Prediction of sexual function after radical prostatectomy

Abstract

Radical prostatectomy (RP) is a commonly used procedure in the treatment of clinically localized prostate cancer. For this report, the authors critically analyzed the factors associated with recovery of erectile function after surgery. A systematic review of the literature using the Medline and CancerLit databases was conducted. Keywords for the literature search included prostate cancer, radical prostatectomy, erectile dysfunction, impotence, treatment, and prophylaxis. Accurate patient selection (based on patient age, preoperative erectile function, and comorbidity profile) and adequate surgical technique (ie, the preservation of neurovascular bundles) were the major determinants of postoperative erectile function. Moreover, better results were achieved when an appropriate pharmacologic treatment using either oral or local approaches was given. Therefore, the authors concluded that, if patients are stratified correctly according to preoperative, intraoperative, and postoperative factors, then a satisfactory functional recovery may be expected after surgery. For these reasons, an ideal multivariate model predicting the restoration of erectile function after surgery should include patient, surgeon, and postsurgical treatment variables. The authors also concluded that the stratification of patients with regard to their risk of developing erectile dysfunction after surgery was feasible based on several parameters, which should be taken into account for correct patient treatment and counseling. To address this objective, accurate tools for predicting the likelihood of complete functional recovery after surgery are needed. Radical prostatectomy (RP) is used increasingly as a therapeutic option for patients who have clinically localized prostate cancer and a life expectancy 10 years. The pioneering work by Walsh and Donker 1 contributed significantly to our understanding of the surgical anatomy of the prostate and represented the basis for the subsequent development of the anatomic RP technique. The objective of this surgical approach is complete excision of the prostate to provide optimal cancer control while maintaining the integrity of the anatomic structures devoted to the functions of urinary continence and sexual potency. [2][3][4] Since the initial reports on this technique, increasing numbers of studies have reported satisfactory *Predictive Modeling in Prostate Cancer, Supplement to Cancer

Erectile dysfunction after radical prostatectomy: the impact of nerve-sparing status and surgical approach

“…Nevertheless, in most clinical trials on EF after RP the presurgical ED rate is 0%. 19 However, our results are consistent with those of other studies, which report presurgical ED rates from 27% to 58%. 20--22 Our data show that nerve-sparing EERPE and nerve-sparing RRPE offer similar outcomes in terms of EF 3, 6 and 12 months after surgery.…”

Extended versus limited pelvic lymph node dissection during bilateral nerve-sparing radical prostatectomy and its effect on continence and erectile function recovery: long-term results and trifecta rates of a comparative analysis

“…First, all patients were treated with BNSRP, which has been reported as major predictor of EF recovery [22,23]. Thus, our results are not applicable to patients treated without a ns approach.…”

Preoperative Evaluation of Sexual Function in Patients Undergoing Bilateral Nerve-Sparing Radical Retropubic Prostatectomy

“…It is known that the preoperative EF is a signi cant predictor of the subsequent risk of ED following surgery [17]. The likelihood of satisfactory erections after surgery is extremely low in patients with severe ED as measured by IIEF [20,21].…”

“…This is a signi cant problem for the physician and the patient, since prostate cancer is diagnosed in sexually active young men who wish to maintain the same quality of life after surgery [11,12]. Preoperative characteristics of patients are known to play a key role in the recovery of erectile function (EF) after surgery, in which case young and healthy patients have signi cantly higher rates of recovery than old and diseased patients [13][14][15][16][17][18][19].…”