Acting on anecdotal evidence, Dr. Nelson and his co-authors, Peter Scardino, MD, and John P. Mulhall, MD, assessed the erectile function of 250 men average age, 59±8 years pre- and post-radical prostatectomy. Of the men with baseline erectile function scores ≥24 mild to no dysfunction, about one-third 32% regained function; however, well over half 60% required medication to do so. Only 13% of men reporting mild to no dysfunction prior to prostatectomy reported returning to full baseline function at 24 months without medication.
via Better patient counseling needed on post-RP erectile function – – UrologyTimes.
This study from Memorial Sloan Kettering points out that it is important to explain to patients that the ability to achieve an erection is less after surgery. Many factors account for a patients ability to recover erectile function including, age, preoperative function, sexual activity, the type of nerve sparing that can be performed (based on the amount of cancer), skill of the surgeon, type of surgery (open vs. robotic), and other factors.
I try to give an estimate of the probability of the ability to get erections after surgery with and without PDE5 medicines (viagra, levitra, cialis) for each patient.
Functional results with regard to erectile function and urinary continence after prostate sparing cystectomy are good. Oncological results have been promising, but need to be confirmed after longer followup and in larger trials.
For men in need of a bladder removal for bladder cancer, my practice has always consisted of removing the entire prostate as well. This is what I learned at Indiana and have continued to do in NJ. As far as I know, urologic oncologists in the USA all agree on this.
In Europe I have read several studies that have left the prostate capsule or most of the prostate in place. I think you will see a higher rate of pelvic recurrences and bladder cancer recurrence in the prostate, as well as new prostate cancers this way. I do agree that men will have less side effects in regards to erections and continence potentially.
I have been performing robotic cystectomies for about 3 years now and feel that I can perform a more careful operation around the erection nerves and urinary muscles. I hope to improve on our past results while still removing the entire prostate with the bladder.
Since Dr. Patrick Walsh described the nerve sparing techniques for radical prostatectomy, urologists have been trying to spare the nerves responsible for erections. There is a debate among urologists on who is a good candidate for nerve sparing. Id like to ask urologists their opinion. Please vote on the poll below and add a comment below if you have time.
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