***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: PURPOSE Anatomical nerve sparing radical prostatectomy provides excellent cancer control , although the recovery of sexual function is variable . We recently described a technique to preserve the prostatic fascia ( veil of Aphrodite ) that appears to enhance the quality of nerve preservation during robotic prostatectomy . In January 2003 we initiated a prospect i ve study comparing patients undergoing prostatic fascia preservation with those undergoing conventional nerve sparing robotic radical prostatectomy .  We report results at 12 months of followup MATERIAL S AND METHODS From January to August 2003 , 58 potent men with a Sexual Health Inventory for Men score ( SHIM ) of greater than 21 without phosphodiesterase 5 inhibitors underwent Vattikuti Institute prostatectomy , including 35 with preservation of the prostatic fascia ( study ) and 23 with conventional nerve sparing ( control ) .  Potency was assessed with self-administered SHIM question naires 12 months after surgery . The primary end point was achievement of erections strong enough for penetration with or without oral medications . The secondary end point was the ability to achieve normal erections ( SHIM greater than 21 ) with and without medications . RESULTS At 12 months of followup 17 of 23 control ( 74 % ) and 34 of 35 study ( 97 % ) patients achieved erections strong enough for intercourse ( p = 0.002 ) . Four control ( 17 % ) and 18 study ( 51 % ) patients achieved normal erections ( SHIM greater than 21 ) without medication ( p < 0.0001 ) . Six control ( 26 % ) and 30 study ( 86 % ) patients achieved normal erections with or without phosphodiesterase 5 inhibitors ( p < 0.0001 ) . CONCLUSIONS Potency rates after radical prostatectomy vary with the measure used to define potency . Irrespective of the definition used patients undergoing prostatic fascia preserving radical prostatectomy have significantly better potency outcomes than patients undergoing conventional nerve sparing robotic prostatectomy at 12 months of followup Four weeks after bilateral nerve-sparing radical retropubic prostatectomy , men with normal erectile function before surgery were r and omized to double-blind sildenafil ( 50 or 100 mg ) or placebo nightly for 36 weeks , followed by an 8-week drug-free period before assessment of erectile function . Enrollment was prematurely ceased and only 76 men completed because , assuming a placebo response rate similar to the published literature ( for example , 34 % in meta- analysis ) , the 25 % response at blinded interim review suggested a lack of treatment effect . On the contrary , spontaneous erectile function ( a combined score of ⩾8 for questions 3 and 4 of the International Index of Erectile Function and a positive response to ‘ Were erections good enough for satisfactory sexual activity ? ’ ) occurred in only 4 % of the placebo group ( n=1 of 25 ) versus 27 % ( n=14 of 51 , P=0.0156 , Fisher 's exact test ) of the sildenafil group . Nightly sildenafil administration for 36 weeks after surgery markedly increased the return of normal spontaneous erections PURPOSE Recent anatomical studies have shown that branches of the cavernous nerves running adjacent to the prostate at the apex travel more anteriorly than previously recognized . Outcomes of robot assisted radical prostatectomy suggest improved postoperative sexual outcomes following high anterior release of the levator fascia . We prospect ively evaluated the effect of high anterior release on oncological and sexual function outcomes following  open radical retropubic prostatectomy .  MATERIAL S AND METHODS A total of 167 patients with clinical ly localized prostate cancer with a preoperative Sexual Health Inventory for Men score of greater than 21 underwent radical retropubic prostatectomy with bilateral nerve sparing and selective high anterior release , as performed by a single surgeon . Data on postoperative sexual function were collected by an independent third party . Sexual function outcomes at 12 months were defined as 1 ) a Sexual Health Inventory for Men score of 16 or greater and /or a satisfaction score of 4 or greater and 2 ) a Sexual Health Inventory for Men score of 22 or greater . RESULTS Because unilateral high anterior release was equivalent to bilateral high anterior release for both definitions ( p > 0.3 ) , they were combined into 1 group for analyses . Patients undergoing high anterior release were more likely to achieve a Sexual Health Inventory for Men score of 16 or greater and /or a satisfaction score of 4 ( 93 % vs 77 % , p = 0.007 ) , and a Sexual Health Inventory for Men score of 22 or greater ( 70 % vs 54 % , p = 0.07 ) at 1 year . Return to baseline ( a Sexual Health Inventory for Men score of 22 or greater ) was even higher among patients receiving high anterior release who were more sexually active ( greater than 1 attempt per week ) preoperatively ( 78 % vs 52 % , p < 0.05 ) . The improved outcomes in potency achieved with high anterior release did not increase the likelihood of a positive surgical margin . CONCLUSIONS Unilateral or bilateral high anterior release of the levator fascia in open radical retropubic prostatectomy provides excellent oncological results and is associated with improved postoperative sexual function PURPOSE To identify surgeon specific factors for preserving sexual function ( and minimize patient related factors ) we report 2-year potency outcomes in men 65 years or younger with normal preoperative sexual function undergoing nerve sparing robot assisted laparoscopic radical prostatectomy .  MATERIAL S AND METHODS Between July 2004 and February 2006 , 200 consecutive patients underwent robot assisted laparoscopic radical prostatectomy by 1 surgeon . Inclusion criteria were age 65 years or younger with normal baseline 5-item International Index of Erectile Function score of 22 to 25 and complete 2-year followup . Postoperatively potency was defined by a yes to " erections adequate for vaginal penetration " and " satisfactory erections " on prospect i ve self-administered vali date d question naires with or without phosphodiesterase type 5 medications . Men also reported 5-item International Index of Erectile Function scores and erectile fullness of 0 % to 10 % , 25 % , 50 % , 75 % or 100 % compared to before surgery . RESULTS A total of 62 patients met the inclusion criteria , and of these 3 were lost to followup and 1 was excluded from study due to receiving hormonal therapy . At 3 months 32.1 % reported potency . At 24 months potency was 89.7 % ( 52 of 58 ) overall , 93.0 % ( 40 of 43 ) for bilateral and 80.0 % ( 12 of 15 ) for unilateral nerve sparing . For potent men the mean 5-item International Index of Erectile Function score was 20.4 at 3 months vs 21.3 at 24 months . Mean erectile firmness at 24 months was 91 % compared to preoperative baseline , with 34 of 52 ( 65 % ) reporting 100 % of preoperative fullness . The 5-item International Index of Erectile Function score and fullness at 24 months were equivalent for unilateral nerve sparing and bilateral nerve sparing . CONCLUSIONS Overall 90 % of men reported return of potency at 24 months , and 46 % returned to baseline with normal 5-item International Index of Erectile Function scores and 100 % firmness . Remarkably there was no difference in 5-item International Index of Erectile Function scores or fullness between unilateral nerve sparing and bilateral nerve sparing PURPOSE This study was aim ed at assessing prospect ively the effect of postoperative intracavernous injections of alprostadil on the recovery of spontaneous erectile function after nerve-sparing radical retropubic prostatectomy . MATERIAL S AND METHODS A total of 30 potent patients with clinical ly localized prostate cancer ( clinical stage B1 or B2 , Gleason sum 7 or greater , prostatic specific antigen less than 20 ng./ml . ) underwent nerve-sparing radical retropubic prostatectomy  and was subsequently r and omized to alprostadil injections 3 times per week for 12 weeks ( group 1 , 15 patients ) or  observation without any erectogenic treatment ( group 2 , 15 patients ) . Patients were assessed at the 6-month followup by sexual history , physical examination , color Doppler sonography of the cavernous arteries and polisomnographic recording of nocturnal erections . RESULTS In group 1 , 12 patients ( 80 % ) completed the entire treatment schedule and were evaluated at the long-term followup . Eight patients in this group ( 67 % ) reported the recovery of spontaneous erection sufficient for satisfactory sexual intercourse , compared with 3 patients ( 20 % ) in group 2 . The difference between the 2 groups was statistically significant ( p < 0.01 ) . In group 1 , all but 1 patient reporting normal postoperative erections also showed normal erections at nocturnal testing , whereas color Doppler sonography demonstrated normal penile hemodynamics in all of them . In these patients , failures were the result of cavernous veno-occlusive dysfunction ( 2 cases , 17 % ) and cavernous nerve injury ( 2 cases , 17 % ) . In group 2 , patients with normal erections showed both normal nocturnal testing and penile hemodynamics , whereas failures were the result of cavernous veno-occlusive dysfunction ( 8 cases , 53 % ) , cavernous arterial insufficiency ( 2 cases , 13 % ) or cavernous nerve injury ( 3 cases , 20 % ) . Complications in patients treated with alprostadil injections accounted for 2 cases ( 13 % ) of a penile nodule and 1 further case ( 6 % ) of prolonged penile erection . Complications were not seen in group 2 patients . CONCLUSIONS Early postoperative administration of alprostadil injections significantly increases the recovery rate of spontaneous erections after nerve-sparing radical retropubic prostatectomy . It is our belief that programmed vasoactive injections improve cavernous oxygenation , thereby limiting the development of hypoxia-induced tissue damage . The potential complications related to the use of intracavernous injections must be clearly explained to patients We evaluated the effect of a chronic treatment with Tadalafil on progenitor cells ( PCs ) number and endothelial function in patients with erectile dysfunction ( ED ) with or without cardiovascular risk factors . Twenty-six subjects with ED and 23 aged matched controls were studied . All subjects underwent blood tests , International Index of Erectile Function ( IIEF-5 ) , Nocturnal Penile Tumescence Rigidity Monitoring test ( NPTRM ) , brachial artery flow-mediated dilation ( FMD ) and PCs count . International index of erectile function , FMD and PC count were re-evaluated in all subjects at the end of Tadalafil and placebo treatment . With respect to controls patients had lower basal FMD ( P<0.05 ) and basal PCs ( P<0.05 ) . Treatment with Tadalafil determined a significant increase in PCs ( P<0.001 ) and FMD ( P<0.001 ) with respect to basal level . Positive correlation was found between basal FMD and PCs ( P<0.05 ) and between basal FMD and PCs increase after Tadalafil treatment ( P<0.05 ) . Tadalafil promotes a mobilization of PCs and improves endothelial function in ED patients To prospect ively evaluate whether a modified surgical technique for neurovascular bundle ( NVB ) preservation during radical prostatectomy ( RP ) is associated with an improvement in erectile function ( EF ) recovery after RP PURPOSE It has been suggested that postradical prostatectomy ( RP ) erectile function outcomes are improved by early use of erectogenic medications . This analysis was design ed to assess the ability of a post-RP vasoactive drug program to improve long-term spontaneous erectile function . METHODS Men with functional preoperative erections who underwent RP were challenged early postoperatively with oral sildenafil . Nonresponders were switched to intracavernosal injection therapy ( ICI ) . Patients were instructed to inject three times a week . Only patients who presented within 6 months post RP , who completed the International Index of Erectile Function ( IIEF ) question naire on at least three separate occasions after surgery , and who had been followed for at least 18 months were included . Data from men who were committed to rehabilitation were compared with those of men who did not follow the protocol but continued to be followed serially following RP . RESULTS There were 58 patients in the rehabilitation ( R ) group and 74 in the nonrehabilitation ( NR ) group . No differences existed in mean patient age , comorbidity profile , intraoperative nerve sparing status , or postoperative erectile hemodynamics between the two groups . At 18 months post RP , there were statistically significant differences between the two groups in the percentage of patients who were capable of having medication-unassisted intercourse ( R=52 % vs. NR=19 % , P<0.001 ) ; mean erectile rigidity ( R=53+/-21 % vs. NR=26+/-43 % , P<0.01 ) ; mean IIEF erectile function ( EF ) domain scores ( R=22+/-6 vs. NR 
    Output:
    
Accurate patient selection ( based on patient age , preoperative erectile function , and comorbidity profile ) and adequate surgical technique ( ie , the preservation of neurovascular bundles ) were the major determinants of postoperative erectile function .
Moreover , better results were achieved when an appropriate pharmacologic treatment using either oral or local approaches was given .
Therefore , the authors concluded that , if patients are stratified correctly according to preoperative , intraoperative , and postoperative factors , then a satisfactory functional recovery may be expected after surgery .
For these reasons , an ideal multivariate model predicting the restoration of erectile function after surgery should include patient , surgeon , and postsurgical treatment variables .