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Ist eine Rehabilitation der erektilen Funktion nach beckenchirurgischen Eingriffen sinnvoll?

Literaturübersicht vom Sport bis zur PDE-5-Inhibitoren-Gabe

Is rehabilitation of erectile function following pelvic surgery reasonable?

Review of the literature: from sports to PDE5 inhibitors

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Zusammenfassung

Immer häufiger stellen sich Patienten mit einer erektilen Dysfunktion (ED) nach beckenchirurgischen Eingriffen in urologischen Praxen vor, wobei es sich in den allermeisten Fällen um Patienten nach radikalen Prostatovesikulektomieoperationen handelt. Trotz Erhaltung des Gefäßnervenbündels tritt in mindestens 50% der Fälle eine ED auf. Dieser Artikel diskutiert die verschiedenen Ursachen und theoretischen Ansätze der Therapie. Dabei werden lebensstilverändernde Maßnahmen, die Unterstützung der Neuroregeneration und die damit verbundene Verhinderung der Apoptose der glatten Muskulatur des Corpus cavernosum und die Verbesserung der Schwellkörpercompliance durch eine verbesserte Oxygenierung angesprochen. Einige dieser Therapieansätze werden in der internationalen Literatur als viel versprechend diskutiert, wobei die frühzeitige Rehabilitation der Erektionsfähigkeit sinnvoll zu sein scheint. Man vermutet, dass die natürliche Wiedererlangung der erektilen Funktion nach beckenchirurgischen Eingriffen häufig bis zu 2 Jahre oder länger dauert, wobei dieser Zeitraum allem Anschein nach durch eine effektive Rehabilitation verkürzt werden kann.

Abstract

Increasingly, urologists are seeing patients with erectile dysfunction after pelvic operations. In most cases, radical prostatectomy is the cause. Even when a nerve-sparing procedure is performed, approximately 50% of the patients suffer from erectile dysfunction. This report discusses the causes and theoretical therapies, including lifestyle changes, strategies for neuroregeneration and the associated prevention of apoptosis of the smooth muscle of the corpus cavernosum and improvement of the corpora cavernosa by increased oxygenation. According to the international literature, many of these agents and lifestyle modifications display promise for treating impotence. Early treatment for patients recovering from pelvic operations seems to be reasonable. It is assumed that the natural recovery of erections may take as long as 18 to 24 months postsurgery or even longer; however, treatment modalities may reduce the time to erectile recovery.

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Authors and Affiliations

  1. Urologische Gemeinschaftspraxis Remscheid, Kooperationspraxis der Klinik für Urologie und Kinderurologie, Klinikum Wuppertal, Universität Witten/Herdecke, Fastenrathstraße 1, 42853, Remscheid, Deutschland

    M.J. Mathers

  2. Klinik für Urologie und Kinderurologie, Klinikum, Weiden, Deutschland

    T. Klotz

  3. Abteilung Urologie, Onkologie und Nephrologie, Rehabilitationsklinik Wildetal, Kliniken Hartenstein, Bad Wildungen, Deutschland

    W. Vahlensieck

  4. Urologische Klinik, Reha-Zentrum Passauer Wolf, Bad Griesbach, Deutschland

    M. Zellner

  5. Klinik für Urologie, Uro-Onkologie und Kinderurologie, St. Josef-Hospital, Troisdorf, Deutschland

    G. Lümmen

  6. Klinik für Urologie und Kinderurologie, Klinikum Wuppertal, Universität Witten/Herdecke, Wuppertal, Deutschland

    S. Roth

  7. Klinik und Poliklinik für Urologie, Universitätsklinium Hamburg-Eppendorf, Hamburg, Deutschland

    H. Huland

  8. Institut für Männergesundheit, Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    F. Sommer

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  1. M.J. Mathers
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  2. T. Klotz
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  8. F. Sommer
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Correspondence to M.J. Mathers.

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Mathers, M., Klotz, T., Vahlensieck, W. et al. Ist eine Rehabilitation der erektilen Funktion nach beckenchirurgischen Eingriffen sinnvoll?. Urologe 47, 685–692 (2008). https://doi.org/10.1007/s00120-008-1668-7

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