Comorbidities Associated with Erectile Dysfunction Following Radical Prostatectomy at a University Hospital

Author(s): Enzo Faria Cunha, Fernando Nestor Facio Junior, Lilian Castiglioni, Ana Karoline Sepedro Lima, Mariana Carvalho Graziano

Prostate cancer is the second most common type of cancer among men. The main therapeutic approach is radical prostatectomy (RP), which exposes patients to erectile dysfunction (ED) as a postoperative risk. In the present retrospective study, records were analyzed of 431 patients submitted to RP. The prevalence of ED in the sample was 84.7%. Higher Gleason scores denote greater disease aggressivity and predispose patients to a greater use of tadalafil in the postoperative period. Older patients and those with high PSA levels used fewer medications for ED, possibly due to the lower response to the drugs. Moreover, ED following RP was correlated with anxiety and depression, predisposing patients to a greater use of medications for ED at the onset of treatment. Adjunct therapy to RP (hormone blocking and/or radiotherapy) was associated with a higher frequency of persistent ED. Thus, age, Gleason score, anxiety, depression, diabetes mellitus and adjunct therapy are variables that predispose patients to a higher incidence of erectile dysfunction following radical prostatectomy.

Prostate Cancer, Prostatectomy, Erectile Dysfunction, Comorbidities, Diabetes Mellitus

1. Faria LS de P, Pereira PC, Lustosa ALM, Aragão ICS, Aragão FMS, Cunha MG de S. PERFIL EPIDEMIOLÓGICO DO CÂNCER DE PRÓSTATA NO BRASIL: RETRATO DE UMA DÉCADA. Revista Uningá. 2020 Dec 23;57(4):76–84.
2. Kesch C, Heidegger I, Kasivisvanathan V, Kretschmer A, Marra G, Preisser F, et al. Radical Prostatectomy: Sequelae in the Course of Time. Frontiers in Surgery. 2021 May 28;8.
3. Vogelzang N. Comprehensive Textbook of Genitourinary Oncology. Lippincott Williams & Wilkins; 2006.
4. JÚNIOR AN. Urologia Fundamental [Internet]. 2010 [cited 2023 Aug 22]. Available from: https://www.fcm.unicamp.br/fcm/sites/default/files/2016/page/urologia_fundamental.pdf
5. Pikramenos K, Zachou M, Papadopoulos D, Papatsoris A, Varkarakis I, Mitsogiannis I. Post Radical Prostatectomy Erectile Dysfunction. A Single Centre Experience. Cureus. 2023 Feb 3;
6. Alves L de S, Velloso AP de S. Tratamento da disfunção erétil: [revisão]. Rev méd Minas Gerais. 2005 Jan 1;110–3.
7. Grassi MVFC, Pereira MEC. O “sujeito-sintoma” impotente na disfunção erétil. Ágora: Estudos em Teoria Psicanalítica. 2001 Jun;4(1):53–76.
8. Araújo JS, Conceição VM da, Zago MMF. Transitory masculinities in the context of being sick with prostate cancer. Revista Latino-Americana de Enfermagem. 2019;27.
9. Olímpio LM, Spessoto LCF, Fácio Jr FN. Sexual health education among undergraduate students of medicine. Translational Andrology and Urology. 2020 Apr;9(2):510–5.
10. Dancey CP, Reidy J. Estatística sem Matemática para Psicologia: Usando SPSS para Windows. Artmed; 2006.
11. Albers LF, Tillier CN, van Muilekom E, van Werkhoven E, Elzevier HW, van Rhijn BWG, et al. Sexual Satisfaction in Men Suffering From Erectile Dysfunction After Robot-Assisted Radical Prostatectomy for Prostate Cancer: An Observational Study. The Journal of Sexual Medicine. 2021 Feb;18(2):339–46. .
12. Junior EDM, Santos DB dos, Abdo CHN, Wroclawski E, Fittipaldi JAS. Epidemiologia da disfunção erétil no Brasil: resultados da pesquisa nacional do Projeto Avaliar [Internet]. 2004. Available from: https://www.arca.fiocruz.br/handle/icict/19471
13. Cozzarini C, Rancati T, Badenchini F, Palorini F, Avuzzi B, Degli Esposti C, et al. Baseline status and dose to the penile bulb predict impotence 1 year after radiotherapy for prostate cancer. Strahlentherapie und Onkologie. 2016 Apr 14;192(5):297–304.
14. Gonzáles AI, Sties SW, Wittkopf PG, Mara LS de, Ulbrich AZ, Cardoso FL, et al. Validation of the International Index of Erectile Function (IIEF) for Use in Brazil. Arquivos Brasileiros de Cardiologia. 2013;
15. Nuno Miguel Rodrigues S. Avaliação Andrológica em Doentes Submetidos a Prostatectomia Radical. Tese de Doutorado Universidade do Porto (Portugal). 2016;
16. Zippe CD, Pahlajani G. Penile Rehabilitation Following Radical Prostatectomy: Role of Early Intervention and Chronic Therapy. Urologic Clinics of North America. 2007 Nov;34(4):601–18.
17. Visscher J, Hiwase M, Bonevski B, O’Callaghan M. The association of smoking with urinary and sexual function recovery following radical prostatectomy for localized prostate cancer: a systematic review and meta-analysis. Prostate Cancer and Prostatic Diseases. 2023 Jul 27;
18. Goh HJ, Sung JM, Lee KH, Jo JK, Kim KN. Efficacy of phosphodiesterase type 5 inhibitors in patients with erectile dysfunction after nerve-sparing radical prostatectomy: a systematic review and meta-analysis. Translational Andrology and Urology. 2022 Feb;11(2):124–38.
19. MELO AS et al. Disfunção Erétil em Pacientes com Neoplasia de Próstata de Baixo Risco Tratados com Radioterapia Exclusiva e Revisão da Literatura. 2020.