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Impotence Following Radical Prostatectomy: Insight Into Etiology and Prevention

1982; Lippincott Williams & Wilkins; Volume: 128; Issue: 3 Linguagem: Inglês

10.1016/s0022-5347(17)53012-8

1527-3792

Patrick C. Walsh, P.J. Donker,

Urinary Bladder and Prostate Research

No AccessJournal of Urology1 Sep 1982Impotence Following Radical Prostatectomy: Insight Into Etiology and Prevention Patrick C. Walsh, and Pieter J. Donker Patrick C. WalshPatrick C. Walsh More articles by this author , and Pieter J. DonkerPieter J. Donker More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)53012-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail This study was undertaken to identify the cause of impotence in men undergoing radical prostatectomy, with the hope that this information may provide insight into the possible prevention of this complication. The autonomic innervation of the corpora cavernosa in the male fetus and newborn was traced to determine the topographical relationship between the pelvic nerve plexus, and the prostate, urethra and urogenital diaphragm. We have demonstrated that the branches of the pelvic plexus that innervate the corpora cavernosa are situated between the rectum and urethra, and penetrate the urogenital diaphragm near or in the muscular wall of the urethra. Injuries to the pelvic plexus can occur in 2 ways: 1) during division of the lateral pedicle and 2) at the time of apical dissection with transection of the urethra. Thirty-one men who underwent radical retropubic prostatectomy were evaluated to determine risk factors that correlated with postoperative impotence: 5 (16 per cent) were fully potent, 7 (23 per cent) had partial erections that were inadequate for sexual intercourse and 19 (61 per cent) had total erectile impotence. The 2 factors that had a favorable influence on postoperative potency were age and pathologic stage of the lesion: 31 per cent of the patients less than 60 years old were potent versus only 6 per cent of the patients more than 60 years, while 33 per cent of the patients with tumor microscopically confined to the prostatic capsule were potent versus only 5 per cent of those with capsular penetration. When the factors of age and capsular penetration were combined 60 per cent of the men less than 60 years old who had an intact prostatic capsule were potent. Arterial insufficiency and psychogenic factors were excluded as major contributing factors by the finding of normal penile blood flow and absence of nocturnal penile tumescence in the impotent patients. We conclude that impotence after radical prostatectomy results from injury to the pelvic nerve plexus that provides autonomic innervation to the corpora cavernosa. Further studies will be necessary to determine whether refinements in surgical technique, especially during ligation of the lateral pedicle and apical dissection, can prevent this complication. © 1982 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByAvulova S, Zhao Z, Lee D, Huang L, Koyama T, Hoffman K, Conwill R, Wu X, Chen V, Cooperberg M, Goodman M, Greenfield S, Hamilton A, Hashibe M, Paddock L, Stroup A, Resnick M, Penson D and Barocas D (2018) The Effect of Nerve Sparing Status on Sexual and Urinary Function: 3-Year Results from the CEASAR StudyJournal of Urology, VOL. 199, NO. 5, (1202-1209), Online publication date: 1-May-2018.Lundgren P, Kjellman A, Norming U and Gustafsson O (2018) Long-Term Outcome of a Single Intervention Population Based Prostate Cancer Screening StudyJournal of Urology, VOL. 200, NO. 1, (82-88), Online publication date: 1-Jul-2018.Lepor H (2016) Surgical Treatment of Prostate CarcinomaJournal of 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publication