26
May

ED: Surgeon Factors

Posted by admin

Surgeon procedure volume and expertise are often cited as important factors for successful surgical outcomes. ED outcomes in regards to individual surgical volumes have been mixed. In a study of 1,778 prostatectomy patients operated upon by 14 different surgeons, patient age, the surgeon performing the RRP, and neurovascular bundle status, but not surgical volume were found to be significant predictors of erectile function adequate for penetrative relations recovery.

Number of Nerves Spared

Advances in prostatectomy surgical technique, the use of loupe magnification, and the understanding of cavernosal nerve anatomy have improved sexual function outcomes. Number of nerves spared has been a consistent predictor of erectile function postprostatectomy. Surgical margins required for cancer control has obvious implications on the ability to spare nerves. One of the original reports in 1991 stated that age, clinical and pathological stage, and the preservation of neurovascular bundles were significant factors in return of preoperative potency in 503 patients undergoing prostatectomy.

A recent review article summarizing ED patients after nerve sparing RRP of ³50 patients, ³1 year f/u, prospective interview or patient questionnaire outcomes, and erectile function defined as the ability to achieve unassisted intercourse with vaginal penetration showed erectile function as 31–86% for bilateral nerve sparing procedures, 13–56% for unilateral nerve sparing, and 0–17% in nonnerve sparing prostatectomies. Further stratification by age showed erectile function as 61–100% postprocedure for age <50 (for both unilateral and bilateral nerve sparing), 47–58% and 44–90% for unilateral and bilateral nerve sparing, respectively, for ages 50–70 and 0–51% for any nerve sparing procedure age >70.

Conclusion

The current literature on ED prevalence after CAP treatment is inconsistent, often poorly interpretable, and yield unacceptably disparate results. The wide range of ED prevalence rates indicates suboptimal study design and data acquisition, as biological variability alone is not likely to account for such drastically wide ED prevalence rates after CAP treatment. Study methodologies pertaining to internal and external validity of the data account for some of the ED data variability viagra online in Australia. Only through optimal ED quantification study can consistent, standardized outcomes be obtained to properly counsel patients and advance the field of study.