with Dr. Ignacio Moncada Iribarren
One of the most common side effects of radical prostatectomy is erectile dysfunction (ED). Although robot-assisted radical prostatectomy has demonstrated a lower incidence of post-surgical ED, with improved precision, it nonetheless remains an important consideration for a patient undergoing this procedure, especially in men over the age of 60 and those who have experienced ED preoperatively. In this regard, patient age and the quality of the nerve-sparing technique are key factors in preserving post-RP erectile function.
We present the case of a 64-year-old patient with high blood pressure, who takes Losartan and Amlodipine. He was a smoker for 50 years (15 cig/day). No previous Erectile Dysfunction although he was taking Tadalafil 10 mg occasionally. After a PSA of 6.8 ng/ml he was diagnosed with a Prostate Cancer Gleason 7 (3 +4) bilateral. Robotic Radical Prostatectomy was performed Dec/2016 (pT2c) with no complications. His PSA after surgery remained undetectable < 0.01 ng/ml and he had a very early recovery of continence, with no need for pads from the beginning. Penile rehabilitation started 7 days after surgery, with Tadalafil 5 mg daily for 6 months, with some response but not enough for penetration. Then the combined use of topical Alprostadil on demand improved his erections but he is still not able to penetrate. EHS grade 2-3. IIEF-EF 16. After 18 months of surgery, it is decided to implant a 3-piece hydraulic penile prosthesis: AMS 700 –CX MS.
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