Dating after radical prostatectomy
The cavernous nerve travels from the pelvicplexus proximally to the penis distally, in close anatomical relationship to the seminal vesicle, prostate, striated urethral sphincter, bladder, and rectum. Anterosuperior oblique view of the same anatomical structures. Anterosuperior oblique view illustrating preservation of the cavernous nervesafter bilateral nerve-sparing prostatectomy and bladder neck anastomosis to theurethral stump.The cavernous nerve fibers are preserved by division and clip-ping of small prostatic nerves alongside the prostate.The management of erectile dysfunction requires expert diagnosis and treatment.Diagnosis includes sexual function history, general medical history, psychosocial history, medication history, physical examination, and appropriate laboratory testing.Now after the surgery, expectations are that physical capacity is fully recovered in most patients within several weeks, return of urinary continence is achieved by more than 95% of patients within a few months, and erection recovery with ability to engage in sexual intercourse is regained by most patients with or without oral phosphodiesterase 5 (PDE5) inhibitors within 2 years. Why is there increasing concern at this time regarding erectile dysfunction issues following radical prostatectomy?The reality of the recovery process after radical prostatectomy today is that erectile function recovery lags behind functional recovery in other areas.When non-nerve-sparingsurgery is required for cancer eradication either unilaterally or bilaterally, wide excision of periprostatic soft tissue includes the cavernous nerves en block withthe removed surgical specimen. What is the importance of preserved erectile function?In considering the impact of the various treatment approaches for prostate cancer on their quality of life, many patients place paramount importance on the possibility of retaining natural erectile function.
Following a series of anatomical discoveries of the prostate and its surrounding structures about 2 decades ago, changes in the surgical approach permitted the procedure to be performed with significantly improved outcomes.Referrals can be made to the Johns Hopkins' noted Sexual Behaviors Consultation Unit.Erectile dysfunction following radical prostatectomy for clinically localized prostate cancer is a known potential complication of the surgery.Non-pharmacologic therapies, which do not rely on the biochemical reactivity of the erectile tissue, include vacuum constriction devices and penile implants (prostheses).Men who have undergone nerve-sparing technique should be offered therapies that are not expected to interfere with the potential recovery of spontaneous, natural erectile function.
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If our diagnosis suggests a psychological association with your erectile dysfunction, we may recommend that you pursue counseling with a qualified psychologist available through the Clinic.