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How do we investigate haematuria and what role has finasteride?

Nerve-sparing radical prostatectomy (NSRP) is a common procedure which has been associated with very satisfactory rates of subsequent urinary continence, while the preservation of erectile function after surgery is clearly a major challenge for most urologists [1]. Several factors are considered to be of major importance in preserving erectile function after NSRP. Patients being considered for NSRP should be potent beforehand; this is very important as patients who report some degree of erectile dysfunction (ED) or who use phosphodiesterase type 5 inhibitors (PDE5-I) before the procedure are more likely to develop severe ED afterward [2]. The use of validated questionnaires such as the International Index of Erectile Function (IIEF) may facilitate the diagnosis of ED during the initial assessment of the patient. The age of the patient at the time of surgery is also important, as the best potency rates are obtained in younger patients and it seems reasonable to consider patients aged £ 65 years as candidates for a nerve-sparing procedure. Comorbid conditions also seem to affect the recovery of spontaneous erections after surgery, as they may affect the baseline penile haemodynamics, i.e. a concomitant diagnosis of diabetes mellitus, hypertension, ischaemic heart disease, hypercholesterolaemia or a history of cigarette smoking identified when the patient is assessed before surgery should be considered as potentially negative predictive factors for the recovery of potency after surgery [3].