date: 1-May-1998.Klein L, Miller M, Buttyan R, Raffo A, Burchard M, Devris G, Cao Y, Olsson C and Shabsigh R (2018) Apoptosis in the Rat Penis After Penile DenervationJournal of Urology, VOL. 158, NO. 2, (626-630), Online publication date: 1-Aug-1997.Ball T, Teichman J, Sharkey F, Rogenes V and Adrian E (2018) Terminal Nerve Distribution to the Urethra and Bladder Neck: Considerations in the Management of Stress Urinary IncontinenceJournal of Urology, VOL. 158, NO. 3, (827-829), Online publication date: 1-Sep-1997.Montorsi F, Luigi G, Strambi L, Da Pozzo L, Nava L, Barbieri L, Rigatti P, Pizzini G and Miani A (2018) RECOVERY OF SPONTANEOUS ERECTILE FUNCTION AFTER NERVE-SPARING RADICAL RETROPUBIC PROSTATECTOMY WITH AND WITHOUT EARLY INTRACAVERNOUS INJECTIONS OF ALPROSTADIL: RESULTS OF A PROSPECTIVE, RANDOMIZED TRIALJournal of Urology, VOL. 158, NO. 4, (1408-1410), Online publication date: 1-Oct-1997.Lu-Yao G, Friedman M and Yao S (2018) Use of Radical Prostatectomy Among Medicare Beneficiaries Before and After the Introduction of Prostate Specific Antigen TestingJournal of Urology, VOL. 157, NO. 6, (2219-2222), Online publication date: 1-Jun-1997.Jorion J (2018) Rectus Fascial Sling Suspension of the Vesicourethral Anastomosis After Radical ProstatectomyJournal of Urology, VOL. 157, NO. 3, (926-928), Online publication date: 1-Mar-1997.Ennemoser O, Colleselli K, Reissigl A, Poisel S, Janetschek G and Bartsch G (2018) Posttraumatic Posterior Urethral Stricture Repair: Anatomy, Surgical Approach and Long-Term ResultsJournal of Urology, VOL. 157, NO. 2, (499-505), Online publication date: 1-Feb-1997.Elmajian D, Stein J, Esrig D, Freeman J, Skinner E, Boyd S, Lieskovsky G and Skinner D (2018) The Kock Ileal Neobladder: Updated Experience in 295 Male PatientsJournal of Urology, VOL. 156, NO. 3, (920-925), Online publication date: 1-Sep-1996.Gould D and Borer J (2018) Applied Stapling Technique in Radical Retropubic Prostatectomy: Efficient, Effective and EfficaciousJournal of Urology, VOL. 155, NO. 3, (1008-1010), Online publication date: 1-Mar-1996.Carrier S, Zvara P, Nunes L, Kour N, Rehman J and Lue T (2018) Regeneration of Nitric Oxide Synthase-Containing Nerves After Cavernous Nerve Neurotomy in the RatJournal of Urology, VOL. 153, NO. 5, (1722-1727), Online publication date: 1-May-1995.Lue T, Gleason C, Brock G, Carroll P and Tanagho E (2018) Intraoperative Electrostimulation of Cavernous Nerve: Technique, Results and LimitationsJournal of Urology, VOL. 154, NO. 4, (1426-1428), Online publication date: 1-Oct-1995.Zimmern P, Kaswick J and Leach G (2018) How Potent is Potent Before Nerve Sparing Radical Retropubic Prostatectomy?Journal of Urology, VOL. 154, NO. 3, (1100-1101), Online publication date: 1-Sep-1995.Polascik T and Walsh P (2018) Radical Retropubic Prostatectomy: The Influence of Accessory Pudendal Arteries on the Recovery of Sexual FunctionJournal of Urology, VOL. 154, NO. 1, (150-152), Online publication date: 1-Jul-1995.Myers R (2018) Editorial: Prostate Cancer--Neurovascular Preservation; Smoking Cessation May Enhance Prognosis?Journal of Urology, VOL. 154, NO. 1, (158-159), Online publication date: 1-Jul-1995.Boemers T, Bax K, Rovekamp M and van Gool J (2018) The Effect of Posterior Sagittal Anorectoplasty and its Variants on Lower Urinary Tract Function in Children With Anorectal MalformationsJournal of Urology, VOL. 153, NO. 1, (191-193), Online publication date: 1-Jan-1995.Kim E, Blackburn D and McVary K (2018) Post-Radical Prostatectomy Penile Blood Flow: Assessment with Color Flow Doppler UltrasoundJournal of Urology, VOL. 152, NO. 6 Part 2, (2276-2279), Online publication date: 1-Dec-1994.Walsh P, Partin A and Epstein J (2018) Cancer Control and Quality of Life Following