摘要：勃起功能障碍(erectile dysfunction,ED)是前列腺癌根治术(radical prostatectomy,RP)后最常见的并发症之一，其关键原因是术中不可避免的损伤勃起神经，并由此引发术后阴茎海绵体血管内皮、平滑肌和静脉 闭塞机制的损伤。如何应对RP术后ED的问题成为当今泌尿外科的热点问题。本文通过查阅文献，从比较不同 RP术式对ED发生率的影响，分析影响术后ED恢复的因素、阴茎康复概念及开展时机、术后ED的管理方法等 角度进行综述，归纳总结应对RP术后ED的策略，以期为临床泌尿外科/男科医师提供参考，为改善患者术后生活质量提供思路。

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[1] WU SY, CHANG CL, CHEN CI, et al. Comparison of Acute and Chronic Surgical Complications Following Robot- Assisted, Laparoscopic, and Traditional Open Radical Prostatectomy Among Men in Taiwan [J]. JAMA Netw Open, 2021, 4(8): e2120156. 

[2] KYRIAZIS I, SPINOS T, TSATURYAN A, et al. Different Nerve-Sparing Techniques during Radical Prostatectomy and Their Impact on Functional Outcomes [J]. Cancers (Basel), 2022,14(7):1601. 

[3] KIM SC,SONG C,KIM W,et al. Factors determining functional outcomes after radical prostatectomy: robot-assisted versus retropubic [J]. Eur Urol, 2011,60(3): 413-419. 

[4] ZIPPE C,NANDIPATI K,AGARWAL A,et al. Sexual dysfunction after pelvic surgery [J]. Int J Impot Res,2006, 18(1):1-18. 

[5] WALSH PC. Anatomic radical prostatectomy: evolution of the surgical technique [J]. J Urol,1998,160(6 Pt 2): 2418- 2424. 

[6] PHILIPPOU YA,JUNG JH, STEGGALL MJ, et al. Penile rehabilitation for postprostatectomy erectile dysfunction [J]. Cochrane Database Syst Rev, 2018,10(10): CD012414. 

[7] YAMASHITA S, KATO R, KOBAYASHI K, et al. Nerve injury- related erectile dysfunction following nerve-sparing radical prostatectomy: a novel experimental dissection model [J]. Int J Urol, 2009,16(11): 905-911. 

[8] CAPOGROSSO P,VERTOSICK EA, BENFANTE NE, et al. Are We Improving Erectile Function Recovery After Radical Prostatectomy? Analysis of Patients Treated over the Last Decade [J]. Eur Urol, 2019,75(2):221-228. 

[9] LEE JK,ASSEL M,THONG AE,et al. Unexpected Long-term Improvements in Urinary and Erectile Function in a Large Cohort of Men with Self-reported Outcomes Following Radical Prostatectomy [J]. Eur Urol, 2015,68(5): 899-905. 

[10] SCHOENTGEN N, CALIFANO G, MANFREDI C, et al. Is it Worth Starting Sexual Rehabilitation Before Radical Prostatectomy? Results From a Systematic Review of the Literature [J]. Front Surg,2021,8: 648345. 

[11] NYBERG M, HUGOSSON J, WIKLUND P,et al. Functional and Oncologic Outcomes Between Open and Robotic Radical Prostatectomy at 24-month Follow-up in the Swedish LAPPRO Trial [J]. Eur Urol Oncol, 2018,1(5): 353-360. 

[12] BASIRI A,DE LA ROSETTE JJ,TABATABAEI S, et al. Comparison of retropubic,laparoscopic and robotic radical prostatectomy: who is the winner?[J]. World J Urol, 2018,36(4): 609-621. 

[13] CAO L,YANG Z, QI L, et al. Robot- assisted and laparoscopic vs open radical prastatectomy in clinically localized prostate cancer: perioperative,functional,and oncological outcomes: A Systematic review and meta- analysis [J]. Medicine(Baltimore), 2019,98(22): e15770.

[14] HAESE A,KNIPPER S, ISBARN H,et al. A comparative study of robot-assisted and open radical prostatectomy in 10790 men treated by highly trained surgeons for both procedures [J]. BJU Int,2019,123(6):1031-1040. 

