The description of the anatomic radical retropubic prostatectomy and the introduction of nerve-sparing radical retropubic prostatectomy (NSRRP) in 1983 represented a major advance in the surgical treatment of prostate cancer. Nonetheless, the results with respect to postoperative potency preservation vary widely between surgeons and institutions. The post–radical retropubic prostatectomy population with erectile dysfunction is unique. Unlike in most patients who have erectile dysfunction in whom there is a gradual reduction in erectile function over many years, the loss of function in the post–radical retropubic prostatectomy patient is initially sudden and total. All patients experience a change in their sexual function ranging from a decrease in orgasmic intensity to loss of ejaculation to erectile dysfunction to a loss of urine at orgasm.<sup>20 Geary E.S., Dendinger T.E., Freiha F.S. , e al. Nerve sparing radical prostatectomy: A different view J Urol 1995 ;  154 : 154-149

Cliccare qui per andare alla sezione Riferimenti, 30 Koeman M., van Driel M.F., Schultz W.C. , e al. Orgasm after radical prostatectomy Br J Urol 1996 ;  77 : 861-864

Cliccare qui per andare alla sezione Riferimenti</sup> Less than 10% of previously potent patients consider their long-term postoperative sexual function as good as their preoperative status. Surgeons are left with the difficult task of explaining to patients why a procedure designed to spare their potency nerves does not translate into a potency-preserving surgery. Patients who preoperatively primarily were concerned with survival, cancer cure, and incontinence are left with the prospect of never again achieving an adequate erection.

Institutions with single surgeons and a large case load report potency rates in excess of 65%, whereas other institutions report success rates of less than 20%.<sup>20 Geary E.S., Dendinger T.E., Freiha F.S. , e al. Nerve sparing radical prostatectomy: A different view J Urol 1995 ;  154 : 154-149

Cliccare qui per andare alla sezione Riferimenti, 24 Heathcote P.S., Mactaggart P.N., Boston R.J. , e al. Health-related quality of life in Australian men remaining disease-free after radical prostatectomy Med J Aust 1998 ;  168 : 483-486

Cliccare qui per andare alla sezione Riferimenti, 46 Quinlan D.M., Epstein J.I., Carter B.S. , e al. Sexual function following radical prostatectomy: Influence of preservation of neurovascular bundles J Urol 1991 ;  145 : 998-1002

Cliccare qui per andare alla sezione Riferimenti, 56 Stanford J.L., Feng Z., Hamilton A.S. , e al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: The Prostate Cancer Outcomes Study JAMA 2000 ;  283 : 354-360  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> The reasons for this discrepancy are multiple. This article reviews current knowledge on the etiology, treatment, and possible prevention of erectile dysfunction and promising future directions.