ABSTRACT
Patients being considered for a nerve-sparing radical prostatectomy should be potent prior to the procedure. This is of major importance as patients who report some degree of ED or patients who use phosphodiesterase type 5 inhibitors (PDE5Is) prior to the procedure are more likely to develop severe ED after the procedure itself.15 The use of validated questionnaires such as the IIEF12 may facilitate the diagnosis of preoperative ED during the initial patient assessment. This questionnaire assesses various domains of male sexuality, including erectile and ejaculatory function, orgasm, desire, and intercourse satisfaction, and by reviewing the results of this patient self-assessment interesting baseline information are always obtained. Morphology of the corpora cavernosa deteriorates with aging, and this may be correlated with the high prevalence of ED seen in the aging men.16 Rates of recovery of erectile function after a nerve-sparing radical prostatectomy are inversely correlated with the patient’s age, i.e., best postoperative potency rates are obtained in the younger patient population, and it seems reasonable to consider patients of 65 years of age or less as candidates for a nervesparing procedure.3 Patient age seems to be one of the most important factors for the recovery of sexual potency also after unilateral nerve sparing surgery. Indeed, in a group of 46 patients who received unilateral nerve-sparing radical retropubic prostatectomy, 14 (30.4%) regained full potency after surgery and, in the vast majority of them, recovery occurred within a period of 18 months. Of these patients, those aged less than 60 years reported the highest rate of recovery of potency, sufficient for vaginal penetration, after a mean of 13 months after surgery.17 Comorbid conditions seem also to affect the recovery of spontaneous erections postoperatively as they may impact on the baseline penile hemodynamics. Therefore, a concomitant diagnosis of diabetes mellitus, hypertension, ischemic heart disease, hypercholesterolemia, or history of cigarette smoking identified at the time of the preoperative patient assessment should be taken into account as a potential negative predictive factor for potency recovery after surgery.15 Although a higher prostate volume could be associated with higher intraoperative bleeding, it does not seem to influence postoperative potency rate.18,19 Nevertheless, body weight does not seem to be related with the feasibility of a nerve-sparing approach, even in clinically obese patients.19
