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Radical prostatectomy and simultaneous penile prosthesis implantation: a narrative review.
International Journal of Impotence Research ( IF 2.8 ) Pub Date : 2019-08-08 , DOI: 10.1038/s41443-019-0176-1
Andrea Cocci 1 , Gianmartin Cito 1 , Andrea Romano 1 , Gaetano Larganà 2 , Graziano Vignolini 1 , Andrea Minervini 1 , Fabrizio Di Maida 1 , Riccardo Campi 1 , Marco Carini 1 , Nicola Mondaini 3 , Giorgio Ivan Russo 2
Affiliation  

Radical prostatectomy (RP) represents one of the most commonly used first-line treatment modalities in men with localized prostate cancer (PCa). Despite efforts to preserve the neurovascular bundles with nerve sparing (NS) surgery, erectile dysfunction (ED) remains common after RP and this may significantly affect patients' quality of life (QoL). The aim of this paper is to evaluate the outcome of simultaneous placement of penile prosthesis and RP. The ideal candidates for simultaneous penile prosthesis implantation are those who report pre-existent refractory ED and patients in whom there is a high risk of extracapsular disease, such as any cT2c or cT3, and undergo non-nerve sparing RP. If the patient chooses to undergo PPI to treat his refractory ED it is clear that this procedure will be associated with higher patients' satisfaction rates, if carried out simultaneously with RP rather than at a later stage. A simultaneous procedure would avoid two admissions, reduce hospitalization time and guarantee a faster recovery of sexual function, preventing the otherwise unavoidable loss of penile length. Since the urologist does not need to preserve the neurovascular bundles, as the penile implant will take care of postoperative rigidity, RP can be performed more radically from an oncological point of view, thus reducing the risk of recurrence and metastasis, especially in patients with high risk of locally advanced disease. In conclusion, simultaneous PPI with RP provides early sexual rehabilitation, improving patients' quality of life, without compromising surgical outcomes. However, larger series will be necessary, to better identify the patients who are more likely to benefit from nerve sparing surgery and postoperative penile rehabilitation from those who would are more likely to develop refractory ED post RP and would therefore benefit from simultaneous implantation of a penile prosthesis.

中文翻译:

根治性前列腺切除术和阴茎假体同时植入:叙述性回顾。

根治性前列腺切除术(RP)代表局限性前列腺癌(PCa)男性最常用的一线治疗方式之一。尽管努力通过神经保留(NS)手术来保护神经血管束,但RP后勃起功能障碍(ED)仍然很常见,这可能会严重影响患者的生活质量(QoL)。本文的目的是评估同时放置阴茎假体和RP的结果。那些同时存在阴茎假体ED的患者以及那些存在囊外疾病高风险(例如任何cT2c或cT3)并接受非神经保留RP的患者,是同时进行阴茎假体植入的理想候选人。如果患者选择接受PPI来治疗他的难治性ED,则很明显,该过程将与较高的患者的病情相关。满意度,如果与RP同时进行,而不是在后期进行。同时进行手术将避免两次入院,减少住院时间,并保证性功能更快恢复,防止否则不可避免的阴茎长度损失。由于泌尿科医师不需要保留神经血管束,因为阴茎植入物会照顾术后的刚度,所以从肿瘤学角度出发,可以更彻底地进行RP,从而降低了复发和转移的风险,尤其是对于高发的患者局部晚期疾病的风险。总之,PPI与RP同时进行可提供早期的性康复,在不影响手术效果的情况下改善患者的生活质量。但是,将需要更大的系列,
更新日期:2019-08-08
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