8% in 1989–1992 to 45.3% in 1991–2001.1,5 Earlier detection has significantly improved cancer cure rates and pushed physicians to concentrate their focus on postprostatectomy quality-of-life issues.6 Han and colleagues reported a 15-year overall actuarial cancer-specific survival rate of 90% for Gleason 6 or Gleason 7 (3+4) prostate cancer treated with radical prostatectomy.2,7,8 This trend of increased detection and improved survival of low-grade prostate cancer necessitates discussion with patients
about their treatment options. Radical prostatectomy (RP) is the gold standard therapeutic option Inhibitors,research,lifescience,medical for patients Inhibitors,research,lifescience,medical with clinically localized prostate cancer who have a life expectancy of longer than
10 years.9–12 Other therapeutic options include brachytherapy, external beam radiation therapy, androgen deprivation therapy, cryotherapy, and active surveillance/watchful waiting.5,13,14 Mulhall and associates reported that, in the United States, over 50,000 RPs are performed each year; whereas other reports suggest this figure Inhibitors,research,lifescience,medical is as high as 161,000 men per year who undergo RP.15,16 Surgical treatment of prostate cancer is associated with severe quality-of-life issues, primarily urinary incontinence (UI) and erectile dysfunction (ED).2,13,17 Since the introduction of anatomic nerve-sparing radical prostatectomy as described by Walsh and Donker in Inhibitors,research,lifescience,medical 1982, surgical morbidity associated with total and stress urinary incontinence (SUI) has decreased to < 10%.18,19 Numerous reports show that ED rates after RP range from 14% to 90%.3,16,20,21 Bergman and colleagues reported
that 30% to 50% of men treated for localized prostate cancer reported use of erectile aids within 5 years after therapy.22 The potency rates after RP vary from 16% to 86% depending on whether the surgery was performed at a center Inhibitors,research,lifescience,medical of excellence or by a community urologist.6,23 These widely varying rates for ED following RP have led urologists to seek therapy to improve post-RP ED. This sexual dysfunction is associated with both organic and psychogenic causes and encompasses loss of ejaculation, ED, decreased orgasmic pleasure, diminished libido, socioeconomic Fedratinib parameters, age, and comorbidities.14,24 Etiology of Post-RP ED Several almost theories have been proposed for the cause of post-RP ED. These theories include neurapraxia, vascular injury leading to ischemia, loss of veno-occlusive mechanism, tissue cell death within the penis leading to loss of smooth muscle content, local inflammatory effects due to surgical manipulation, and penile hypoxia.8,10,11,15,25–27 Neuropraxia is inevitable despite technically advanced surgical techniques for RP.