HOW I DO IT

• Transrectal implantation of electromagnetic transponders following radical prostatectomy for delivery of IMRT

  Canter Daniel , Kutikov Alexander , Horwitz M. Eric , Greenberg E. Richard, MD Department of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA

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  Surgical treatment for men with localized prostate cancer open, laparoscopic, or robotically-assisted-- remains one of the therapeutic mainstays for this group of patients. Despite the stage migration witnessed in patients with prostate cancer since the introduction of prostate-specific antigen (PSA) screening, detection of extraprostatic disease at the time of surgery and biochemical recurrence following prostatectomy pose significant therapeutic challenges. Radiation therapy (RT) after radical prostatectomy (RP) has been associated with a survival benefit in both the adjuvant and salvage setting. Nevertheless, optimal targeting of the prostate bed following surgery remains challenging. The Calypso 4D Localization System (Calypso Medical Technologies, Seattle, WA, USA) is a target positioning device that continuously monitors the location of three implantable electromagnetic transponders. These transponders can be placed into the empty prostatic bed after prostatectomy to facilitate the delivery of radiation therapy in the post-surgical setting. In this article, we detail our technique for transrectal placement of electromagnetic transponders into the post-prostatectomy bed for the delivery of adjuvant or salvage intensity-modulated radiation therapy. We prefer this technique of post-surgical radiation therapy because it allows for improved localization of the target area allowing for the maximal delivery of the radiation dose while minimizing exposure of surrounding normal tissues. Although emerging, our initial oncologic and functional outcomes have been promising.

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

  Aug 2011 (Vol. 18, Issue 4 , Page 5844)
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• 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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