All forms of treatment for prostate cancer affect erectile function. Appropriately selected RPP candidates (PSA ^10ng/ml and Gleason score ^6) may be offered a nerve-sparing approach. Nerve-sparing RPP is equally effective in preserving potency as the retropubic approach and may be performed unilaterally or bilaterally.6 It has been our practice to offer bilateral nerve-sparing only to those patients with a single positive biopsy core. Most patients undergo a unilateral nerve-sparing RPP with deliberate sacrifice of the neurovascular bundle on that side on which side biopsies were positive, suggesting the location of the bulk of the tumor. Frazier et al. found 77% of patients to be potent 1 year after nerve-sparing RPP.5 Weldon et al. analyzed the time course to recovery of potency and found that potency returned in 50% of patients after 1 year and in 70% after 2 years. A further important observation was the strong inverse correlation of the rate of successful potency sparing and increasing age. Potency returned in all patients less than 50 years of age, but only 29% of patients age 70 or older.16 Our experience confirms these observations. It is most important to communicate realistic expectations to patients preoperatively regarding the likelihood of regaining potency as well as the extended time this may take. Appropriately selected patients with realistic expectations meanwhile have excellent outcomes after a nerve-sparing approach with high satisfaction ratings regarding their perceived quality of life in terms of sexual function.
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