Patient Age, Co-morbidities and Psychosexual Concerns
There are two cohorts that need to be taken into account-the younger and older patients when thinking about erectile function after robotic surgery. O’Brien et al.,  touches on this (Level 2b, recommendation C). The younger patients are actually more vocal. The older patients, as highlighted by O’Brien et al., , may actually be more embarrassed and not ask for help, or forgo erectile function entirely . This is re-enforced by other research. Kimura et al.,  (n = 319) found patients with psychosexual impairment, despite having operations were more likely to be older and not seek help (Level 2b, recommendation B) . This is again re-enforced by Becker et al., , who then goes onto show the degree of impairment of erectile function drops, in younger and older cohorts . The study is important, as the drop is double in older patients, yet they may not be as vocal, which clearly needs to be addressed as part of a psychosexual pathway (Level 2b, recommendation A). These results were re-enforced by Tewari et al.,  Level 2c, recommendation A)  (n = 224).
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