Optimizing postoperative sexual function after radical prostatectomy

Abstract

Erectile dysfunction (ED) is one of the complications associated with pelvic surgery. The significance of ED as a complication following pelvic surgery, especially radical prostatectomy (RP), lies in the negative impact that it has on patients' sexual and overall life. In the literature, rates of ED following RP range from 25% to 100%. Such variety is associated with pelvic dissection and conservation of neurovascular structures. Another important factor impacting on postoperative ED is the preoperative erectile function of the patient. Advances in the knowledge of pelvic anatomy and pathological mechanisms led to a refinement of pelvic surgical techniques, with attention to the main structures that if damaged compromise erectile function. These improvements resulted in lower postoperative ED rates and better erectile recovery, especially in patients undergoing RP. Furthermore, surgery alone is not sufficient to prevent this complication, and thus, several medical strategies have been tested with the aim of maximizing erectile function recovery. Indeed it seems that prevention of postoperative ED must be addressed by a multimodal approach. The aim of this review is to give a picture of recent knowledge, novel techniques and therapeutic approaches in order to reach the best combination of treatments to reduce the rate of ED after pelvic surgery.

Improvement in sexual function after robot-assisted radical prostatectomy: A rehabilitation program with involvement of a clinical sexologist

“…With this altered expression of their sexual function, it is very likely that they will benefit from the increased support provided by a CS [ 31 , 32 ]. As other authors have reported [ 33 , 34 ], the rehabilitation efforts are resource and time consuming. It is very important, preoperatively, to assess the importance of sexual function, and what role a sexual life plays for the patient and his partner; as the motivation for postoperative sexual rehabilitation is to a large extent dependent on this [ 19 , 29 ].…”

Development of UK recommendations on treatment for post‐surgical erectile dysfunction

“…Indeed, with the adoption of this technique, EF recovery rates between 60% and 85% have been reported in some centres . Unfortunately, many men have less favourable results and ED can be a long‐term and sometimes permanent complication, even when maximal cavernous NS techniques are applied .…”

A comparison of time taken to return to baseline erectile function following focal and whole gland ablative therapies for localized prostate cancer: A systematic review

“…Regular use of PDE-5I has been shown to improve PSV and may enhance nerve regeneration after ablation 40 . The role and method of penile rehabilitation after RP remains controversial [41][42][43][44] . None of the studies within the amalgamation had control groups…”