title: Prevention and management of post prostatectomy erectile dysfunction.
abstract: Sexual dysfunction is common in patients with prostate cancer (PC) following radical prostatectomy (RP). Review the available literature concerning prevention and management strategies for post-RP erectile function (EF) impairment in terms of preoperative patient characteristics, intra and postoperative factors that may influence EF recovery, and postoperative treatments for erectile dysfunction (ED). A literature search was performed using Google and PubMed database for English-language original and review articles, either published or e-published up to July 2013. The literature still demonstrates a great inconsistency in the definition of what is considered normal EF both before and after RP. Thus, using validated psychometric instruments with recognized cut-offs for normalcy and severity during the pre- and post-operative evaluation should be routinely considered. Therefore, a comprehensive discussion with the patient about the true prevalence of postoperative ED, the concept of spontaneous or pharmacologically-assisted erections, and the difference between "back to baseline" EF and "erections adequate enough to have successful intercourse" clearly emerge as key issues in the eventual understanding of post-RP ED prevention and promotion of satisfactory EF recovery. Patient factors (including age, baseline EF, comorbid conditions status), cancer selection (non- vs. uni- vs. bilateral nerve-sparing), type of surgery (i.e., intra vs. inter vs. extrafascial surgeries), surgical techniques (i.e., open, laparoscopic and robotically-assisted RP), and surgeon factors (i.e., surgical volume and surgical skill) represent the key significant contributors to EF recovery. A number of preclinical and clinical data show that rehabilitation and treatment in due time are undoubtedly better than leaving the erectile tissue to its unassisted postoperative fate. The role of postoperative ED treatment for those patients who received a non-nerve-sparing RP was also extensively discussed. Optimal outcomes are achieved mainly by the careful choice of the correct patient for the correct type of surgery. Despite a plethora of potential rehabilitative approaches, they should be only considered as "strategies", since incontrovertible evidence of their effectiveness for improving natural EF recovery is limited. Conversely, numerous effective therapeutic options are available for treating post-RP ED.
authors.affiliation: 1 Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; 2 Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
authors.affiliation: 1 Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; 2 Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Castagna
authors.affiliation: 1 Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; 2 Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Capogrosso
authors.affiliation: 1 Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; 2 Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Castiglione
authors.affiliation: 1 Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; 2 Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.affiliation: 1 Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; 2 Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
keywords: Prostate cancer (PCa); erectile dysfunction (ED); erectile function (EF); radical prostatectomy (RP)
references.citation: J Sex Med. 2011 Jun;8(6):1797-804
references.pmid: 21426495
references.citation: Eur Urol. 2008 Oct;54(4):924-31
references.pmid: 18640769
references.citation: J Urol. 2006 Jun;175(6):2011-7
references.pmid: 16697787
references.citation: J Sex Med. 2010 Jul;7(7):2521-31
references.pmid: 20487236
references.citation: Eur Urol. 2012 Sep;62(3):418-30
references.pmid: 22749850
references.citation: Br J Cancer. 2013 May 14;108(9):1784-9
references.pmid: 23612450
references.citation: Eur Urol. 2009 Aug;56(2):317-24
references.pmid: 19501454
references.citation: J Sex Med. 2012 Feb;9(2):602-7
references.pmid: 21933350
references.citation: J Sex Med. 2013 Aug;10(8):2101-7
references.pmid: 23679104
references.citation: BJU Int. 2013 Apr;111(4):658-65
references.pmid: 23186312
references.citation: Curr Opin Urol. 2013 Mar;23(2):129-34
references.pmid: 23321631
references.citation: J Urol. 2012 Dec;188(6):2213-8
references.pmid: 23083647
references.citation: Eur Urol. 2011 Sep;60(3):536-47
references.pmid: 21620561
references.citation: J Urol. 1997 Oct;158(4):1408-10
references.pmid: 9302132