[15] MARCHIONI M, DE FRANCESCO P,CASTELLUCCI R, et al. Management of erectile dysfunction following robotassisted radical prostatectomy: a systematie review [J]. Minerva Urol Nefrol, 2020,72(5): 543-554. 

[16] GERSHMAN B,PSUTKA SP,MCGOVERN F J, et al. Patient- reported Functional Outcomes Following Open, Laparoscopic, and Robotic Assisted Radical Prostatectomy Performed by High- volume Surgeons at High- volume Hospitals [J]. Eur Urol Focus, 2016,2(2): 172-179. 

[17] LEWIS RW,FUGL-MEYER KS, CORONA G,et al. Defnitions/epidemiology/risk factors for sexual dysfunction [J]. J Sex Med,2010,7(4 Pt 2): 1598-1607. 

[18] SCHMID FA,POYET C,RIZZI G,et al. Dynamic contrast enhancement in prostate MRI as predictor of erectile function and recovery after radical prostatectomy [J]. Aging Male, 2020, 23(5): 1518-1526. 

[19] AGOCHUKWU-MMONUN,MURALIA,WITTMANN D, et al. Development and Validation of Dynamic Multivariate Prediction Models of Sexual Function Recovery in Patients with Prostate Cancer Undergoing Radical Prostatectomy: Results from the MUSIC Statewide Collaborative [J]. Eur Urol Open Sci, 2022,40:1-8. 

[20] TERRIER JE,MASTERSON M,MULHALL JP,et al. Decrease in Intercourse Satisfaction in Men Who Recover Erections After Radical Prostatectomy [J]. J Sex Med, 2018,15(8): 1133-1139. 

[21] LIN H,WANG R. The science of vacuum erectile device in penile rehabilitation after radical prostatectomy [J]. Transl Androl Urol, 2013, 2(1): 61-66. 

[22] YUAN J, LIN H,LI P,et al. Molecular mechanisms of vacuum therapy in penile rehabilitation: a novel animal study [J]. Eur Urol, 2010, 58(5):773-780. 

[23] LIMA TFN,BITRAN J,FRECH FS,et al. Prevalence of post-prostatectomy erectile dysfunction and a review of the recommended therapeutic modalities [J]. Int J Impot Res, 2021, 33(4): 401-409. 

[24] SARI MOTLAGH R,ABUFARAJ M,YANG L,et al. Penile Rehabilitation Strategy after Nerve Sparing Radical Prostatectomy:A Systematic Review and Network Meta-Analysis of Randomized Trials [J]. J Urol,2021,205(4): 1018-1030. 

[25] SALONIA A,ADAIKAN G, BUVAT J,et al. Sexual Rehabilitation After Treatment For Prostate Cancer-Part2: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015)[J]. J Sex Med,2017, 14(3): 297-315.

[26] QIN F,WANG S,LI J, et al. The Early Use of Vacuum Therapy for Penile Rehabilitation After Radical Prostatectomy: Systematic Review and Meta- Analysis [J]. Am J Mens Health, 2018,12(6): 2136-2143. 

[27] NOH TI, SHIM JS, KANG SG, et al. Efficacy of Tadalafil in Penile Rehabilitation Started Before Nerve-Sparing Robot-Assisted Radical Prostatectomy: A DoubleBlind Pilot Study [J]. Sex Med,2022,10(3): 100508. 

[28] NATHAN A,SHUKLA S,SINHA A,et al. Immediate post-operative PDE5i therapy improves early erectile function outcomes after robot assisted radical prostatectomy (RARP)[J]. J Robot Surg, 2022,16(1): 37-43. 

[29] MADEIRA CR,TONIN FS,FACHI MM,et al. Efficacy and safety of oral phosphodiesterase 5 inhibitors for erectile dysfunction: a network meta-analysis and multicriteria decision analysis [J]. World J Urol, 2021,39(3): 953-962. 

