5. 5.

    Michl UH, Friedrich MG, Graefen M et al. (2006) Prediction of postoperative sexual function after nerve sparing radical retropubic prostatectomy. J Urol 176: 227–231

    PubMed  Article  Google Scholar 

  6. 6.

    Walsh PC, Marschke P, Ricker D, Burnett AL (2000) Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. Urology 55: 58–61

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Rabbani F, Stapleton AM, Kattan MW et al. (2000) Factors predicting recovery of erections after radical prostatectomy. J Urol 164: 1929–1934

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Sommer F, Peters, Klotz T et al. (2002) Sport und Bewegung in der Prävention urologischer Erkrankungen. Urologe B 42: 297–305

    Google Scholar 

  9. 9.

    Esposito K, Giugliano D (2005) Obesity, the metabolic syndrom, and sexual dysfunktion. Int J Imp Res 17: 391–398

    Article  CAS  Google Scholar 

  10. 10.

    Dorland’s Illustrated Medical Dictionary (1988) Dorland’s Illustrated Medical Dictionary, 27th edn. Saunders, Philadelphia, p 1126

  11. 11.

    McCullough AR (2001) Prevention and management of erectile dysfunction following radical prostatectomy. Urol Clin North Am 28: 613–627

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Quinlan DM, Epstein JI, Carter BS, Walsh PC (1991) Sexual function following radical prostatectomy: influence of preservation of neurovascular bundles. J Urol 145: 998–1002

    PubMed  CAS  Google Scholar 

  13. 13.

    Walsh PC, Marschke P, Ricker D, Burnett AL (2000) Use of intraoperative video documentation to improve sexual function after radical retropubic prostatectomy. Urology 55: 62–67

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Podlasek CA, Gonzalez CM, Zelner DJ et al. (2001) Analysis of NOS isoform changes in a post radical prostatectomy model of erectile dysfunction. Int J Impot Res 13(Suppl 5): 1–15

    Article  Google Scholar 

  15. 15.

    Zagaja GP, Mhoon DA, Aikens JE, Brendler CB (2000) Sildenafil in the treatment of erectile dysfunction after radical prostatectomy. Urology 56: 631–634

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Zippe CD, Jhaveri FM, Klein EA et al. (2000) Role of Viagra after radical prostatectomy. Urology 55: 241–245

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Wespes E, de Goes PM, Schulman CC (1998) Age-related changes in the quantification of the intracavernous smooth muscles potent men. J Urol 159(Suppl 5): 99

    Article  Google Scholar 

  18. 18.

    Wespes E (2002) Smooth muscle pathology and erectile dysfunction. Int J Impot Res 14(Suppl 1): 17–21

    Article  Google Scholar 

  19. 19.

    Bondil P, Costa P, Daures JP et al. (1992) Clinical study of the longitudinal deformation of the flaccid penis and of its variations with aging. Eur Urol 21: 284–286

    PubMed  CAS  Google Scholar 

  20. 20.

    Fraiman MC, Lepor H, McCullough AR (1999) Changes in penile morphometrics in men with erectile dysfunction after nerve-sparing radical retropubic prostatectomy. Mol Urol 3: 109–115

    PubMed  Google Scholar 

  21. 21.

    Klein LT, Miller MI, Buttyan R et al. (1997) Apoptosis in the rat penis after penile denervation. J Urol 158: 626–630

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    User HM, Hairston JH, Zelner DJ et al. (2003) Penile weight and cell subtype specific changes in a post-radical prostatectomy model of erectile dysfunction. J Urol 169: 1175–1179

    PubMed  Article  Google Scholar 

  23. 23.

    Polascik TJ, Walsh PC (1995) Radical retropubic prostatectomy: the influence of accessory pudendal arteries on the recovery of sexual function. J Urol 154: 150–152

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Tarhan F, Kuyumcuoglu U, Kolsuz A et al. (1997) Cavernous oxygen tension in the patients with erectile dysfunction. Int J Impot Res 9: 149–153

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Mersdorf A, Goldsmith PC, Diederichs W et al. (1991) Ultrastructural changes in impotent penile tissue: a comparison of 65 patients. J Urol 145: 749–785

    PubMed  CAS  Google Scholar 

  26. 26.

    Krane RJ, Goldstein I, Saenz de Tejada I (1989) Impotence. Medical Progress. N Engl J Med 321: 1648–1659

    PubMed  CAS  Google Scholar 

  27. 27.

    Lerner SE, Melman A, Christ GJ (1993) A review of erectile dysfunction: new insights and more questions. J Urol 149: 1246

    PubMed  CAS  Google Scholar 

  28. 28.

