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Sexual Function in the Prostate Cancer Patient

:	John P Mulhall
:	John P Mulhall
:	Sexual Function in the Prostate Cancer Patient
:	Humana Press
:	9781603275552
:	1
:	CHF 95.00
:

:	Klinische Fächer
:	English

:	268
:	Wasserzeichen/DRM
:	PC/MAC/eReader/Tablet
:	PDF

Sexual dysfunction presents a major challenge to physicians who take on the task of treating men with prostate cancer. While curing the disease and saving a life is paramount, improving technologies and therapies offer skilled surgeons and clinical oncologists the opportunity to eradicate the disease without compromising sexual function. InSexual Function of the Prostate Cancer Patient, John Mulhall and a panel of internationally recognized experts on prostate cancer and sexual function assess in detail the current state of prostate cancer treatment. The authors offer a broad overview of the pathophysiology and treatment of erectile dysfunction in men with prostate cancer, reviewing the latest findings regarding erection-sparing radiation therapy and sexual function outcomes after laparascopic and robotic prostatectomy. Additional chapters discuss intra-operative maneuvers to minimize post-operative erectile dysfunction and pharmacologic penile preservation and rehabilitation. Timely and authoritative,Sexual Function in the Prostate Cancer Patient is a highly readable guide to preserving post-prostate cancer sexual function that no urologist or radiation and medical oncologist should be without.

	Foreword	5
	Preface	7
	Contents	10
	Contributors	12
	Color Plates	17
	Chapter 1 Sexual Dysfunction After Radical Prostatectomy	18
	1.1 Introduction	19
	1.2 Erectile Dysfunction	19
	2.1 Defining Erectile Function Outcomes After Radical Prostatectomy	20
	2.2 Erectile Function Outcomes	22
	1.3 Anejaculation	24
	1.4 Orgasm Alterations	25
	1.5 Peyronies Disease	27
	1.6 Penile Length Alterations	28
	1.7 Summary	30
	Chapter 2 The Impact of Prostate Cancer Diagnosis and Post-treatment Sexual Dysfunction on Quality of Life	34
	2.1 Assessing Quality of Life in Prostate Cancer Survivors	34
	2.2 The Effect of Prostate Cancer Diagnosis on Generic Quality of Life	36
	2.3 The Psychological Effect of a New Prostate Cancer Diagnosis	38
	2.4 The Effect of Post-treatment Sexual Dysfunction on Quality of Life	40
	2.5 The Psychological Effect of Post-treatment Sexual Dysfunction	44
	2.6 Conclusions	45
	Chapter 3 Pathophysiology of Erectile Dysfunction Following Radical Prostatectomy	50
	3.1 Epidemiology of Prostate Cancer and Erectile Dysfunction	51
	3.2 Penile Anatomy and Physiology	52
	2.1 Morphology of the Penis	52
	2.2 Vascular Anatomy of the Penis	52
	2.3 Neural Innervation of the Penis	54
	3.3 Molecular Signaling of Erections	54
	3.1 NO/NOS	55
	3.1.1 Normal Signaling	55
	3.1.2 NO/NOS after RRP	56
	3.2 Smooth Muscle/Myosin--Actin/Calcium/Rho-Kinase	57
	3.3 SHH and the Penis	59
	3.4 Supporting Cast/Integration	61
	3.4 Long-Term ED	62
	4.1 Hypoxia	62
	4.2 Ultra-structural End Organ Changes and Long-Term ED	63
	3.5 Conclusions	64
	Chapter 4 Pathophysiology of Erectile Dysfunction Following Radiation Therapy	71
	4.1 Introduction	71
	4.2 Normal Physiology	72
	4.3 Mechanisms of Injury After Prostate Irradiation	74
	3.1 Vasculogenic Mechanisms	74
	3.2 Neurogenic Mechanisms	77
	3.3 Structural Injury	78
	4.4 Conclusion	80
	Chapter 5 Evolution of Radical Prostatectomy as It Pertains to Nerve-Sparing	84
	5.1 Introduction	84
	5.2 Anatomical Considerations	85
	5.3 Technique	87
	3.1 Initial Steps and Control of Bleeding	87
	3.2 Preservation of the Neurovascular Bundle (NVB)	88
	5.4 Erectile Function After Nerve-Sparing Radical Prostatectomy	92
	5.5 Strategies to Improve Sexual Function after Radical Prostatectomy	94
	5.1 Early Use of Intracavernosal Agents	94
	5.2 Early Use of Phosphodiesterase-5 Inhibitors	95
	5.3 Perioperative Immunophilin Ligand Therapy	95
	Chapter 6 Laparoscopic and Robotic-Assisted Radical Prostatectomy: Sexual Function Outcome	97
	6.1 Introduction	97
	6.2 Heterogeneity of Results	98
	6.3 Sexual Function Outcome	98
	Chapter 7 Potency-Sparing Radiation: Myth or Reality?	104
	7.1 Introduction	105
	7.2 Critical Endpoints	105
	7.3 Post-radiation Effects on Sexual Function Timing and Targets	108
	3.1 Biology, Timing, and Targets	108
	3.2 Radiation Reactions	109
	3.3 Clinical Syndromes	111
	7.4 Potential Target Definition	111
	4.1 Prostate Apex Definition	112
	4.2 Definition of Critical Erectile Structures (CES)	113
	4.3 Radiation Treatment Planning	116
	7.5 Potency-Sparing Radiotherapy Preliminary Results	116
	7.6 Summary	118
	Chapter 8 Neuromodulatory Drugs for the Radical Prostatectomy Patient	123
	8.1 Introduction	124
	8.2 Pathogenesis of Acute, Traumatic Penile Neuropathy	125
	2.1 Peripheral Nerve Degeneration and Regeneration	125
	2.2 Cavernous Nerve Injury	127
	8.3 Therapeutic Penile Neurogenesis	127
	3.1 Preclinical Investigation	128
	3.2 Clinical Trials	131
	8.4 New Frontiers in Molecular Neurobiology	132
	4.1 Signal Transduction Mechanisms	133
	8.5 Special Considerations	134
	8.6 Conclusion	135
	Chapter 9 Nerve Grafting at Radical Retropubic Prostatectomy: Rationale, Technique, and Results	141
	9.1 Introduction	141
	9.2 Fundamentals	142
	9.3 Indications	143
	9.4 Surgical Technique	144
	9.5 Results	146
	9.6 Conclusions	148
	Chapter 10 Erectile Function Preservation and Rehabilitation	151
	10.1 Introduction	152
	10.2 Pathophysiology of Erectile Dysfunction After Radical Prostatectomy	152
	2.1 Neural Trauma	153
	2.2 Arteriogenic ED	154
	2.3 The Concept of Cavernosal Oxygenation	158
	2.4 Corporo-venoocclusive Dysfunction	158
	2.5 Psychogenic Mechanisms	159
	10.3 Penile Rehabilitation of the Erectile Function After Radical Prostatectomy	159
	3.1 Data Supporting the Concept of PDE5 Inhibitor Rehabilitation	159
	3.2 Endothelial Protection	160
	3.3 PDE5 Inhibitor-Induced Neurogenesis	162
	10.4 Cavernosal Smooth Muscle Protection	162
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