Male erectile dysfunction
ICD-10 F52.2; N48.4 · ICD-11 HA01.1

Erectile Dysfunction After Radical Prostatectomy: When Intracavernous Therapy Has Not Achieved Sufficient Rigidity

This protocol covers male erectile dysfunction in patients with a history of radical prostatectomy or curative pelvic surgery for prostate cancer, specifically at the stage where the previous intracavernous treatment line failed to meet its target.

Clinical Scenario

The patient has a history of radical prostatectomy or curative pelvic surgery for prostate cancer. Pro-erectile treatment has been initiated following surgery, yet adequate erectile function has not been restored through the prior line of therapy.

Previous Treatment Line — Target Not Reached

Intracavernous alprostadil, Trimix, or Invicorp was used as the preceding treatment. These agents did not achieve a rigid erectile response sufficient for satisfactory intercourse — the defined target of that line. This protocol addresses the structured step taken after that failure.

Next-Line Approach — Partial Overview

When intracavernous injection therapy is inadequate, surgical prosthetic implantation represents an established pathway. The complete protocol specifies the implant types considered, how patient preference factors in, and the full clinical decision sequence.

Clinical goal: restoration of penile erection sufficient for satisfactory intercourse. Full detail — including device selection, eligibility criteria, and sequencing — is available in the structured regimen.

Instant Access to Structured Evidence-Based Regimens

References

PDE5Is have been considered as the first-line therapy in patients who have undergone nerve-sparing surgery, regardless of the surgical technique used.

Start pro-erectile treatments at the earliest opportunity after radical prostatectomy/pelvic surgery and other curative treatments for PCa.

Implant a penile prosthesis if other treatments fail or depending upon patient preference.

Intracavernous injections and penile implants had been suggested as second- and third-line treatments, respectively, when oral PDE5Is are not adequately effective or not suitable for postoperative patients.

Efficacy is defined as an erection, with rigidity, sufficient for satisfactory intercourse.

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