RECONSTRUCTIVE UROLOGY

Current and future strategies for preventing and managing erectile dysfunction following radical prostatectomy
Montorsi F, Briganti A, Salonia A, Rigatti P, Burnett AL
Department of Urology, Università Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy, and Department of Urology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
Eur Urol. 2004; 45: 123-133

• Introduction and Objectives: 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.
  
  
• Editorial Comment
  This paper written by a team of young experts on the treatment of sexual dysfunction nicely describes how erectile function can currently be treated after oncological pelvic surgery. It is a valuable reference for both the pelvic surgeons performing potency preserving techniques and those who deal with these patients postoperatively. Nerve preservation is currently the only clinically truly proven method of preserving potency after radical prostatectomy or cystoprostatectomy. Although there are data that have shown the results of autologous nerve interposition if autonomic periprostatic nerves cannot be preserved, the true value and applicability needs to be reproduced in larger patient cohorts. Another interesting future aspect may be the use of neurogenesis inducing drugs or pharmatherapeutically protective substances such as immunophilin ligands, which are currently under clinical investigation.

Dr. Arnulf Stenzl
Professor and Chairman of Urology
Eberhard-Karls-University Tuebingen
Tuebingen, Germany