Current and future strategies for preventing and managing erectile dysfunction following radical prostatectomy.
OBJECTIVE
As radical prostatectomy remains a commonly used procedure in the treatment of clinically localized prostate cancer, we critically analyzed current and future strategies for preventing and managing postoperative erectile dysfunction.


METHODS
Systematic literature review using Medline and CancerLit from January 1997 to June 2003. Abstracts published in the journals European Urology, The Journal of Urology and the International Journal of Impotence Research as official proceedings of internationally known scientific societies held in the same time period were also assessed.


RESULTS
Patient selection and surgical technique are the major determinants of postoperative erectile function. Apoptosis of corporeal smooth muscle cells plays a role in the development of cavernous veno-occlusive dysfunction following radical prostatectomy. Pharmacological prophylaxis and treatment of postoperative erectile dysfunction is effective and safe. The concepts of cavernous nerve reconstruction and neuroprotection have been associated to promising results.


CONCLUSIONS
In the hands of experienced surgeons, properly selected patients undergoing a nerve sparing radical prostatectomy should achieve unassisted or medically assisted erections postoperatively.
Montorsi
Francesco
F
Department of Urology, Università Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy. montorsi.francesco@hsr.it
Briganti
Alberto
A
Salonia
Andrea
A
Rigatti
Patrizio
P
Burnett
Arthur L
AL
D007172:Erectile Dysfunction / Q000503:physiopathology / Q000517:prevention & control*; D005544:Forecasting; D006801:Humans; D008297:Male; D018579:Patient Selection; D010413:Penis / Q000294:innervation / Q000601:surgery; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D011467:Prostate / Q000294:innervation; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods / Q000639:trends; D019651:Plastic Surgery Procedures
D010726:Phosphodiesterase Inhibitors