Current Strategies to Improve Erectile Function in Patients Undergoing Radical Prostatectomy - Preoperative Scenario - Beyond the Abstract

Erectile dysfunction (ED) after radical prostatectomy (RP) has a complex pathophysiology and requires a transdisciplinary approach from the time of prostate cancer diagnosis. The understanding of patients’ cultural and psychosocial background, as well as their baseline health status and lifestyle before surgery, are fundamental to accomplish successful and personalized multilevel interventions. We have divided preoperative strategies into 2 main categories: planning and prehabilitation:



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Models that combine clinical variables and imaging, mainly multiparametric MRI, allow a better prediction of non-organic confined disease, which impacts the decision about the aggressiveness of periprostatic tissue resection and consequently, functional and oncological outcomes. On the other hand, preoperative assessment of sexual function, ideals, beliefs, and masculinity views of the patients and their partners is valuable for the surgical team to design tailored strategies in each case.

Prehabilitation seeks to improve the health and well-being of patients at the time of PCa diagnosis to enhance intraoperative and postoperative results.  Exercise programs, balanced diet, healthy lifestyle and optimization of sleep patterns are contemplated in this concept. Furthermore, the addition of oral medications to promote erectile tissue oxygenation before surgery has demonstrated positive outcomes.

In general, the establishment of protocols addressing preoperative strategies in radical prostatectomy is an interesting field that has a high impact on erectile function recovery and requires further exploration.

Written by: Adriana M Pedraza, Krunal Pandav, Mani Menon, Mohit Khera, Vinayak Wagaskar, Zachary Dovey, Nihal Mohamed, Sneha Parekh, Ashutosh K Tewari

Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY., Scott Department of Urology, Baylor College of Medicine, Houston, TX., Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY.

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