Prostate cancer: 8. Urinary incontinence and erectile dysfunction
| Table 1: Options for treating erectile dysfunction after radical prostatectomy | ||
| Option | Benefit | Problems |
| Do nothing | Little "fuss" | May go against patient’s, partner’s and society’s expectations |
| Intracavernous injection of prostaglandin | Prompt, reliable erection Probably most effective |
Intrusive |
| Transurethral suppository (prostaglandin) | Prompt and safe 40% efficacy |
Mildly intrusive |
| Older oral agents | Non-intrusive | Seldom effective |
| New oral agent (sildenafil) | Non-intrusive Efficacy probably similar to injection |
Contraindicated if patient is receiving nitrates* 1-h onset time |
| Other new agents (e.g., phentolamine or apomorphine) | Non-intrusive Variable efficacy |
Depends on drug class |
| Vacuum erection device | Effective | Intrusive, results in cold penis |
| Penile prosthesis | Effective | Invasive, irreversible |
| *It is unusual for patients who have undergone prostatectomy to use nitrates. | ||
