Abstract
Objective: As radical prostatectomy remains a commonly used procedure in the treatment of clinically localized prostate cancer, we critically analyzed the current strategies for preventing and managing postoperative erectile dysfunction. Methods: Systematic literature review using Medline and CancerLit from January 1997 to March 2004. Abstracts published in the journals European Urology, The Journal of Urology and the International Journal of Impotence Research as official proceedings of internationally known scientific societies held in the same time period were also assessed. Results: Patient selection and surgical technique are the major determinants of postoperative erectile function. Intracavernosal hypoxia following radical prostatectomy seems to be one of the major determinants of post-operative erectile dysfunction. Pharmacological prophylaxis and treatment of postoperative erectile dysfunction is effective and safe, although no general agreement regarding timing and dosing of its clinical application has been assessed yet. Conclusions: In the hands of experienced surgeons, properly selected patients undergoing a nerve sparing radical prostatectomy should achieve unassisted or medically assisted erections postoperatively.
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