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 signifi cantly contributed to the understanding of the surgical anatomy of the prostate and posed the bases for the subsequent development of the anatomical radical prostatectomy technique: i.e. a surgical approach aimed at completely excising the prostate, providing optimal cancer control while maintaining the integrity of the anatomical 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 been clearly shown to be a major challenge for most urologists.6-8 This fi nding has contributed to the development of an increasing interest in the elucidation of the pathophysiology of postoperative erectile dysfunction (ED) and 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 been demonstrated that different defi nitions of potency after surgery yield different results when applied to the same patients at the same time. This underlines the observation that sexual function entails more than penile erection fi rm enough for intercourse, as the classic defi nition of potency, in fact demonstrated variable agreement.13