Erectile dysfunction post radical prostatectomy

Deirdre M Kiernan1

1 Mater Hospital Brisbane, Raymond Terrace, South Brisbane, QLD 4101. deirdre.kiernan@mater.org.au

 

Prostate cancer is the most commonly diagnosed male cancer in western society (1). It is predicted that greater than 17,000 Australian cases will be diagnosed in 2015 (2).Patients diagnosed with localised prostate cancer can be offered a number of treatment modalities, however radical prostatectomy (RP) or external beam radiation treatment(EBRT)are the most common conventional treatments offered(3, 4).The five-year survival rate following conventional treatment for localised prostate cancer is over 90%(5). The treatment modalities are associated with potential side effects, which include alterations in urinary function, sexual function and bowel function (1). Therefore long-term quality of life (QOL) concerns are prevalent among men following treatment of prostate cancer(5).

Erectile dysfunction (ED) is one of the most common problems experienced by men post RP. ED is the inability to achieve or maintain a satisfactory erection for sexual intercourse(4).ED can be persistant,recovery time can take from 6 months to over two years in some cases satisfactory  sexual function may never return (6). The condition occurs following a RP due to damage or removal of the nerves responsible for erectile function (5).Penile hypoxia results due to neuropraxia and decreased vascularity of the cavernosal fibrosis (6). If penile hypoxia persists this compounds long term erectile dysfunction(6). Cancer control is the main objective of surgery, nerves will not be spared if disease control is compromised(7). The incidence of ED post RP vary mostly due to lack of consistency and the variability in recording its occurrence (4). The extent of ED can vary depending on a number of factors including age of patient, erectile function prior to surgery, presence of other co morbidities for example diabetes and the extent of surgery whether it was nerve sparing surgery or non-nerve sparing (6). Nursing care for these men needs to focus on recovering erectile function post operatively.

Key Words

Erectile dysfunction, radical prostatectomy, quality of life, sexual function.

References:

  1. Schiavina R, Borghesi M, Dababneh H, Pultrone CV, Chessa F, Concetti S, et al. Survival, Continence and Potency (SCP) recovery after radical retropubic prostatectomy: a long-term combined evaluation of surgical outcomes. European Journal Of Surgical Oncology: The Journal Of The European Society Of Surgical Oncology And The British Association Of Surgical Oncology. 2014;40(12):1716-23.
  2. Welfare AIoHa. Cancer in Australia an overview 2014: AIHW; 2014 [cited 2014 11/08/2015]. Available from: http://www.aihw.gov.au/acim-books/.
  3. Keyes M, Crook J, Morton G, Vigneault E, Usmani N, Morris WJ. Treatment options for localized prostate cancer. Canadian Family Physician Médecin De Famille Canadien. 2013;59(12):1269-74.
  4. Saleh A, Abboudi H, Ghazal-Aswad M, Mayer EK, Vale JA. Management of erectile dysfunction post-radical prostatectomy. Research And Reports In Urology. 2015;7:19-33.
  5. Kirby MG, White ID, Butcher J, Challacombe B, Coe J, Grover L, et al. Development of UK recommendations on treatment for post-surgical erectile dysfunction. International Journal Of Clinical Practice. 2014;68(5):590-608.
  6. Nandipati KC, Raina R, Agarwal A, Zippe CD. Erectile dysfunction following radical retropubic prostatectomy: epidemiology, pathophysiology and pharmacological management. Drugs & aging. 2006;23(2):101-17.
  7. Simpson P. Prostatectomy: information provision and education for patients. British Journal Of Nursing (Mark Allen Publishing). 2015;24(9):S24-S8.

 

Biography

Originally from Ireland , graduated as a registered general nurse in 1997 and following some traveling specialised in intensive care nursing. Moved  to Australia in 2005 and commenced work within the dept. of Urology at Mater Hospital Brisbane since 2009 .Completed a Masters of Nurse Practitioners in 2012. Commenced in current role of Prostate Cancer Specialist Nurse in 2012.