    Moreland RB (1998) Is there a role of hypoxemia in penile fibrosis: a viewpoint presented to the Society for the Study of Impotence. Int J Impot Res 10: 113–120

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Wilborn J, Croffrod LJ, Burdick MD et al. (1995) Cultured lung fibroblasts isolated from patients with idiopathie pulmonary fibrosis have a diminished capacity to synthesize prostaglandin E2 and to express cyclooxygenase-2. J Clin Inv 95: 1861–1868

    Article  CAS  Google Scholar 

  30. 30.

    Kim N, Vardi Y, Padma-Nathan H et al. (1993) Oxygen tension regulates the nitric oxide pathway. Physiological role in penile erection. J Clin Invest 91: 437–442

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Halverson HM (1940) Genital and sphincter behavior of the male infant. J Gen Psychol 56: 95

    Google Scholar 

  32. 32.

    Fischer C, Gross J, Zuch J (1965) Cycle of penile erections synchronous with dreaming (REM) sleep: preliminary report. Arch Gen Psychiatry 12: 29–45

    Google Scholar 

  33. 33.

    Karacan I, Williams R, Salis P (1970) The effect of sexual intercourse in sleep patterns and nocturnal penile erections. Psychophysiology 7: 338

    Google Scholar 

  34. 34.

    Karacan I (1986) Erectile dysfunction in narcoleptic patients. Sleep 9: 227–231

    PubMed  CAS  Google Scholar 

  35. 35.

    Montorsi F, Maga T, Strambi LF et al. (2000) Sildenafil taken at bedtime significantly increases nocturnal erections: results of a placebo-controlled study. Urology 56: 906–911

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Moreland RB, Traish A, McMillin MA et al. (1995) PGE1 suppresses the induction of collagen synthesis by transforming growth factor-beta 1 in human corpus cavernosum smooth muscle. J Urol 153: 826–834

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    Muller A, Mulhall JP (2006) Cardiovascular disease, metabolic syndrome and erectile dysfunction. Curr Opin Urol 16: 435–443

    PubMed  Article  Google Scholar 

  38. 38.

    Wirth A, Manning M, Büttner H (2007) Metabolic syndrome and erectile dysfunction. Epidemiologic associations and pathogenetic links. Urologe A 46: 287–292

    PubMed  Article  CAS  Google Scholar 

  39. 39.

    Van der Horst C, Martinez Portill FJ, Banowsky A et al. (2003) Early erectile function after catheter removal in patients undergoing nerve-sparing prostatectomy. Int J Impot Res 15(Suppl 6): 13

    Google Scholar 

  40. 40.

    Montorsi F, Guazzoni G, Strambi LF (1997) Recovery of spontaneous erectile function after nerve-sparing radical retropubic prostatectomy with and without early intracavernous injections of alprostadil: results of a prospective, randomized trail. J Urol 158: 1408–1410

    PubMed  Article  CAS  Google Scholar 

  41. 41.

    Montorsi F, Briganti A, Salonia A et al. (2004) Current and future strategies for prevention and managing erectile dysfunction following radical prostatektomy. Eur Urol 45: 123–133

    PubMed  Article  Google Scholar 

  42. 42.

    Sommer F, Mathers MJ (2007) Lifestyle, erektile Dysfunktion, Hormone, metabolisches Syndrom – Möglichkeiten einer geschlechtsspezifischen männlichen Prävention. Urologe 46: 628–635

    PubMed  Article  CAS  Google Scholar 

  43. 43.

    Mathers MJ, Rundstedt F v, Lazica DA, Sommer F (2008) Diet-induced weight loss vs. exercise-induced weight loss: is there an effect on erectile dysfunction in obese men? European Urology (in press)

  44. 44.

    Wespes E, Amar E, Hatzichristou D et al. (2006) EAU Guidelines on erectile dysfunction: an update. Eur Urol 49: 806–815

    PubMed  Article  Google Scholar 

  45. 45.

    Travison TG, Shabsigh R, Araujo AB et al. (2007) The natural progression and remission of erectile dysfunction: results from the Massachusetts Male Aging Study. J Urol 177: 241–246

    PubMed  Article  Google Scholar 

  46. 46.

    Bacon CG, Mittleman MA, Kawachi I et al. (2003) Sexual function in men older than 50 years of age: results from the health professionals follow-up study. Ann Intern Med 139: 161–168

    PubMed  Google Scholar 

  47. 47.

    Blanker MH, Bohnen AM, Groeneveld FP et al. (2001) Correlates for erectile and ejaculatory dysfunction in older Dutch men: a community-based study. J Am Geriatr Soc 49: 436–442

    PubMed  Article  CAS  Google Scholar 

  48. 48.

    Martin-Morales A, Sanchez-Cruz JJ, Saenz de Tejada I et al. (2001) Prevalence and independent risk factors for erectile dysfunction in Spain: results of the Epidemiologia de la Disfuncion Erectil Masculina Study. J Urol 166: 569–575

    PubMed  Article  CAS  Google Scholar 

  49. 49.