[30] GOH HJ, SUNG JM,LEE KH, et al. Efficacy of phosphodiesterase type 5 inhibitors in patients with erectile dysfunction after nerve- sparing radical prostatectomy: a systematic review and meta- analysis [J]. Transl Androl Urol, 2022,11(2): 124-138. 

[31] ZHANG M,CHE JZ,LIU YD,et al. A prospective randomized controlled study on scheduled PDE5i and vacuum erectile devices in the treatment of erectile dysfunction after nerve sparing prostatectomy [J]. Asian J Androl, 2022, 24(5): 473-477.

[32] PRABHU V,ALUKAL JP,LAZE J,et al. Long-term satisfaction and predictors of use of intracorporeal injections for post- prostatectomy erectile dysfunction [J]. J Urol, 2013,189(1): 238-242. 

[33] MULHALL J,LAND S,PARKER M,et al. The use of an erectogenic pharmacotherapy regimen following radical prostatectomy improves recovery of spontaneous erectile function [J]. J Sex Med,2005,2(4): 532-542. 

[34] NICOLAI M,URKMEZ A,SARIKAYA S,et al. Penile Rehabilitation and Treatment Options for Erectile Dysfunction Following Radical Prostatectomy and Radiotherapy: A Systematic Review [J]. Front Surg,2021,8:636974. 

[35] MADIRAJU SK,HAKKY TS,PERITO PE,et al. Placement of Inflatable Penile Implants in Patients With Prior Radical Pelvic Surgery: A Literature Review [J]. Sex Med Rev, 2019, 7(1): 189-197. 

[36] DADHICH P,HOCKENBERRY M,KIRBY EW,et al. Penile prosthesis in the management of erectile dysfunction following cancer therapy [J]. Transl Androl Urol,2017, 6(Suppl 5): S883-S889. 

[37] SHEN C,JAIN K, SHAH T,et al. Relationships between erectile dysfunction, prostate cancer treatment type and inflatable penile prosthesis implantation [J]. Investig Clin Urol,2022, 63(3): 316-324. 

[38] CHUNG E.Regenerative technology to restore and preserve erectile function in men following prostate cancer treatment: evidence for penile rehabilitation in the context of prostate cancer survivorship [J]. Ther Ady Urol,2021,13:175628 72211026421.

林浩成，郑仲杰，洪锴.前列腺癌根治术后勃起功能障碍的应对策略[J]. 泌尿外科杂志（电子版）,2023,15(2):86-91. DOI:10.20020/j.CNKI.1674-7410.2023.02.19

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前列腺癌是全球男性第二常见的肿瘤，由于前列腺特异性抗原筛查的广泛使用，越来越多的患者在疾病早期被发现，手术治疗的患者也年轻化， 因此术后的生活质量已成为一个核心问题。前列腺癌根治术(radical prostatectomy,RP)是局限性前列腺癌最常见的治疗选择，但它可能会带来如勃起功能障碍(erectile dysfunction,ED)和尿失禁等并发症。如何管理RP术后ED,成为泌尿科/男科医护人员和前列腺癌患者广泛关注的重要问题。

1 RP及其术后ED

    1.1 RP手术类型对ED的影响

    1.2 影响RP术后EF恢复的因素

2 阴茎康复治疗概念和开始治疗时机

3 RP术后ED的管理方法

    3.1 口服PDE5I

    3.2 真空勃起装置(VED)

    3.3 海绵体内注射(ICI)

    3.4 前列地尔经尿道给药

    3.5 阴茎假体植入手术

    3.6 其他新兴的治疗方法

4 结论

ED是RP术后的常见并发症，对患者的生活质量有显著的负面影响。因此，针对RP术后ED的应对策略非常重要。这些策略应包括但不限于：术前告知患者RP术后ED的真正潜在风险以及现有的管 理方案。这些方案包括通过使用口服PDE5I,VED 和海绵体内注射治疗进行早期阴茎康复治疗和作为最终治疗手段的假体植入手术。术中通过改良的手术技术，采用更先进的手术辅助设备，尽量减少ED 发生率。术后早期开展阴茎康复治疗，促进勃起功能恢复，必要时行假体植入手术，帮助患者重获满意的性生活。

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