[Surgical solutions to iatrogenic impotence following total cysto-prostatectomy]

Sixty-nine patients who underwent major pelvic surgery for bladder cancer were evaluated for sexual consequences. Impotence was observed in 85% of the patients after 48 radical cysto-prostatectomies. Among them, one third developed a parallel sexuality without erection but with orgasm: they are candidates for penile implants. In a small number (15%) of the patients, erections were preserved: this was observed in 5 out of 12 patients (41%) who were operated with the new technique sparing the cavernous nerves. An optimistic note emerges from surgical solutions, whether prophylactic or palliative, but one must insist on the necessity of a psychological support before and after the operation.