達文西攝護腺根除術後勃起功能障礙：文獻回顧與治療建議

朱宏霖¹、徐政文¹、梁哲維¹、徐慧燕²、廖沛瑀³、鄭如惠⁴、蔡蔓綺⁵、黃品叡⁶

1李綜合醫療社團法人大甲李綜合醫院 醫療部 專科護理師小組

2李綜合醫療社團法人大甲李綜合醫院 護理部

3李綜合醫療社團法人苑裡李綜合醫院 醫療部 專科護理師小組

4李綜合醫療社團法人苑裡李綜合醫院 護理部

5疾病管制署中區管制中心 檢疫科

6李綜合醫療社團法人大甲李綜合醫院 外科部 泌尿外科

Erectile Dysfunction After Robot-Assisted Radical Prostatectomy: A Literature Review and Therapeutic Recommendations

Hung-Lin Chu ¹, Cheng-Wen Hsu¹, Che-Wei Liang¹, Hui-Yen Hsu², Pei-Yu Liao³ , Ru-Hui Cheng⁴,
Man-Chi Tsai⁵, Pin-Jui Huang⁶

1Division of Nursing Participants, Department of Medical Affairs, Dajia Lee Hospital

2Nursing Department, Dajia Lee Hospital

3Division of Nursing Participants, Department of Medical Affairs, Yuanli Lee Hospital

4Nursing Department, Yuanli Lee Hospital

5Quarantine Department, Central Regional Center, Centers for Disease Control, Ministry of Health and Welfare

6Division of Urology, Department of Surgery, Dajia Lee Hospital

Background:

Erectile dysfunction (ED) remains one of the most distressing complications following robot-assisted radical prostatectomy (RARP), affecting postoperative quality of life and patient satisfaction. Despite advances in nerve-sparing techniques and robotic precision, the incidence of postoperative ED remains high, with reported rates ranging from 20% to 70% depending on surgical experience, patient selection, and preoperative function. This review summarizes current evidence regarding pathophysiology, risk factors, recovery timeline, and emerging treatment strategies for post-RARP ED.

Methods:

A comprehensive literature search was performed through PubMed, Scopus, and Web of Science using the keywords “robot-assisted radical prostatectomy,” “erectile dysfunction,” “nerve-sparing,” and “penile rehabilitation.” Studies published between 2015 and 2025 were included if they reported clinical outcomes or interventions related to erectile recovery after RARP. Both randomized controlled trials and large-scale cohort studies were analyzed to extract data on incidence, predictors, and therapeutic efficacy.

Results:

The primary mechanism of post-RARP ED involves neuropraxia of the cavernous nerves, leading to smooth muscle apoptosis, penile hypoxia, and subsequent fibrosis. Predictive factors include patient age, baseline International Index of Erectile Function (IIEF) score, extent of nerve preservation, and surgeon experience. Early initiation of penile rehabilitation is strongly associated with improved long-term outcomes. Phosphodiesterase type 5 inhibitors (PDE5i) remain the first-line therapy, with daily or on-demand regimens demonstrating modest recovery rates. Adjunctive strategies such as vacuum erection devices, intracavernosal injections, and low-intensity shockwave therapy have shown additional benefits in promoting endothelial recovery. Recent evidence suggests that regenerative modalities—including platelet-rich plasma (PRP), stem cell therapy, and nerve grafting—may enhance neurovascular regeneration, though long-term data remain limited. Robotic nerve-sparing techniques, particularly the “Veil of Aphrodite” and retrograde dissection methods, have demonstrated superior preservation of erectile function when performed by high-volume surgeons.

Discussion:

While robotic precision offers theoretical advantages in nerve preservation, functional recovery remains highly variable. Multimodal penile rehabilitation protocols integrating pharmacologic, mechanical, and regenerative interventions appear most promising. Early counseling and preoperative optimization of comorbidities (diabetes, cardiovascular disease) are essential to maximize postoperative outcomes. Future directions should focus on standardizing rehabilitation timing, dose-response of PDE5i therapy, and integrating imaging or neurophysiologic biomarkers to predict erectile recovery.

Conclusion:

Post-RARP erectile dysfunction remains a multifactorial challenge despite technical refinements in robotic surgery. Early, structured penile rehabilitation combined with emerging regenerative therapies holds the potential to restore sexual function and improve quality of life. Multidisciplinary collaboration among urologists, rehabilitation specialists, and psychologists is critical to achieving comprehensive recovery in post-prostatectomy patients.