Evaluation of vascular changes in cavernous arteries by penile doppler ultrasound in patients undergoing laparoscopic radical prostatectomy

Evaluación de los cambios vasculares sobre las arterias cavernosas usando ecografía doppler de pene en pacientes sometidos a prostatectomía radical laparoscópica

Patients undergoing radical prostatectomy for prostate cancer may experience erectile dysfunction (ED). Age of patients, experience of the surgeons and existence of ED before surgery are factors related to its appearance. The objective of the study was to assess the hemodynamic changes produced in the cavernous arteries in patients undergoing laparoscopic radical prostatectomy (LRP) measured with penile Doppler ultrasound (PDUS). A prospective database of 83 patients undergoing LRP was analysed. PDUS were performed at baseline and twelve months after surgery. International Index of Erectile Function (IIEF) and Erectile Hardness Score (EHS) questionnaires were also evaluated. A 12-month decrease in all hemodynamic parameters of both cavernous arteries was found except for the end diastolic velocity (EDV) on the left cavernous artery. Only changes between baseline and twelve-months mean values of the diameter (0.725 vs. 0.67 mm; p = 0.033) and peak systolic velocity (PSV) of the right cavernous artery (32.6 vs. 27.22 cm/s; p = 0.004) presented significant variations. The rest of the parameters were close to statistical significance, except for EDV of the right cavernous artery (p = 0.887). The erectile function domain of the IIEF showed a significant decrease (median at baseline: 26 vs. post-surgery: 7; p < 0.0001) as well as the EHS test (grade I at baseline: 2.4% vs. 12-months: 31.3%; p < 0.0001). Our study supports the idea that LRP produces local vascular injuries. A decrease in the PSV and in the diameter of both cavernous arteries was observed with PDUS and it may explain the vascular origin of ED.

Resumen

Los pacientes sometidos a prostatectomía radical (PR) por cáncer de próstata pueden presentar disfunción eréctil (DE). La edad de los pacientes, la experiencia de los cirujanos y la existencia de DE antes de la cirugía son factores relacionados con su aparición. El objetivo del estudio fue evaluar los cambios hemodinámicos producidos en las arterias cavernosas en pacientes sometidos a PR laparoscópica medidos con ecografía Doppler de pene (EDP). Se analizó una base de datos prospectiva de 83 pacientes sometidos a PR laparoscópica. Las EDP se realizaron al inicio del estudio y doce meses después de la cirugía. También se evaluaron los cuestionarios IIEF y Erectile Hardness Score (EHS). Se encontró una disminución a los 12 meses de todos los parámetros hemodinámicos de ambas arterias cavernosas (AC) excepto la velocidad diastólica final (VDF) en la AC izquierda. Los cambios entre los valores medios basales y de doce meses del diámetro (0.725 vs. 0.67 mm; p = 0.033) y la velocidad pico sistólica (VPS) de la AC derecha (32.6 vs. 27.22 cm/s; p = 0.004) presentaron cambios significativos. El resto de parámetros se acercaron a la significación estadística, excepto la VDF de la AC derecha (p = 0.887). El dominio de la función eréctil del IIEF mostró una disminución significativa (mediana basal: 26 vs. 12 meses: 7; p < 0.0001), así como la prueba EHS (grado I basal: 2.4% vs. 12 meses: 31.3%; p < 0.0001). Nuestro estudio apoya la idea de que la PR laparoscópica produce lesiones vasculares locales. La EDP se observó una disminución de la VPS y del diámetro de ambas AC y puede explicar el origen vascular de la DE.

Radical prostatectomy; Penile doppler ultrasound; Erectile dysfunction

Palabras Clave

Prostatectomía radical; Ecografía doppler de pene; Disfunción eréctil

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