title: [Functional results and treatment of functional dysfunctions after radical prostatectomy].
abstract: OBJECTIVE
  To describe the functional results and treatment of functional dysfunctions after radical prostatectomy for localized prostate cancer.
  
  
  METHODS
  Bibliography search was performed from the database Medline (National Library of Medicine, Pubmed) selected according to the scientific relevance. The research was focused on continence, potency, les dyserections, couple sexuality, incontinence, treatments of postoperative incontinence, dysrection and trifecta.
  
  
  RESULTS
  Radical prostatectomy is an elaborate and challenging procedure when carcinological risk balances with functional results. Despite recent developments in surgical techniques, post-radical prostatectomy urinary incontinence (pRP-UI) continues to be one of the most devastating complications, which affects 9-16% of patients. Sphincter injury and bladder dysfunction are the most common causes or pRP-UI. The assessment of severity of pRP-UI that affects the choice of treatment is still not well standardized but should include at least a pad test and self-administered questionnaires. The implantation of an artificial urinary sphincter AMS800 remains the gold standard treatment for patients with moderate to severe pRP-UI. The development of less invasive techniques such as the male sling of Pro-ACT balloons has provided alternative therapeutic options for moderate and slight forms of pRP-UI. Most groups now consider the bulbo-urethral compressive sling as the treatment of choice for patients with non-severe pRP-UI. The most appropriate second-line therapeutic strategy is not clearly determined. Recent therapies such as adjustable artificial urinary sphincters and sling and stem cells injections have been investigated. Maintenance of a satisfying sex life is a major concern of a majority of men facing prostate cancer and its treatments. It is essential to assess the couple's sexuality before treating prostate cancer in order to deliver comprehensive information and consider early therapeutic solutions adapted to the couple's expectations. Active pharmacological erectile rehabilitation (intracavernous injections or phosphodiesterase type 5 inhibitors [PDE5i] on demand, during in the month following surgery) or passive (daily PDE5i after surgery) might improve the quality of erections especially in response to PDE5i. Unimpaired aspects of sexual response (orgasm) may, when the erection is not yet recovered, represent an alternative allowing the couple to preserve intimacy and complicity. Androgen blockade is a major barrier to maintain or return to a satisfying sex. Trifecta is a simple tool to present in one way the results of radical prostatectomy: in case of bilateral neurovascular preservation, Trifecta is 60% whatever the surgical approach.
  
  
  CONCLUSIONS
  Radical prostatectomy is an elaborate and challenging procedure when carcinological risk balances with functional results. Various treatments of postoperative incontinence and dysrections exist. Functional disorders after surgery have to be treated to ameliorate quality of life of patients.
authors.affiliation: Service d'urologie et de transplantation rénale et pancréatique, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France. Electronic address: laurent.salomon@aphp.fr.
authors.forename: L
authors.initials: L
authors.lastname: Salomon
authors.affiliation: Service d'urologie et d'andrologie, CHU de Nîmes, place du Professeur-Robert-Debré, 30029 Nîmes cedex 09, France.
authors.forename: S
authors.initials: S
authors.lastname: Droupy
authors.affiliation: Service d'urologie et de transplantation rénale et pancréatique, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France.
authors.forename: R
authors.initials: R
authors.lastname: Yiou
authors.affiliation: Département d'urologie-andrologie-transplantation rénale, CHU Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse cedex 9, France.
authors.forename: M
authors.initials: M
authors.lastname: Soulié
mesh_terms: D007172:Erectile Dysfunction / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000601:surgery*; D011474:Prosthesis Design; D011788:Quality of Life; D053825:Suburethral Slings; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000209:etiology* / Q000628:therapy; D016741:Urinary Sphincter, Artificial
keywords: Artificial urinary sphincter; Ballons Pro-ACT; Bandelette sous-urétrale; Cancer de la prostate; Cell therapy; Chirurgie; Continence; Couple; Incontinence; Incontinence urinaire; Potency; Pro-ACT; Prostate cancer; Prostatectomie totale; Radical prostatectomy; Rehabilitation; Rééducation; Sexuality; Sexualité; Sphincter urinaire artificiel; Thérapie cellulaire; Urethral sling; Urinary; Érection