The role of arterial hypertension and antihypertensive therapy in planning nerve-sparing prostatectomy: impact on erectile function

Assessment of erectile function in patients with prostate cancer is essential when planning nerve-sparing radical prostatectomy. However, reliance solely on validated questionnaires may result in biased estimates because of the subjective nature of self-assessment and the psychological impact of a cancer diagnosis. Therefore, comparing questionnairebased findings with objective methods of erectile function assessment and evaluating factors that may influence erectile function, including arterial hypertension and antihypertensive therapy, is clinically important.

Purpose of the study. To evaluate preoperative erectile function in patients with low- and intermediate-risk prostate cancer scheduled for robot-assisted nerve-sparing radical prostatectomy and to assess the impact of hypertension, hypertension grade, and antihypertensive therapy on erectile function.

Patients and methods. This prospective study included 150 patients with prostate cancer. Erectile function was assessed using the International Index of Erectile Function‑5 (IIEF‑5), the Erection Hardness Score (EHS), the Sexual Encounter Profile (SEP), and nocturnal penile tumescence (NPT) monitoring with the Androscan MIT device. Statistical analysis was performed using StatTech version 4.13.0.

Results. The presence of hypertension was significantly associated with a greater severity of erectile dysfunction (ED), as assessed both by IIEF‑5 (p = 0.030) and NPT data (p = 0.023). The stage of hypertension and the grade of arterial hypertension were associated with deterioration of objective NPT parameters (p = 0.047 and p = 0.031, respectively). Among antihypertensive medications, the use of ACE inhibitors/angiotensin receptor blockers (ARBs), calcium channel blockers, and diuretics (predominantly indapamide) was associated with a significant reduction in NPT duration; statins, classified separately as lipid-lowering rather than antihypertensive therapy, showed no significant association. ED severity categories assigned by IIEF‑5 and by Androscan did not match in 62.2 % of cases.

Conclusion. Arterial hypertension is an independent preoperative risk factor for erectile dysfunction in patients with prostate cancer. Objective NPT monitoring identifies a substantially higher prevalence of erectile function impairment compared with self-assessment using the IIEF‑5. These findings may be useful in selecting candidates for nerve-sparing prostatectomy.

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