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Intraurethral delivery of alprostadil was rst introduced by Padma-Nathan et al, in 1997, who claimed an overall ef cacy rate of 44% for post-RP ED [77] Raina et al in a retrospective study, reported a 48% rate of signi cant improvement in all domains of the Sexual Health Inventory for Men (SHIM) after a mean of 22 years in 27 patients with post-RP ED treated with intraurethral alprostadil, although seldom reaching pre-operative scores, and 52% of patients had discontinued after a mean of eight months, mainly due to inadequate response or side effects [78] Mulhall et al reported a lack of consistency in the erectile response of patients treated with this therapy They showed that only 51% of patients that had a rigid erection in an of ce-test could obtain the same response at home, although this was not con ned to patients post-RP [79] Intraurethral alprostadil is a safe alternative for the treatment of PRPED, but with a low ef cacy, high dropout rate, and inconsistent results Nehra et al reported that combination therapy with intraurethral alprostadil and sildena l was more ef cacious in the salvage of patients who desire noninvasive therapy but in whom single-treatment modalities fail [80]

Vacuum constriction device (VCD)

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VCD is probably the oldest described tool for treatment of ED Cookson and Nadig (1993) reported long-term ef cacy and high satisfaction rate for nonselected patients and couples treated with VCD [73] However Dutta and Eid (1999) reported a dropout rate of 65% and most patients reported stopping the treatment within a mean of four months [74] Raina

The use of intracavernosal injections to treat postRP ED was rst proposed by Dennis and McDougal in 1988 [81] They reported a success rate of 85% (12/14 patients) with a mixture of papaverine and phentolamine Intracorporeal injection therapy with alprostadil alone is effective in the majority of

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The source could populate the seqnum eld above using a hash function on a node s unique identity pseudonym In order to populate the tr_dest eld, the source needs to share secret trapdoor keys with the destination This secret trapdoor key will ensure that only the destination can obtain the information Any node on route to the destination will not be able to obtain this information since they do not possess the relevant keys This ensures that the identity of the destination is kept secret Finally, to populate the onion, the source has different choices In one option the source randomly picks a symmetric key Ks, which it uses to encrypt its own address (or a special source tag) and populates the resulting ciphertext in this eld Following this the RREQ packet is broadcast by the source

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Radical Pelvic Surgery-Associated Sexual Dysfunction post-RP ED patients regardless of the status of their cavernosal nerves [82] Gontero et al evaluated the best regimen for starting intracavernosal injections in a series of patients who had undergone non-nerve sparing RP [83] They demonstrated that when commenced within month three after the operation, a signi cantly higher proportion of patients had a successful response Injections given in postoperative month one gave the best response rate but with poor patient compliance The main complaint of patients using intracavernosal alprostadil alone for the treatment of post-RP ED is penile pain, which can be minimized by the use of combination agents that permit reduction in alprostadil dose [84] Claro et al reported a ef cacy rate of almost 95% in post-RP ED patients treated with self-injection therapy using papaverine/phentolamine/PGE1 [85] Raina et al evaluated 102 patients treated with ICI [86] They found that 68% of patients were satis ed with the treatment and 48% of patients continued for a mean of 35 years The majority of the patients used alprostadil alone (61%) and the others the combination of alprostadil, papaverine and phentolamine Mulhall et al mailed a questionnaire to 1424 nonselected patients who completed the of ce training and home use phases of a penile self-injection program to understand the major reasons for the high dropout rate that is common among ICI users [87] The overall attrition rate was 31% of the 720 men who completed the questionnaire, with a mean follow-up of 38 months The main reasons for dropout were cost of therapy, patient,\ and partner problems with the concept of penile injection, lack of partner availability, and spontaneous improvement in erections Lack of ef cacy of therapy was the primary reason for only 1/7 dropouts Furthermore, adverse effects of penile injections (priapism, penile nodules, pain) appeared to be only minor contributors to dropout in the general population.

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