Prevention and Management of Post Prostatectomy ED
Prevention and Management of Post Prostatectomy ED
The literature offers a great inconsistency in the definition of what is considered a normal EF before surgery and what a man may consider a normal erection after RP. Validated psychometric instruments with recognized cut-offs for normalcy and severity during the pre- and postoperative evaluation have to be routinely considered. Therefore, a comprehensive discussion with the patient about the true prevalence of postoperative ED, the concept of back to baseline, the meaning of either spontaneous or pharmacologically-assisted erections clearly emerge as key issues to eventually understanding how to prevent and to promote recovery of satisfactory post-RP EF.
In this context, patients should be given individualized outcomes based on a tailored surgical technique, and on patient and surgeon factors. Even if the literature lacks comprehensive data, type of surgery (i.e., intra vs. inter vs. extrafascial surgeries) and surgical techniques (i.e., open, laparoscopic and robotically-assisted RP) achieve the role of significant contributors to EF recovery. The complexity of the issues discussed throughout this manuscript precisely outlines that prevention and possible management of EF of patients treated with RP necessarily passes once more through a careful choice of the right patient at the right time for the correct type of surgery.
Several preventive and therapeutic "strategies" for the preservation and recovery of post-RP EF are available in the everyday clinical setting. Conversely, no specific recommendation emerges regarding the structure of the optimal rehabilitation or treatment regimen. It is of major importance to stress that "postoperative EF rehabilitation" could mean interventions designed to achieve faster and better natural EF recovery, but it could also mean interventions actually able to preserve sexual continuity without necessitating natural EF. In this context, rehabilitation and treatment, set as early as possible, are undoubtedly better than leaving the erectile tissue to its unassisted, unfavorable fate. Likewise, the role of postoperative ED treatment for those patients who received a non-NS surgical approach (i.e., ICI and penile prosthesis implantation) also deserves the highest attention of the clinicians.
Conclusions
The literature offers a great inconsistency in the definition of what is considered a normal EF before surgery and what a man may consider a normal erection after RP. Validated psychometric instruments with recognized cut-offs for normalcy and severity during the pre- and postoperative evaluation have to be routinely considered. Therefore, a comprehensive discussion with the patient about the true prevalence of postoperative ED, the concept of back to baseline, the meaning of either spontaneous or pharmacologically-assisted erections clearly emerge as key issues to eventually understanding how to prevent and to promote recovery of satisfactory post-RP EF.
In this context, patients should be given individualized outcomes based on a tailored surgical technique, and on patient and surgeon factors. Even if the literature lacks comprehensive data, type of surgery (i.e., intra vs. inter vs. extrafascial surgeries) and surgical techniques (i.e., open, laparoscopic and robotically-assisted RP) achieve the role of significant contributors to EF recovery. The complexity of the issues discussed throughout this manuscript precisely outlines that prevention and possible management of EF of patients treated with RP necessarily passes once more through a careful choice of the right patient at the right time for the correct type of surgery.
Several preventive and therapeutic "strategies" for the preservation and recovery of post-RP EF are available in the everyday clinical setting. Conversely, no specific recommendation emerges regarding the structure of the optimal rehabilitation or treatment regimen. It is of major importance to stress that "postoperative EF rehabilitation" could mean interventions designed to achieve faster and better natural EF recovery, but it could also mean interventions actually able to preserve sexual continuity without necessitating natural EF. In this context, rehabilitation and treatment, set as early as possible, are undoubtedly better than leaving the erectile tissue to its unassisted, unfavorable fate. Likewise, the role of postoperative ED treatment for those patients who received a non-NS surgical approach (i.e., ICI and penile prosthesis implantation) also deserves the highest attention of the clinicians.