Anatomical Radical Retropubic Prostatectomy: Results at 10 YearsJournal of Urology, VOL. 152, NO. 5 Part 2, (1831-1836), Online publication date: 1-Nov-1994.Litwin M (2018) Measuring Health Related Quality of Life in Men with Prostate CancerJournal of Urology, VOL. 152, NO. 5 Part 2, (1882-1887), Online publication date: 1-Nov-1994.van den Ouden D, Davidson P, Hop W and Schröder F (2018) Radical Prostatectomy as a Monotherapy for Locally Advanced (Stage T3) Prostate CancerJournal of Urology, VOL. 151, NO. 3, (646-651), Online publication date: 1-Mar-1994.Parra R, Boullier J, Rauscher J and Cummings J (2018) The Value of Laparoscopic Lymphadenectomy in Conjunction with Radical Perineal or Retropubic ProstatectomyJournal of Urology, VOL. 151, NO. 6, (1599-1602), Online publication date: 1-Jun-1994.Burnett A, Tillman S, Chang T, Epstein J, Lowenstein C, Bredt D, Snyder S and Walsh P (2018) Immunohistochemical Localization of Nitric Oxide Synthase in the Autonomic Innervation of the Human PenisJournal of Urology, VOL. 150, NO. 1, (73-76), Online publication date: 1-Jul-1993.Catalona W and Basler J (2018) Return of Erections and Urinary Continence Following Nerve Sparing Radical Retropubic ProstatectomyJournal of Urology, VOL. 150, NO. 3, (905-907), Online publication date: 1-Sep-1993.Donohue J, Thornhill J, Foster R, Rowland R and Bihrle R (2018) Retroperitoneal Lymphadenectomy for Clinical Stage a Testis Cancer (1965 to 1989): Modifications of Technique and Impact on EjaculationJournal of Urology, VOL. 149, NO. 2, (237-243), Online publication date: 1-Feb-1993.Thrasher J and Crawford E (2018) Current Management of Invasive and Metastatic Transitional Cell Carcinoma of the BladderJournal of Urology, VOL. 149, NO. 5 Part 1, (957-972), Online publication date: 1-May-1993.Ball R, Lipton S, Dreyer E, Richie J and Vickers M (2018) Entubulization Repair of Severed Cavernous Nerves in the Rat Resulting in Return of Erectile FunctionJournal of Urology, VOL. 148, NO. 1, (211-215), Online publication date: 1-Jul-1992.Dixon C, Hricak H and McAninch J (2018) Magnetic Resonance Imaging of Traumatic Posterior Urethral Defects and Pelvic Crush InjuriesJournal of Urology, VOL. 148, NO. 4, (1162-1165), Online publication date: 1-Oct-1992.Leandri P, Rossignol G, Gautier J and Ramon J (2018) Radical retropubic prostatectomy: morbidity and quality of life. Experience with 620 consecutive casesJournal of Urology, VOL. 147, NO. 3 Part 2, (883-887), Online publication date: 1-Mar-1992.Maggio M, Costabile R and Foley J (2018) Endoscopically Controlled Placement of Urethrovesical Anastomotic Sutures After Radical Retropubic ProstatectomyJournal of Urology, VOL. 147, NO. 3 Part 2, (903-904), Online publication date: 1-Mar-1992.Burgers J, Nelson R, Quinlan D and Walsh P (2018) Nerve Growth Factor, Nerve Grafts and Amniotic Membrane Grafts Restore Erectile Function in RatsJournal of Urology, VOL. 146, NO. 2 Part 1, (463-468), Online publication date: 1-Aug-1991.Lue T (2018) This Month in Investigative Urology: Restoration of Erectile Function by Cavernous Nerve GraftJournal of Urology, VOL. 145, NO. 2, (378-379), Online publication date: 1-Feb-1991.Quinlan D, Nelson R and Walsh P (2018) Cavernous Nerve Grafts Restore Erectile Function in Denervated RatsJournal of Urology, VOL. 145, NO. 2, (380-383), Online publication date: 1-Feb-1991.Steiner M, Morton R and Walsh P (2018) Impact of Anatomical Radical Prostatectomy on Urinary ContinenceJournal of Urology, VOL. 145, NO. 3, (512-514), Online publication date: 1-Mar-1991.Wein A (2018) Editorial CommentsJournal of Urology, VOL. 145, NO. 3, (514-515), Online publication date: 1-Mar-1991.Quinlan D, Epstein J, Carter B and Walsh P (2018) Sexual Function following Radical Prostatectomy: