Advances in the Management of Post-Radical Prostatectomy Erectile Dysfunction

[摘要] The radical prostatectomy has become the most commonly performed major open surgery in urological residency. With the widespread acceptance of the use of prostate-specific antigen for cancer screening, the resultant increase in screening sensitivity, and the relatively “noninvasive” nature of transrectal ultrasound-guided biopsies, there has been a downward stage migration to less advanced disease at the time of diagnosis, and the diagnosis is being made at a younger age and with a longer survival from the time of diagnosis and therapeutic intervention, regardless of the form of intervention chosen by the patient. Improvements in surgical techniques have resulted in better continence and potency rates with less surgical morbidity and mortality. Nevertheless, sexual dysfunction remains the most common and persistent postoperative morbidity. The dysfunction is global, encompassing all domains of sexual function (libido, orgasmic and erectile function), and is predominantly derived from the radical prostatectomy itself. The sexual dysfunction has been created by the surgery and yet is ignored by many urologists, forcing men to give up or seek another opinion elsewhere. In this era of guidelines and consensus-driven medicine, we find ourselves without them for problems resulting from the surgery and which can be devastating for the patient and his partner. Part of the difficulty for urologists is that even if they acknowledge that the problems exist, there is no standardized approach for dealing with them.

[学科分类] 基础医学