references.citation: J Urol. 2013 Jun;189(6):2229-36
references.pmid: 23219537
references.citation: Eur Urol. 2012 Nov;62(5):779-90
references.pmid: 22664219
references.citation: J Urol. 2010 Nov;184(5):2062-7
references.pmid: 20850829
references.citation: J Sex Med. 2009 Jul;6(7):2032-8
references.pmid: 19453918
references.citation: Eur Urol. 2007 Jan;51(1):45-55; discussion 56
references.pmid: 16854519
references.citation: Eur Urol. 2008 Mar;53(3):564-70
references.pmid: 17761385
references.citation: Urology. 2007 Sep;70(3):539-42
references.pmid: 17686509
references.citation: Urology. 1999 Sep;54(3):503-8
references.pmid: 10475362
references.citation: J Endourol. 2009 Sep;23(9):1467-72
references.pmid: 19698051
references.citation: Eur Urol. 2007 May;51(5):1229-35
references.pmid: 16989942
references.citation: J Sex Med. 2008 May;5(5):1126-36
references.pmid: 18331274
references.citation: J Sex Med. 2010 Dec;7(12):3984-90
references.pmid: 20722784
references.citation: Eur Urol. 2011 Jan;59(1):61-71
references.pmid: 21056534
references.citation: Curr Opin Urol. 2013 Jan;23(1):88-94
references.pmid: 23169152
references.citation: BJU Int. 2008 Jan;101(2):203-10
references.pmid: 17888043
references.citation: Urology. 2010 Sep;76(3):743-8
references.pmid: 20573384
references.citation: J Sex Med. 2011 Dec;8(12):3479-86
references.pmid: 21951645
references.citation: Surg Radiol Anat. 2011 May;33(4):301-12
references.pmid: 20686767
references.citation: BJU Int. 2012 Dec;110(11 Pt C):E954-7
references.pmid: 23078100
references.citation: J Urol. 2012 Mar;187(3):894-8
references.pmid: 22245326
references.citation: Urology. 2000 Dec 20;56(6):899-905
references.pmid: 11113727
references.citation: BJU Int. 2009 Dec;104(11):1730-3
references.pmid: 20063449
references.citation: Prostate. 2012 Feb 1;72(2):181-5
references.pmid: 21538427
references.citation: J Sex Med. 2006 Jul;3(4):743-8
references.pmid: 16839332
references.citation: Eur Urol. 2012 Aug;62(2):261-72
references.pmid: 22575909
references.citation: Eur Urol. 2013 Jan;63(1):169-77
references.pmid: 23092543
references.citation: J Urol. 2002 Mar;167(3):1371-5
references.pmid: 11832735
references.citation: Eur Urol. 2012 Apr;61(4):796-802
references.pmid: 22230713
references.citation: J Sex Med. 2007 Mar;4(2):472-6
references.pmid: 17367442
references.citation: Eur Urol. 2006 Apr;49(4):612-24
references.pmid: 16442210
references.citation: Urology. 2006 Aug;68(2):429-35
references.pmid: 16904479
references.citation: J Urol. 2003 Jun;169(6):2166-9
references.pmid: 12771740
references.citation: Eur Urol. 1999 Apr;35(4):312-7
references.pmid: 10087394
references.citation: Expert Rev Anticancer Ther. 2010 May;10(5):747-54
references.pmid: 20470006
references.citation: BJU Int. 2005 Feb;95(3):359-65
references.pmid: 15679794
references.citation: J Chronic Dis. 1987;40(5):373-83
references.pmid: 3558716
references.citation: Radiology. 2012 Mar;262(3):903-11
references.pmid: 22357890
references.citation: Int J Impot Res. 2005 Jul-Aug;17(4):307-19
references.pmid: 15875061
references.citation: J Sex Med. 2011 May;8(5):1330-40
references.pmid: 21366883
references.citation: J Urol. 2009 Feb;181(2):731-5
references.pmid: 19091349
references.citation: JAMA. 1993 Jul 7;270(1):83-90
references.pmid: 8510302
references.citation: Prostate. 2012 Jan;72(1):58-64
references.pmid: 21520163
references.citation: BJU Int. 2008 Aug 5;102(5):592-6
references.pmid: 18694409
references.citation: Urology. 2009 Apr;73(4):816-21
references.pmid: 19195692
references.citation: Int J Impot Res. 2008 Sep-Oct;20(5):479-86
references.pmid: 18650827
references.citation: Eur Urol. 2010 Sep;58(3):457-61
references.pmid: 20566236
references.citation: J Endourol. 2012 Dec;26(12 ):1578-85
references.pmid: 23072396
references.citation: BJU Int. 2013 Oct;112(6):798-812
references.pmid: 23890416
references.citation: J Sex Med. 2011 May;8(5):1503-12
references.pmid: 21324093
references.citation: J Sex Med. 2010 Jan;7(1 Pt 1):298-303
references.pmid: 19912507
references.citation: J Urol. 2005 Dec;174(6):2105-10
references.pmid: 16280737
references.citation: Urology. 2011 Mar;77(3):761.e1-7
references.pmid: 21256544
references.citation: J Sex Med. 2009 Feb;6(2):498-504
references.pmid: 19143908
references.citation: J Urol. 2008 Mar;179(3):827-31
references.pmid: 18221962
references.citation: BJU Int. 2012 Dec;110(11):1787-91
references.pmid: 22564343
references.citation: Eur Urol. 2007 Mar;51(3):648-57; discussion 657-8
references.pmid: 17097214
references.citation: Urology. 1999 Aug;54(2):346-51
references.pmid: 10443736
