Potency after Radical Prostatectomy: From New Techniques to Better Results

Introduction and objectives: Radical prostatectomy remains a commonly used procedure in the treatment of clinically localized prostate cancer. We critically analyzed current and future evidence-based strategies for preventing and managing postoperative erectile dysfunction (ED). Methods: We conducted a systematic literature review using MEDLINE and CancerLit for the period from January 1997 through August 2005. We also assessed abstracts published in European Urology, the Journal of Urology, the International Journal of Impotence Research, and the Journal of Sexual Medicine, as well as official proceedings of internationally recognized scientific societies, during the same period. Results: Patient selection and surgical technique are the major determinants of postoperative erectile function. Novel surgical approaches have been associated with increasing success in terms of restoring of erectile and urinary function after surgery. Pathophysiology of ED after radical prostatectomy includes chronic cavernosal hypoxia and apoptosis of corporeal smooth muscle cells, which might play a role in the development of cavernous arteriogenic and veno-occlusive dysfunction following radical prostatectomy. Recent evidence suggests that both pharmacological prophylaxis and treatment of postoperative ED are effective and safe. Conclusion: In the hands of experienced high-volume surgeons, properly selected patients undergoing nerve-sparing radical prostatectomy should be able to achieve unassisted or medically assisted full erections in the postoperative period. © 2005 Elsevier B.V. All rights reserved.