Indian Journal of Urology
SYMPOSIUM
Year
: 2014  |  Volume : 30  |  Issue : 4  |  Page : 434--442

Erectile dysfunction in robotic radical prostatectomy: Outcomes and management


Patrick Whelan, Shahid Ekbal, Ajay Nehra 
 Department of Urology, Rush University, Rush Medical College, Chicago, IL, USA

Correspondence Address:
Ajay Nehra
1725 West Harrison Street; Chicago, IL 60612
USA

Robot-assisted laparoscopic prostatectomy (RALP) has emerged as the most common treatment for localized prostate cancer. With improved surgical precision, RALP has produced hope of improved potency rates, especially with the advent of nerve-sparing and other modified techniques. However, erectile dysfunction (ED) remains a significant problem for many men regardless of surgical technique. To identify the functional outcomes of robotic versus open and laparoscopic techniques, new robotic surgical techniques and current treatment options of ED following RALP. A Medline search was performed in March 2014 to identify studies comparing RALP with open retropubic radical prostatectomy (RRP) and laparoscopic radical prostatectomy, modified RALP techniques and treatment options and management for ED following radical prostatectomy. RALP demonstrates adequate potency rates without compromising oncologic benefit, with observed benefit for potency rates compared with RRP. Additionally, specific surgical technical modifications appear to provide benefit over traditional RALP. Phosphodiesterase-5 inhibitors (PDE5I) demonstrate benefit for ED treatment compared with placebo. However, long-term benefit is often lost after use. Other therapies have been less extensively studied. Additionally, correct patient identification is important for greatest clinical benefit. RALP appears to provide beneficial potency rates compared with RRP; however, these effects are most pronounced at high-volume centers with experienced surgeons. No optimal rehabilitation program with PDE5Is has been identified based on current data. Additionally, vacuum erection devices, intracavernosal injections and other techniques have not been well validated for post RALP ED treatment.


How to cite this article:
Whelan P, Ekbal S, Nehra A. Erectile dysfunction in robotic radical prostatectomy: Outcomes and management .Indian J Urol 2014;30:434-442


How to cite this URL:
Whelan P, Ekbal S, Nehra A. Erectile dysfunction in robotic radical prostatectomy: Outcomes and management . Indian J Urol [serial online] 2014 [cited 2019 Dec 11 ];30:434-442
Available from: http://www.indianjurol.com/article.asp?issn=0970-1591;year=2014;volume=30;issue=4;spage=434;epage=442;aulast=Whelan;type=0