Abstract
PURPOSE: We aimed to assess objectively the integrity of the parasympathetic neural pathway that controls the inflow choke vessels to the corpora cavernosa in a group of male patients with postproctectomy erectile dysfunction. METHODS: The study group was male patients with erectile dysfunction after proctectomy for rectal cancer and inflammatory bowel disease identified by sexual function questionnaire. The group underwent two consecutive nights of home nocturnal penile tumescence monitoring with the Nocturnal Electrobioimpedance Volumetric Assessment device. The control group was also monitored. It comprised preoperative potent patients with rectal cancer and inflammatory bowel disease who had not yet undergone a variety of surgical procedures. Demographics and nocturnal penile tumescence parameters were recorded, including number, duration, and percentage increase in penile volume of tumescent events. RESULTS: Thirty-four impotent study group and 28 potent control group patients underwent nocturnal penile tumescence monitoring. The groups were well matched for mean age (difference, 1.4 years; 95 percent confidence interval, −5.8 to 8.6 years) and proportion with rectal cancer (difference, 6 percent; 95 percent confidence interval, −1 to 13 percent). The number of nocturnal penile tumescent events was greater for the potent group than for the control group (mean rank, 40.4 vs. 24.2; P = 0.0004). There was no significant difference between the mean duration (difference, 2.6 minutes; mean rank, 27.9 vs. 34.4; P = 0.16) or the mean penile volume increase (difference, 5.4 percent increase; mean rank, 30.6 vs. 32.6; P = 0.66) for tumescent events between the study and control groups. Mean age was significantly higher in complete than in partial impotence (60.9 vs. 53.1 years; difference, 7.8 years; 95 percent confidence interval, 0.1 to 15.5 years). There was a nonsignificant trend to a lower mean number of tumescence events among sildenafil responders than among nonresponders (3.5 vs. 4.8 events; mean rank, 11.2 vs. 17.3; P = 0.14). CONCLUSION: Nocturnal penile tumescence activity is diminished but not ablated by the trauma of surgical dissection. This suggests that some of the cavernous nerves that govern inflow to the corpora cavernosa are intact after surgery and that the nerve lesion responsible for erectile dysfunction is partial, and it explains why the response to sildenafil in such patients is surprisingly high.
Similar content being viewed by others
References
I Lindsey RJ Guy BF Warren NJ Mortensen (2000) ArticleTitleAnatomy of Denonvilliers’ fascia and pelvic nerves, impotence, and implications for the colorectal surgeon Br J Surg 87 1288–1299
RC Rosen A Riley G Wagner IH Osterloh J Kirkpatrick A Mishra (1997) ArticleTitleThe International Index of Erectile Function (IIEF) Urology 49 822–830
SA Kaplan RB Reis IJ Kohn et al. (1999) ArticleTitleSafety and efficacy of sildenafil in postmenopausal women with sexual dysfunction Urology 53 481–486
JC Cappelleri RC Rosen MD Smith A Mishra IH Osterloh (1999) ArticleTitleDiagnostic evaluation of the erectile function domain of the International Index of Erectile Function Urology 54 346–351
M Weinstein M Roberts (1977) ArticleTitleSexual potency following surgery for rectal carcinoma Ann Surg 185 295–300
JM Watts FT de Dombal JC Goligher (1966) ArticleTitleLong-term complications and prognosis following major surgery for ulcerative colitis Br J Surg 53 1014–1023
H Lepor M Gregerman R Crosby FK Mostafi PC Walsh (1985) ArticleTitlePrecise localisation of the autonomic nerves from the pelvic plexus to the corpora cavernosa J Urol 133 207–212
PC Walsh H Lepor JC Eggleston (1983) ArticleTitleRadical prostatectomy with preservation of sexual function Prostate 4 473–485
I Lindsey BD George MG Kettlewell NJ Mortensen (2001) ArticleTitleImpotence after mesorectal and close rectal dissection for inflammatory bowel disease Dis Colon Rectum 44 831–835
AR Mundy (1982) ArticleTitleAn anatomical explanation for bladder dysfunction following rectal and uterine surgery Br J Urol 54 501–504
OM Jones N Smeulders O Wiseman R Miller (1999) ArticleTitleLateral ligaments of the rectum Br J Surg 86 487–489
A Ek WE Bradley RJ Krane (1983) ArticleTitleNocturnal penile rigidity measured by the snap-gauge band J Urol 129 964–966
WS Chung HK Choi (1990) ArticleTitleErotic erection versus nocturnal erection J Urol 143 294–297
WE Bradley GW Timm JM Gallagher et al. (1985) ArticleTitleNew method for continuous measurement of nocturnal penile tumescence and rigidity Urology 26 4–9
DL Knoll JH Abrams (1999) ArticleTitleApplication of nocturnal electrobioimpedance volumetric assessment J Urol 161 1137–1140
DL Knoll JH Abrams (1999) ArticleTitleNocturnal electrobioimpedance volumetric assessment of patients with erectile dysfunction Urology 53 1200–1204
I Lindsey BD George MG Kettlewell NJ Mortensen (2002) ArticleTitleRandomized, double-blind, placebo-controlled trial of sildenafil (Viagra®) for erectile dysfunction after rectal excision for cancer and inflammatory bowel disease Dis Colon Rectum 45 727–732
BH Lowentritt PT Scardino BJ Miles et al. (1999) ArticleTitleSildenafil citrate after radical retropubic prostatectomy J Urol 162 1614–1617
CD Zippe AW Kedia K Kedia DR Nelson A Agarwal (1998) ArticleTitleTreatment of erectile dysfunction after radical prostatectomy with sildenafil citrate (Viagra) Urology 52 537–542
S Carrier P Zvara L Nunes et al. (1995) ArticleTitleRegeneration of nitric oxide synthetase-containing nerves after cavernous nerve neurotomy in the rat J Urol 153 1722–1727
Author information
Authors and Affiliations
About this article
Cite this article
Lindsey, I., Cunningham, C., George, B.D. et al. Nocturnal Penile Tumescence Is Diminished but Not Ablated in Postproctectomy Impotence. Dis Colon Rectum 46, 14–19 (2003). https://doi.org/10.1007/s10350-004-6489-1
Issue Date:
DOI: https://doi.org/10.1007/s10350-004-6489-1