Influence of Preservation of Neurovascular BundlesJournal of Urology, VOL. 145, NO. 5, (998-1002), Online publication date: 1-May-1991.Morton R, Steiner M and Walsh P (2018) Cancer Control following Anatomical Radical Prostatectomy: An Interim ReportJournal of Urology, VOL. 145, NO. 6, (1197-1200), Online publication date: 1-Jun-1991.Brendler C, Schlegel P and Walsh P (2018) Urethrectomy with Preservation of PotencyJournal of Urology, VOL. 144, NO. 2 Part 1, (270-273), Online publication date: 1-Aug-1990.Donohue J, Foster R, Rowland R, Bihrle R, Jones J and Geier G (2018) Nerve-Sparing Retroperitoneal Lymphadenectomy with Preservation of EjaculationJournal of Urology, VOL. 144, NO. 2 Part 1, (287-291), Online publication date: 1-Aug-1990.Jumper B, McLorie G, Churchill B, Khoury A and Toi A (2018) Effects of the Artificial Urinary Sphincter on Prostatic Development and Sexual Function in Pubertal Boys with MeningomyeloceleJournal of Urology, VOL. 144, NO. 2 Part 2, (438-442), Online publication date: 1-Aug-1990.Brendler C, Steinberg G, Marshall F, Mostwin J and Walsh P (2018) Local Recurrence and Survival Following Nerve-Sparing Radical CystoprostatectomyJournal of Urology, VOL. 144, NO. 5, (1137-1140), Online publication date: 1-Nov-1990.Bigg S, Kavoussi L and Catalona W (2018) Role of Nerve-Sparing Radical Prostatectomy for Clinical Stage B2 Prostate CancerJournal of Urology, VOL. 144, NO. 6, (1420-1424), Online publication date: 1-Dec-1990.Jewett M (2018) Editorial CommentJournal of Urology, VOL. 144, NO. 2 Part 1, (291-292), Online publication date: 1-Aug-1990.Venable D (2018) Modification of the Anterior Perineal Transanorectal Approach for Complicated Prostatic Urethrorectal Fistula RepairJournal of Urology, VOL. 142, NO. 2 Part 1, (381-384), Online publication date: 1-Aug-1989.Villers A, McNeal J, Redwine E, Freiha F and Stamey T (2018) The Role of Perineural Space Invasion in the Local Spread of Prostatic AdenocarcinomaJournal of Urology, VOL. 142, NO. 3, (763-768), Online publication date: 1-Sep-1989.O’Donnell P and Finan B (2018) Continence Following Nerve-Sparing Radical ProstatectomyJournal of Urology, VOL. 142, NO. 5, (1227-1228), Online publication date: 1-Nov-1989.Breza J, Aboseif S, Orvis B, Lue T and Tanagho E (2018) Detailed Anatomy of Penile Neurovascular Structures: Surgical SignificanceJournal of Urology, VOL. 141, NO. 2, (437-443), Online publication date: 1-Feb-1989.Quinlan D, Nelson R, Partin A, Mostwin J and Walsh P (2018) The Rat as a Model for the Study of Penile ErectionJournal of Urology, VOL. 141, NO. 3 Part 1, (656-661), Online publication date: 1-Mar-1989.Weldon V and Tavel F (2018) Potency-Sparing Radical Perineal Prostatectomy: Anatomy, Surgical Technique and Initial ResultsJournal of Urology, VOL. 140, NO. 3, (559-562), Online publication date: 1-Sep-1988.Nelson R (2018) Nonoperative Management of ImpotenceJournal of Urology, VOL. 139, NO. 1, (2-5), Online publication date: 1-Jan-1988.Laudone V, Green K and Wyker A (2018) Giant Posterior Urethral Diverticulum after Radical Retropubic ProstatectomyJournal of Urology, VOL. 139, NO. 2, (364-366), Online publication date: 1-Feb-1988.Bahnson R and Catalona W (2018) Papaverine Testing of Impotent Patients Following Nerve-Sparing Radical ProstatectomyJournal of Urology, VOL. 139, NO. 4, (773-774), Online publication date: 1-Apr-1988.Lockhart J (2018) Remodeled Right Colon: An Alternative Urinary ReservoirJournal of Urology, VOL. 138, NO. 4 Part 1, (730-734), Online publication date: 1-Oct-1987.Walsh P, Epstein J and Lowe F (2018) Potency Following Radical Prostatectomy with Wide Unilateral Excision of the Neurovascular BundleJournal of Urology, VOL. 138, NO. 4 Part 1, (823-827), Online publication date: 1-Oct-1987.Shapiro E and