PTU - Polskie Towarzystwo Urologiczne
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CODE: 13.2 - Assesment of changes in penile hemodynamics in men after radical retropubic prostatectomy in 5 years postoperative follow up
Article published in Urologia Polska 2006/59/Suplement 1.


Andrzej Gołubiński, Piotr Petrasz, Andrzej Sikorski
Katedra i Klinika Urologii PAM w Szczecinie


Introduction. Radical prostatectomy (RP) may lead to serious disturbances in cavernosal bodies innervation. It results in decreased oxygenation of the penile tissues and reduced nitric oxide (NO) synthesis. These disorders intensify fibrotic changes in blood vessels and in cavernosal bodies of the penis. It secondarily leads to disturbed blood inflow and outflow in the cavernosal bodies.
Objectives. Comparative evaluation of changes in penile blood flow in men after radical prostatectomy assessed at 2 and 5 years postoperatively.
Materials and methods. Prospective study was done in 42 men who were sexually active before operation (mean age: 62.7 ? 8.11 years). All of them were examined before prostatec-tomy and at 2 years after the operation. Second assessment was done at 5 years after prostatectomy. At every time patients were examined by IIEF-5 questionnaire and underwent colour doppler examination of the blood flow in deep penile arteries, assessed after intracav-ernosal injection of vasoactive agent. During doppler examination PSV (peak systolic velocity) and EDV (end diastolic velocity) were measured. Mean PSV and EDV values were compared at 2 and 5 years after radical prostatectomy. The difference between mean values was evaluated with the t-test for dependent samples.
Results. Between 42 men assessed at 2 years after RP normal values of penile blood flow were found in 14.3%. Arterial, venous and mixed blood flow disorders were found in 35.7%, 16.7% and 33.3% of cases respectively. At the second postoperative examination (5 years after RP) 18 men were evaluated. Normal blood flow values were not found in any of them. Arterial, venous and mixed blood flow disturbances were diagnosed in 17%, 11% and 72% of cases respectively. There was no significant difference found between the mean number of points in IIEF-5 questionnaire assessed at 2 and 5 years postoperatively (6.8 and 7.9 points respectively). The difference between mean value of EDV at 2 and 5 years after RP (7.07 ?2.18 and 7.8 ?1.57 cm/s respectively) was not statistically significant (p=250). The mean value of PSV measured at 2 and 5 years after RP was 24.6 ?5.8 cm/s and 21.9 ?5.3 cm/s respectively. The difference was statistically significant (p=0.043).
Conclusions. Vascularistion of penis changes significantly after prostatectomy. Frequency and severity of arterial blood flow disorders and venous leakage increases. At 5 years after radical prostatectomy isolated arterial or venous disorders are rare and the most common vascular pathology is mixed type.