The role of arterial injury as a cause of ED is unclear. In a large series of preoperatively potent men with postoperative ED undergoing penile Doppler imaging after radical prostatectomy (RP),1 the incidence of arterial injury was less than 10%. In men with no arterial disease, the most common finding was veno-occlusive disease. A neurogenic injury is the most likely initial cause of post-RP ED. Damage after cavernous nerve injury and prostate surgery reduces the amount of neuronal nitric oxide synthase (n-NOS) and nitric oxide (NO) that can be released during sexual activity, thereby reducing

erectile function. A certain degree of recovery can be documented in the cavernous nerve injury rat model. Consistent with the importance Inhibitors,research,lifescience,medical of surgical technique, there appears to be an advantage to nerve-sparing over non-nerve-sparing ablation and bilateral to unilateral nerve ablation. Gralnek and colleagues2 reported a study involving Inhibitors,research,lifescience,medical 129 men who responded to a questionnaire, 83 of whom had non-nerve-sparing radical retropubic prostatectomy (NNSRRP) and 46 who had a unilateral nerve-sparing radical retropubic prostatectomy (UNSRRP). The sexual function score, which included questions regarding spontaneous erections and the use of erectile aids, showed a statistically significant

difference in sexual function in men with a unilateral Inhibitors,research,lifescience,medical versus a non-nerve-sparing surgery. In a series of almost 3500 men, Kundu and coworkers3 reported erections sufficient for intercourse in 76% of preoperatively potent men treated with bilateral nerve-sparing radical retropubic prostatectomy (BNSRRP) and 53% of men with UNSRRP. In men younger than 70 years of age, the response rates were

78% and 53%, respectively. This series retrospectively included men from 1983, prior to standardized Inhibitors,research,lifescience,medical ED questionnaires, and men currently taking phosphodiesterase type 5 (PDE-5) inhibitors. These data suggest that preservation of local nerves is important for maintenance of erectile function. Decreased or loss of enervation within the erectile tissues has a number of deleterious Inhibitors,research,lifescience,medical effects: it prevents Cilengitide the release of NO from nonadrenergic, noncholinergic nerves; decreases the production of cyclic nucleotides within the vascular smooth muscle of the erectile tissues; and reduces the subsequent relaxation of these tissues. As a result, the increased blood flow and tumescence that would normally occur during nocturnal penile tumescence (NPT) or sexual stimulation is abolished or diminished. Herbert Lepor, MD: My group recently reported in the Journal of Urology a series of 1110 men undergoing RP whose erectile function was prospectively followed for at least 2 years using a selleck chemicals llc self-administered University of California at Los Angeles Prostate Cancer Index.4 A multivariant analysis demonstrated that age, prior history of diabetes, and the number of cavernous nerves spared were the factors that significantly predicted return of potency.