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N16 Vascular disorders in cavernosal bodies limit the effectiveness of treatment of erectile dysfunction following radical prostatectomy

      Introduction and Objectives

      Blood flow disturbances in cavernosal bodies develop in many patients after radical prostatectomy (RP). Impaired hemodynamic of the penis may limit the ability to attain and maintain rigid erection either after natural or pharmacological stimulation, therefore it seems to be an important factor influencing the severity of erectile dysfunction (ED) in men who underwent radical resection of the prostate. The aim of the study is to evaluate: 1) The correlation between impaired blood flow in penile arteries and type of reaction to intracavernosal injection of PGE1. 2) The influence of penile vascular disorders on severity of erectile dysfunction.

      Material and Methods

      The prospective study comprised 67 preoperatively potent men. The preoperative diagnostics of potency consisted of anaemnesis, IIEF-5 questionnaire, Power Doppler evaluation of blood flow in penis following intracavernosal injection (ICI) of 10 ug of Alprostadil and assessment of reaction to ICI (rigid erection, tumescence, no visible reaction). Only potent men – with normal results were enrolled. These tests were repeated at six months after RP. Correct vascular blood flow was found in 31 patients (46%) – group 1. In the remaining 36 men (54%) blood flow disturbances were diagnosed – group 2.

      Results

      At six months after RP mean IIEF5 score in group 1 was 16.6; while in group 2 it was seriously lower – 3.3; (p < 0.000001) and indicated severe ED in men with impaired blood flow in penis. In group 2 the most frequent type of vascular disorders was venous leakage (18 men – 50%). Arterial and mixed disorders were found in 3 (8%) and 15 (42%) patients respectively. Rigid erection following ICI was attained by 45 men. Between them correct blood flow, arterial, venous and mixed disorders were found in 31 (68.89%), 3 (6.67%), 7 (15.56%) and 4 (8.89%) patients respectively (p = 0,00001). Tumescence was observed both in 8 men (50%) with venous and mixed disorders. 6 patients presented no reaction following ICI (venous leakage – 3(50%), mixed disorders – 3(50%)). Mean values of Doppler study in men with erection, tumescence and no reaction after ICI were: PSV: 32.5; 26.6; 25.1 cm/s (p = 0.0012); EDV: 1.5; 3.7; 12.8 cm/s (p = 0.000001); RI: 0.936; 0.877; 0.515 (p = 0.000001) respectively.

      Conclusions

      1) Impaired blood flow in cavernosal bodies correlates with higher severity of ED 2) Presence of vascular disorders in penis deteriorates the reaction to intracavernosal injection of PGE1 and limits the effectiveness of ED treatment following radical prostatectomy.