AB269. Optimizing recovery of potency and continence during radical prostatectomy

Abstract: To date, prostate cancer is the most common cancer in men in the United States, with an estimated 218,000 new cases and 27,000 deaths expected each year. The prevalence of prostate cancer in Korea quadrupled between 2002 and 2008, with the highest increased incidence rate in total forms of malignancy. The incidence of prostate cancer in Korea increased up to 24.8 per 100,000 men in 2009 in comparison with 13 per 100,000 men in 2008. Radical prostatectomy (RP), radiation therapy, brachytherapy and androgen ablation are well established options for the treatment of various stages of prostate cancers. However, erectile dysfunction (ED) or postprostatectomy incontinence (PPI) following prostate cancer treatment remains a significant quality of life issue for men. Despite advancements in understanding the anatomy of the prostate and the neurovascular bundle with improved surgical techniques and improved technologies, the incidence of ED after prostate cancer treatment with above mentioned modalities is still very high and ranges from 26% to 100%. RP is the oldest and the most frequent treatment modality for patients with an organ-confined prostate cancer. The challenge for the urologist treating patients with prostate cancer is cancer control with the preservation of erectile function. Since initiation of penile erection is dependent on nerves, preservation of the cavernous nerves during RP is the most important factor for the recovery of erectile function. The pathophysiology of ED after RP involves neural injury, vascular injury, and corporal smooth muscle damage. The neuropraxia and endothelial dysfunction resulting in ischemia, hypoxia, fibrosis and apoptosis are all believed to contribute to ED and penile atrophy associated with prostate cancer treatment. There have been a number of studies that have attempted to prevent or reverse these deleterious changes. However, there are no clear guidelines for penile rehabilitation regimens even though these have become the commonly used penile rehabilitation methods. Currently, the body of evidence does seem to suggest a beneficial role for penile rehabilitation after prostatectomy in improving return of potency. Such a program should begin with a detailed evaluation on the preoperative sexual performance characteristic of the patient and then a thorough discussion of the available rehabilitation regiments. The practitioner should consider factors that are important to the patient including ease of use and compliance, patient motivation, conditioning, cost and patient expectations about sexual function, and penile length. Penile rehabilitation may continue to remain investigative until more standardized clinical data becomes available.

Keywords: Radical; prostatectomy; postprostatectomy; incontinence; erectile; dysfunction