Radical prostatectomy with preservation of sexual function: Anatomical and pathological considerations

Walsh, Patrick C.; Lepor, Herbert; Eggleston, Joseph C.

doi:10.1002/pros.2990040506

Cited by 966 publications

(391 citation statements)

References 15 publications

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“…1c) developed a modified technique for radical retropubic prostatectomy -on the basis of an anatomical approach -to enhance control of bleeding. This approach avoided injury to the neurovascular bundles that innervated the corpora cavernosa of the penis 42 , thereby allowing erectile function and sexual potency to be maintained without compromising the adequacy of surgical margins.…”

Section: Prostatectomymentioning

confidence: 99%

A history of prostate cancer treatment

2002

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The increased incidence of prostate cancer has led to remarkable changes in diagnosis and treatment over the past century. What were the first ways in which prostate cancer was treated, and how did these evolve into the variety of therapeutic strategies from which patients have to choose today?In 1853, J. Adams, a surgeon at The London Hospital, described the first case of prostate cancer, which he discovered by histological examination 1 . Adams noted in his report that this condition was "a very rare disease". Remarkably, 150 years later, prostate cancer has become a significant health problem. In the United States, it is the most commonly diagnosed cancer in men, with 180,000 new cases and about 31,000 deaths occurring annually 2 . This dramatic increase in the number of prostate cancer cases can be attributed to several causes. First, prostate cancer was not differentiated from other types of urinary obstruction until the early 1900s. Second, the incidence of prostate cancer increases more rapidly with age than any other cancer type 2 . The number of cases has risen as the average life expectancy has increased over the past century. Third, the increased incidence seems to be, in some way, related to the 'Western' lifestyle: the incidence of clinical prostate cancer is significantly lower in Asian populations, compared with Western populations 3 , and it

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Section: Prostatectomymentioning

confidence: 99%

A history of prostate cancer treatment

2002

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“…Female cystectomy (quality of life cystectomy) -surgical modification Walsh et al 44 popularized the role of nerve-sparing surgery in men with prostate cancer, which later 41 first reported in 1995 that removal of distal urethra has been associated with significant devascularization of clitoris and reduced sexual arousal. They also reported that preservation of urethra was not associated with increased risk of local recurrence.…”

Section: Sexual Dysfunction In Femalesmentioning

confidence: 99%

Sexual dysfunction after pelvic surgery

et al. 2005

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Pelvic surgeries are among the most common causes of organic sexual dysfunction in men and women. The impact of nerve-sparing surgery on potency has been well documented in radical prostatectomy. However, its impact on potency needs to be evaluated in other pelvic surgeries. Sexual dysfunction is highly prevalent even after multiple technical advances in the field of oncological surgeries. The prevalence varies from 8 to 82%, depending on the type of pelvic surgery. In females, sexual dysfunction has not been evaluated adequately using validated questionnaires. However, in subspecialized circles, treatment for female sexual dysfunction is becoming routine. Currently, physicians have several options for the treatment of erectile dysfunction (ED) in men. Since the introduction of oral PDE-5 inhibitors, oral therapy has become the first-line treatment option for ED, irrespective of etiology. Currently available treatment options for the female sexual dysfunction include estrogens, androgens, phosphodiesterase inhibitors, and dopamine receptor antagonists. Initial reports regarding the role of early rehabilitation are encouraging and may become the part of routine practice in the management of ED after pelvic surgery. In this article, we summarize the sexual dysfunction following pelvic surgeries and their management. International Journal of Impotence Research (2006) IntroductionErectile dysfunction (ED) is defined as the inability to achieve and maintain an erection sufficient for satisfactory sexual intercourse. 1 Several factors have been implicated in the etiology of ED. Vascular and neurogenic causes are the most common among them. Diabetes, smoking and hypertension are the most important risk factors for vasculogenic sexual dysfunction. Neurological dysfunction is mainly associated with certain neurological syndromes like autonomic neuropathy. Sexual dysfunction after pelvic surgery has been an important and underreported cause of ED. The pathophysiology of sexual dysfunction after pelvic surgery is unique because it can be either vascular or neurogenic factors alone, or a combination of both. The pelvic surgeries in males that are associated with considerable ED include radical prostatectomy (RP), radical cystoprostatectomy (cystectomy) and low anterior or abdominoperineal resections (APRs) for rectal cancer. The pelvic surgeries in females associated with sexual dysfunction include radical cystectomy (RC) for bladder cancer, radical hysterectomy for cancers of the cervix and endometrium and, potentially, simple hysterectomy for benign tumors.In this article, we summarize male and female sexual dysfunction following pelvic surgeries for prostate, bladder and rectal cancer. We also discuss our experience in the treatment of sexual dysfunction following RP and RC. than 10%, urologists still report that the majority of patients experience ED following RRP. [3][4][5] Until recently, ED following RP was not an overwhelming concern, as most prostate cancers were detected in older men. 6 However, since the adven...

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“…The RRP was performed as described by Walsh et al [20]. A subsphincteric RPP was carried out using the technique originally described by Belt [21] with modi®cations described by Paulson [4].…”

Section: Operative Proceduresmentioning

confidence: 99%

A comparison of the relative merits of radical perineal and radical retropubic prostatectomy

Sullivan

Weir²,

Kinahan

et al. 2000

BJU International

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Objective To compare the outcome, advantages and disadvantages of retropubic and perineal approach to radical prostatectomy, as performed by one surgeon. Patients and methods This unrandomized study included 138 patients who underwent either radical retropubic (RRP) or radical perineal prostatectomy (RPP), based on the speci®c conditions or the patient's choice; 79 patients (mean age 64.6 years) underwent RPP and 59 (mean age 61.7 years) RRP. Outcome measures included estimated blood loss, the incidence of blood transfusions, positive margins and complications, operative duration, analgesic use, days in hospital and quality of life. Results There was no difference in operative duration, and the incidence of positive margins or complications between the groups. The mean estimated blood loss in the RPP and RRP groups was 415 and 1138 mL, respectively. The RPP group stayed a mean of 2.2 days less in hospital and took 2.8 days less to regain a full diet than the RRP group; the RPP group needed 1.7 days before using oral analgesics and the RRP group 3.8 days. Of patients in both groups, 85% were pad-free at one year and their overall quality of life was similar. Conclusions The results of RRP and RPP are comparable; the advantages of the perineal approach include minimal blood loss, low-intensity postoperative nursing care, low analgesic use and earlier discharge from hospital.

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Radical prostatectomy with preservation of sexual function: Anatomical and pathological considerations

Cited by 966 publications

References 15 publications

A history of prostate cancer treatment

A history of prostate cancer treatment

Sexual dysfunction after pelvic surgery

A comparison of the relative merits of radical perineal and radical retropubic prostatectomy

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