Cargando…

Erectile dysfunction in robotic radical prostatectomy: Outcomes and management

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 dy...

Descripción completa

Detalles Bibliográficos
Autores principales: Whelan, Patrick, Ekbal, Shahid, Nehra, Ajay
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4220385/
https://www.ncbi.nlm.nih.gov/pubmed/25378827
http://dx.doi.org/10.4103/0970-1591.142078
_version_ 1782342723827662848
author Whelan, Patrick
Ekbal, Shahid
Nehra, Ajay
author_facet Whelan, Patrick
Ekbal, Shahid
Nehra, Ajay
author_sort Whelan, Patrick
collection PubMed
description 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.
format Online
Article
Text
id pubmed-4220385
institution National Center for Biotechnology Information
language English
publishDate 2014
publisher Medknow Publications & Media Pvt Ltd
record_format MEDLINE/PubMed
spelling pubmed-42203852014-11-06 Erectile dysfunction in robotic radical prostatectomy: Outcomes and management Whelan, Patrick Ekbal, Shahid Nehra, Ajay Indian J Urol Symposium 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. Medknow Publications & Media Pvt Ltd 2014 /pmc/articles/PMC4220385/ /pubmed/25378827 http://dx.doi.org/10.4103/0970-1591.142078 Text en Copyright: © Indian Journal of Urology http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Symposium
Whelan, Patrick
Ekbal, Shahid
Nehra, Ajay
Erectile dysfunction in robotic radical prostatectomy: Outcomes and management
title Erectile dysfunction in robotic radical prostatectomy: Outcomes and management
title_full Erectile dysfunction in robotic radical prostatectomy: Outcomes and management
title_fullStr Erectile dysfunction in robotic radical prostatectomy: Outcomes and management
title_full_unstemmed Erectile dysfunction in robotic radical prostatectomy: Outcomes and management
title_short Erectile dysfunction in robotic radical prostatectomy: Outcomes and management
title_sort erectile dysfunction in robotic radical prostatectomy: outcomes and management
topic Symposium
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4220385/
https://www.ncbi.nlm.nih.gov/pubmed/25378827
http://dx.doi.org/10.4103/0970-1591.142078
work_keys_str_mv AT whelanpatrick erectiledysfunctioninroboticradicalprostatectomyoutcomesandmanagement
AT ekbalshahid erectiledysfunctioninroboticradicalprostatectomyoutcomesandmanagement
AT nehraajay erectiledysfunctioninroboticradicalprostatectomyoutcomesandmanagement