    Mirone V, Imbimbo C, Bortolotti A et al. (2002) Cigarette smoking as risk factor for erectile dysfunction: results from an Italian epidemiological study. Eur Urol 41: 294–297

    PubMed  Article  Google Scholar 

  50. 50.

    Feldman HA, Johannes CB, Derby CA et al. (2000) Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts male aging study. Prev Med 30: 328–338

    PubMed  Article  CAS  Google Scholar 

  51. 51.

    Laumann EO, Paik A, Rosen RC (1999) Sexual dysfunction in the United States: prevalence and predictors. Jama 281: 537–544

    PubMed  Article  CAS  Google Scholar 

  52. 52.

    Derouet H, Nolden W, Jost WH et al. (1998) Treatment of erectile dysfunction by an external ischiocavernous muscle stimulator. Eur Urol 34: 355–359

    PubMed  Article  CAS  Google Scholar 

  53. 53.

    Gontero P, Fontana F, Bagnasacco A et al. (2003) Is there an optimal time for intracavernous prostaglandin E1 rehabilitation following nonnerve sparing radical prostatectomy? Results from a hemodynamic prospective study. J Urol 169: 2166–2169

    PubMed  Article  Google Scholar 

  54. 54.

    Sommer F, Heidenreich A, Reddy P, Derakhshani P (1999) Vergleich von Effektivität und Nebenwirkungen der Therapie mit MUSE und SKAT. 45. Tagung der Nordrhein-Westfälischen Gesellschaft für Urologie, Münster 16.04

  55. 55.

    Mathers MJ, Klotz T, Brandt AS et al. (2008) Long-term treatment of erectile dysfunction with a phosphodiesterase-5 inhibitor and dose optimization based on nocturnal penile tumescence. BJU Int 10 (Epub ahead of print)

  56. 56.

    Padma-Nathan H, McCullough A, Forest C (2004) Erectile dysfunction secondary to nerve-sparing radical retropubic prostatectomy: comparative phosphodiesterase-5 inhibitor efficacy for therapy and novel prevention strategies. Curr Urol Rep 5: 467–471

    PubMed  Article  Google Scholar 

  57. 57.

    Sommer F, Schulze W (2005) Treating erectile dysfunction by endothelial rehabilitation with phosphodiesterase 5 inhibitors. World J Urol 23: 385–392

    PubMed  Article  CAS  Google Scholar 

  58. 58.

    Zhang XH, Hu LQ, Chen J et al. (2002) The rat model of erectile dysfunction caused by cavernous nerve injury. Zhonghua Nan Ke Xue 8: 120–121

    PubMed  Google Scholar 

  59. 59.

    Mulhall J, Land S, Parker M et al. (2005) The use of an erectogenic pharmacotherapy regimen following radical prostatectomy improves recovery of spontaneous erectile function. J Sex Med 2: 532–540

    PubMed  Article  CAS  Google Scholar 

  60. 60.

    Herkommer K, Geschwend J, Jerzinowski N et al. (2006) Versorgung der erektilen Dysfunktion nach radikaler Prostatektomie in Deutschland. Urologe 1: 135

    Google Scholar 

  61. 61.

    Herkommer K, Niespodziany S, Zorn C et al. (2006) Versorgung der erektilen Dysfunktion nach radikaler Prostatektomie in Deutschland. Urologe 45: 336–342

    PubMed  Article  CAS  Google Scholar 

  62. 62.

    Gontero P, Fontana F, Zitella A et al. (2005) A prospective evaluation of efficacy and compliance with a multistep treatment approach for erectile dysfunction in patients after non-nerve sparing radical prostatectomy. BJU Int 95: 359–365

    PubMed  Article  Google Scholar 

  63. 63.

    Bannowsky A, Schulze H, van der Horst C et al. (2005) Erectile function after nerve-sparing radical prostatectomy. Nocturnal early erection as a parameter of postoperative organic erectile integrity. Urologe A 44: 521–526

    PubMed  Article  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Dr. M.J. Mathers.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Mathers, M., Klotz, T., Vahlensieck, W. et al. Ist eine Rehabilitation der erektilen Funktion nach beckenchirurgischen Eingriffen sinnvoll?. Urologe 47, 685 (2008). https://doi.org/10.1007/s00120-008-1668-7

Download citation

Schlüsselwörter

  • Postoperative erektile Dysfunktion
  • Rehabilitation
  • Lebensstilveränderung
  • PDE-5-Inhibitoren

Keywords

  • Postoperative erectile dysfunction
  • Rehabilitation
  • Lifestyle changes
  • PDE5 inhibitors