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N12 Preventive role of postoperatively early introduced intracavernosal PGE1 injections on the development of blood flow disturbances in penis after radical prostatectomy

      Introduction and Objectives

      Erectile dysfunction (ED) is a natural sequel of radical prostatectomy (RP). The operation results in apraxia of cavernosal nerves and development of impaired blood flow in penis; these changes tend to progress with time and lead to loss of spontaneous erections and irreversible vascular disturbances in cavernosal bodies. Application of the nerve sparing RP technique and early commencement of pharmacotherapy for ED may limit the development of the above mentioned pathologies. The aim of the study is to evaluate: 1) The incidence and characteristics of hemodynamic changes in penis after RP. 2) The influence of early started pharmacotherapy after RP on blood flow in cavernosal bodies.

      Material and Methods

      The prospective study comprised 67 preoperatively potent men. The preoperative diagnostics of potency consisted of anaemnesis, IIEF-5 questionnaire and Power Doppler evaluation of blood flow in penis following intracavernosal injection (ICI) of 10 ug of Alprostadil (only potent men – with normal results were enrolled). The Power Doppler study was repeated at 6 weeks and at 6 months after the surgery. At 6 weeks after operation all patients were offered to start the therapy with intracavernosal injections of 10 ug of PGE1 done twice a week, and were trained how to perform the ICI. The ICI-therapy was started and continued by 29 men (43.3%) – group 1. The remaining patients refused or stopped ICI within the study period – group 2.

      Results

      At 6 weeks after RP correct vascular blood flow, arterial, venous and mixed type of vascular disorders were found in 34 (50.75%), 18 (26.87%), 8 (11.94%) and 7 (10.45%) patients respectively. At this timepoint a significant decrease of mean PSV and RI values was found whereas mean EDV value increased slightly in comparison to the preoperative results. At 6 months after the surgery statistically significant differences of PSV, EDV and RI values were noted between group 1 and group 2. Mean results of Doppler examination for group 1 and group 2 were: PSV – 36.09 cm/s vs. 25.78 cm/s (p = 0,000001), EDV – 1.96 cm/s vs. 9.72 cm/s (p = 0.000001) and RI – 0.926 vs. 0.613 (p = 0.000001) respectively. Correct blood flow was diagnosed in 27 patients (93.1%) treated with ICI (group 1) and 4 (10.5%) men not treated with ICI (group 2). The frequencies of cavernosal vascular disorders in group 1 and group 2 were: arterial – 3.45% vs. 5.26%, venous 3.45% vs. 44.74% and mixed 0% vs. 39.47% respectively. The frequencies of correct blood flow, venous and mixed vascular disorders in penis differed significantly (p < 0.05) between both groups.

      Conclusions

      1. In the early postoperative period dominate arterial disturbances, and with the time venous leakage becomes more intense. 2. Early start of ICI-therapy seriously limits the development of hemodynamic dysfunctions in penis after radical prostatectomy