ABSTRACT
Radical prostatectomy is an increasingly used therapeutic option for patients with clinically localized prostate cancer and a life expectancy of at least 10 years.1
The pioneering work by Walsh and Donker2
significantly contributed to the understanding of the surgical anatomy of the prostate and posed the bases for the subsequent development of the anatomic radical prostatectomy technique, i.e., a surgical approach aimed at completely excising the prostate providing optimal cancer control while maintaining the integrity of the anatomic structures devoted to the functions of urinary continence and sexual potency.3-5 Since the initial reports on this technique, an increasing number of studies have reported very satisfactory postoperative rates of urinary continence, while the preservation of erectile function after surgery has clearly been shown to be a major challenge for most urologists.6-8 This finding contributed to the development of an increasing interest in the elucidation of the pathophysiology of postoperative erectile dysfunction (ED) and on its potential prophylaxis and treatment.9,10 Furthermore ED after radical prostatectomy shows a profound effect on quality of life (QoL). Indeed, it has been shown that more than 70% of patients who had undergone radical retropubic prostatectomy had a moderately or severely affected QoL because of their postoperative ED, when investigated.11 Moreover, although the International Index of Erectile Function (IIEF)12 has been widely accepted as a validated instrument to assess ED, it has it has been demonstrated that different definitions of potency after surgery yield different results when applied to the same patients in the same time. This
underlines the observation that sexual function entails more than penile erection as the classic definition of potency firm enough for intercourse in fact demonstrated variable agreement.13