Lepor H (2018) Alpha1, Adrenergic Receptors in Canine Lower Genitourinary Tissues: Insight into Development and FunctionJournal of Urology, VOL. 138, NO. 4 Part 2, (979-983), Online publication date: 1-Oct-1987.Middleton A (2018) Radical Prostatectomy for Carcinoma in Men More Than 69 Years OldJournal of Urology, VOL. 138, NO. 5, (1185-1188), Online publication date: 1-Nov-1987.Schlegel P and Walsh P (2018) Neuroanatomical Approach to Radical Cystoprostatectomy with Preservation of Sexual FunctionJournal of Urology, VOL. 138, NO. 6, (1402-1406), Online publication date: 1-Dec-1987. (2018) Reply by AuthorsJournal of Urology, VOL. 136, NO. 1 Part 1, (70-70), Online publication date: 1-Jul-1986.Klimberg I and Wajsman Z (2018) Treatment for Muscle Invasive Carcinoma of the BladderJournal of Urology, VOL. 136, NO. 6, (1169-1175), Online publication date: 1-Dec-1986.Steven K, Klarskov P, Jakobsen H, Bay-Nielsen H and Rasmussen F (2018) Transpubic Cystectomy and Ileocecal Bladder Replacement after Preoperative Radiotherapy for Bladder CancerJournal of Urology, VOL. 135, NO. 3, (470-475), Online publication date: 1-Mar-1986.Schove L and Von Eschenbach A (2018) Sexual Function and Female Radical Cystectomy: A Case SeriesJournal of Urology, VOL. 134, NO. 3, (465-468), Online publication date: 1-Sep-1985.Eggleston J and Walsh P (2018) Radical Prostatectomy with Preservation of Sexual Function: Pathological Findings in the First 100 CasesJournal of Urology, VOL. 134, NO. 6, (1146-1148), Online publication date: 1-Dec-1985.Skinner D and Lieskovsky G (2018) Carcinoma of the Prostate: An Opinion on Management of Early Stage Disease With a Commentary on the Meaning of Capsular PenetrationJournal of Urology, VOL. 134, NO. 6, (1183-1184), Online publication date: 1-Dec-1985.Lepor H, Gregerman M, Crosby R, Mostofi F and Walsh P (2018) Precise Localization of the Autonomic Nerves From the pelvic Plexus to the Corpora Cavernosa: a Detailed Anatomical Study of the Adult Male PelvisJournal of Urology, VOL. 133, NO. 2, (207-212), Online publication date: 1-Feb-1985.Carroll P, Lue T, Schmidt R, Trengrove-jones G and McAninch J (2018) Penile Replantation: Current ConceptsJournal of Urology, VOL. 133, NO. 2, (281-285), Online publication date: 1-Feb-1985. (2018) Note by EditorJournal of Urology, VOL. 133, NO. 2, (212-212), Online publication date: 1-Feb-1985.Kursh E and Resnick M (2018) Radical Transpubic ProstatectomyJournal of Urology, VOL. 132, NO. 6, (1131-1133), Online publication date: 1-Dec-1984.Gibbons R, Correa R, Brannen G and Mason J (2018) Total Prostatectomy for Localized Prostatic CancerJournal of Urology, VOL. 131, NO. 1, (73-76), Online publication date: 1-Jan-1984.Lue T, Zeineh S, Schmidt R and Tanagho E (2018) Neuroanatomy of Penile Erection: Its Relevance to Iatrogenic ImpotenceJournal of Urology, VOL. 131, NO. 2, (273-280), Online publication date: 1-Feb-1984.Jewett H (2018) Prostatic Cancer: A Personal View of the ProblemJournal of Urology, VOL. 131, NO. 5, (845-849), Online publication date: 1-May-1984.Koyanagi T, Takamatsu T and Taniguchi K (2018) Further Characterization of the External Urethral Sphincter in Spinal Cord Injury: Study during Spinal Shock and Evolution of Responsiveness to Alpha-Adrenergic StimulationJournal of Urology, VOL. 131, NO. 6, (1122-1126), Online publication date: 1-Jun-1984.McGuire E (2018) Spinal Cord Injury and the UrethraJournal of Urology, VOL. 131, NO. 6, (1146-1146), Online publication date: 1-Jun-1984. Volume 128Issue 3September 1982Page: 492-497 Advertisement Copyright & Permissions© 1982 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick C. Walsh More articles by this author Pieter J. Donker More articles by this author Expand All Advertisement PDF DownloadLoading ...