references.citation: J Sex Med. 2010 Jan;7(1 Pt 1):304-9
references.pmid: 19758282
references.citation: J Sex Med. 2011 May;8(5):1495-502
references.pmid: 21324091
references.citation: J Sex Med. 2010 Jul;7(7):2564-71
references.pmid: 20524975
references.citation: Int J Androl. 2008 Sep;31(5):483-9
references.pmid: 17651400
references.citation: Eur Urol. 2009 Feb;55(2):334-47
references.pmid: 18986755
references.citation: J Sex Med. 2010 Nov;7(11):3659-65
references.pmid: 20819141
references.citation: Eur Urol. 2006 Aug;50(2):360-5
references.pmid: 16413666
references.citation: J Sex Med. 2011 Apr;8(4):1048-60
references.pmid: 21269401
references.citation: BJU Int. 2010 Aug;106(4):543-7
references.pmid: 20067455
references.citation: J Urol. 2009 Feb;181(2):462-71
references.pmid: 19084865
references.citation: J Sex Med. 2009 Dec;6(12):3347-55
references.pmid: 19751390
references.citation: Urology. 1998 Dec;52(6):1106-12
references.pmid: 9836564
references.citation: Surgeon. 2011 Apr;9(2):65-71
references.pmid: 21342669
references.citation: J Endourol. 2010 Apr;24(4):577-82
references.pmid: 20136397
references.citation: BJU Int. 2013 Oct;112(6):844-51
references.pmid: 23937708
references.citation: J Urol. 2010 Jun;183(6):2451-6
references.pmid: 20403617
references.citation: J Sex Med. 2010 Jan;7(1 Pt 2):501-23
references.pmid: 20092450
references.citation: J Urol. 2006 Jun;175(6):2214-7
references.pmid: 16697842
references.citation: J Sex Med. 2012 Mar;9(3):903-8
references.pmid: 22240189
references.citation: Eur Urol. 2012 Aug;62(2):273-86
references.pmid: 22575910
references.citation: Urology. 1997 Jun;49(6):822-30
references.pmid: 9187685
references.citation: BJU Int. 2010 Jan;105(1):37-41
references.pmid: 19659465
references.citation: Int J Urol. 2013 Mar;20(3):285-9
references.pmid: 23311962
references.citation: Eur Urol. 2013 Dec;64(6):974-80
references.pmid: 23856036
references.citation: J Endourol. 2009 Sep;23 (9):1479-84
references.pmid: 19694530
references.citation: BJU Int. 2013 Aug;112(3):338-45
references.pmid: 23470027
references.citation: BJU Int. 2013 Mar;111(3):451-8
references.pmid: 22900712
references.citation: J Urol. 2000 Dec;164(6):1929-34
references.pmid: 11061884
references.citation: J Sex Med. 2013 Jan;10(1):195-203
references.pmid: 22970890
references.citation: J Urol. 2008 Jun;179(6):2317-20
references.pmid: 18423744
references.citation: J Urol. 2013 Sep;190(3):981-6
references.pmid: 23410984
references.citation: J Urol. 2007 Aug;178(2):597-601
references.pmid: 17570435
references.citation: J Urol. 2006 Jul;176(1):227-31
references.pmid: 16753406
references.citation: Oncol Rep. 2013 Jun;29(6):2445-50
references.pmid: 23545628
references.citation: J Sex Med. 2011 Apr;8(4):1210-7
references.pmid: 21269392
references.citation: World J Urol. 2011 Feb;29(1):29-34
references.pmid: 21107844
references.citation: BJU Int. 2007 Aug;100(2):368-70
references.pmid: 17617141
references.citation: J Sex Med. 2005 Jul;2(4):532-40; discussion 540-2
references.pmid: 16422848
references.citation: J Sex Med. 2006 Mar;3(2):267-73
references.pmid: 16490019
references.citation: Eur Urol. 2011 Sep;60(3):413-9
references.pmid: 21612859
references.citation: J Urol. 2005 May;173(5):1673-6
references.pmid: 15821546
references.citation: Urology. 2012 Jan;79(1):150-5
references.pmid: 22055695
references.citation: J Sex Med. 2009 Oct;6(10):2813-9
references.pmid: 19686421
references.citation: J Sex Med. 2010 Feb;7(2 Pt 1):839-45
references.pmid: 19912486
references.citation: BJU Int. 2013 Nov;112(7):998-1008
references.pmid: 23826962
references.citation: J Sex Med. 2013 Jun;10(6):1636-43
references.pmid: 23551767
references.citation: BJU Int. 2008 May;101(10):1279-83
references.pmid: 18284406
references.citation: J Sex Med. 2008 Feb;5(2):448-57
references.pmid: 18042217
references.citation: J Sex Med. 2009 Sep;6(9):2538-46
references.pmid: 19515209
references.citation: Eur Urol. 2014 Jan;65(1):52-7
references.pmid: 23957946
references.citation: Eur Urol. 2010 Feb;57(2):179-92
references.pmid: 19931974
references.citation: J Sex Med. 2011 Feb;8(2):575-82
references.pmid: 20807323
references.citation: J Sex Med. 2010 Feb;7(2 Pt 1):803-9
references.pmid: 19796019
references.citation: J Sex Med. 2008 Mar;5(3):677-83
references.pmid: 18194187
references.citation: J Sex Med. 2010 Apr;7(4 Pt 2):1687-98
references.pmid: 20388165
references.citation: Int J Impot Res. 2008 Mar-Apr;20(2):202-12
references.pmid: 17882231
references.citation: Urology. 2006 Sep;68(3 Suppl):17-25
references.pmid: 17011372