Comprehensive prevention of cavernous fibrosis after nerve-sparing radical prostatectomy

Advances in laboratory and radiation diagnostics have improved the detection of early prostate cancer in patients aged 45 to 60 years who are sexually active and interested in preserving their erectile function after surgery. Objective: to improve sexual rehabilitation of patients after nerve-sparing robot-assisted radical prostatectomy (NS-RARP). Patients and methods. This study was conducted at the Medical Research and Educational Center of Lomonosov Moscow State University and included 32 patients who had undergone NS-RARP. Their mean age was 58 ± 6.4 years. Mean PSA level at diagnosis was 7.07 ± 2.9 ng/mL. The stages of prostate cancer were distributed as follows: 3 cases of T1bN0M0 (9%), 17 cases of T1cN0M0 (53%), 7 cases of T2aN0M0 (22%), and 5 cases of T2bN0M0 (16%). All patients were operated on by the same surgeon; neurovascular bundles were preserved using the intrafascial technique. Conclusion. Implementation of the robot-assisted technique reduced the frequency of postoperative erectile dysfunction. It is well known that even a successful standard prostatectomy is likely to result in erectile dysfunction due to partial denervation and ischemia of the cavernous bodies in the early postoperative period and cavernous fibrosis in the late postoperative period causing venogenic erectile dysfunction. Prophylaxis of cavernous fibrosis with phosphodiesterase type 5 inhibitors does not always ensure normal erection: 75% of patients have complaints of erectile dysfunction one year postoperatively. Comprehensive prevention (pharmacotherapy plus physiotherapy) of cavernous fibrosis in the early postoperative period significantly improved erectile function as demonstrated by the International Index of Erectile Function (IIEF). It was also confirmed by better hemodynamic parameters and increased stiffness of cavernous tissue in the patients studied.