Prostate cancer is the most common tumor diagnosed among men in the USA. In 2001 an estimated 180000 new cases will have been diagnosed and 32000 deaths will have occurred secondary to this disease.1 The patient with prostate cancer has numerous treatment options, which include radical retropubic prostatectomy, radical perineal prostatectomy, laparoscopic radical prostatectomy, external beam radiation therapy, brachy-therapy, cryosurgery, hormonal therapy, and expectant or deferred therapy. Each of these treatments has associated risks and side effects, which must be carefully explained to patients to facilitate their decision-making process.
Erectile dysfunction (ED) is one of the most common and troubling complications following treatment for prostate cancer. It is defined as the inability to have an erection sufficient for vaginal penetration and orgasm.2 Because prostate cancer is a slow-growing neoplasm, and because more men are being diagnosed earlier in their lives, urologists are faced with a therapeutic dilemma. How can the prostate be successfully extirpated from the pelvis without compromising the delicate nerves that are responsible for erection? In 1982, Walsh and Donker introduced the anatomic radical retropubic prostatectomy, which preserved erections by avoiding injury to the cavernous neurovascular bundles.3 This finding greatly improved the quality of life of men with localized prostatic carcinoma, since the morbidity of erectile dysfunction following radical prostatectomy could be minimized. Still, potency rates vary widely in the literature, from 20% to greater than 80% after radical prostatectomy.1'2'417 This wide discrepancy stems from differences in study design, study size and patient selection.
Sexual dysfunction is important to men since many are sexually active well into their ninth decade.18 Prostatic surgery has long been associated with erectile dysfunction but patients today expect this procedure to be performed with low morbidity. Therefore, therapy for sexual dysfunction is a prime issue before considering any kind of prostate surgery. Numerous treatments for erectile dysfunction secondary to radical prostatectomy, radiation therapy, cryosurgery and hormonal therapy are available today.
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