Impotence after radical pelvic surgery: physiology and management.

Impotence has been a common problem after radical surgery of the colon, rectum, prostate, bladder, and seminal vesicle. However, a better understanding of the neuroanatomy of erection has resulted in its decline. When impotence does result, in cases where the extent of tumor involvement renders preservation of the neurovascular bundle impossible, the variety of treatments available is now improved: these include intracavernous injection of vasodilators, vacuum constriction devices, penile arterial and venous surgery, and penile prostheses. The improved understanding and management of impotence has greatly enhanced the quality of life of patients after radical pelvic surgery.