HOW I DO IT

• Management of post-prostatectomy erectile dysfunction

  Jamal E. Joseph , Engel D. Jason, MD Department of Urology, George Washington University Hospital, Washington, DC, USA

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  The management of post-prostatectomy erectile function has been debated since the nerve sparing radical prostatectomy was first introduced. A number of penile rehabilitation protocols have been proposed with varying degrees of success and patient satisfaction. My management of post-prostatectomy erectile dysfunction has evolved based on an honest and critical appraisal of the literature and my own experience and research. A review of major studies published on the topic of post-prostatectomy penile rehabilitation is included here, in addition to a critical evaluation of my own clinical practice. After evaluating the efficacy of these various approaches, it is clear to me that a nerve sparing procedure is only one of many factors involved in recovering erectile function. Moreover, in addition to assessing a patients goals and their motivation for erectile function after prostatectomy, setting appropriate patient expectations is paramount to avoiding patient frustration. A frank evaluation and discussion with a patient and their partner is paramount to managing these expectations. A 'one size fits all' approach is not appropriate. Herein, I discuss the evolution of my approach to managing post-prostatectomy erectile dysfunction.

  Keywords: radical prostatectomy, salvage radiation, vacuum erection device, erectile dysfunction, phosphodiesterase type-5 inhibitor, rehabilitation,

  Jun 2011 (Vol. 18, Issue 3 , Page 5726)
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