Does penile rehabilitation have a role in the treatment of erectile dysfunction following radical prostatectomy?

Abstract

In men undergoing radical treatment for prostate cancer, erectile function is one of the most important health-related quality-of-life outcomes influencing patient choice in treatment. Penile rehabilitation has emerged as a therapeutic measure to prevent erectile dysfunction and expedite return of erectile function after radical prostatectomy. Penile rehabilitation involves a program designed to increase the likelihood of return to baseline-level erectile function, as opposed to treatment, which implies the therapeutic treatment of symptoms, a key component of post–radical prostatectomy management. Several pathological theories form the basis for rehabilitation, and a plethora of treatments are currently in widespread use. However, whilst there is some evidence supporting the concept of penile rehabilitation from animal studies, randomised controlled trials are contradictory in outcomes. Similarly, urological guidelines are conflicted in terms of recommendations. Furthermore, it is clear that in spite of the lack of evidence for the role of penile rehabilitation, many urologists continue to employ some form of rehabilitation in their patients after radical prostatectomy. This is a significant burden to health resources in public-funded health economies, and no effective cost-benefit analysis has been undertaken to support this practice. Thus, further research is warranted to provide both scientific and clinical evidence for this contemporary practice and the development of preventative strategies in treating erectile dysfunction after radical prostatectomy.

Pre-emptive Use of Riboflavin in a Rat Model of Bilateral Cavernous Nerve Injury

“…Nevertheless, all penile rehabilitation strategies with PDE5i suggest the use of these agents after RP, following daily or on-demand protocols (34). No reported data was found except our previous study on the pre-injury treatment and pre-emptive penile rehabilitation, which is the first reported study on the data of pre-emptive penile rehabilitation before bilateral CNI in rats (35).…”

Benefits of erectile function recovery programs after radical prostatectomy (Review)

“…Smooth muscle relaxation enhances the arterial blood flow and leads to engorgement of cavernous sinusoids. Once the cavernous sinusoids start to increase their volume, the pressure within the penis is raised and the venous plexus is compressed under the albuginea tunica, thus reducing the blood outflow and leading to penile tumescence (10,15). Other important mediators that have an active role in the mechanism of penile erection are prostaglandin E1 (PGE1) and cyclic adenosine 3',5'-monophosphate (cAMP) (16).…”

“…This phenomenon is unavoidable and it is the result of intraoperative pelvic and periprostatic tissue trauma, especially at the level of the neurovascular bundles, which leads to local inflammatory reactions and ischemia. Local hypoxia is associated with decreased PGE1 and cAMP levels, which alters the smooth muscle relaxation process at the level of cavernous cells, as well as with increased levels of profibrotic and proapoptotic factors, such endothelin 1 and transforming growth factor-β (TGF-β) (15). Therefore, local hypoxia will lead to cavernosal structural changes, the smooth muscle fibers being gradually replaced by collagen and fibrotic tissue, which severely decreases the penile tumescence capability and also affects the vein-occlusive component of the erection, allowing blood outflow and affecting penile rigidity (17).…”

Evaluation of Combined Pharmacologic Treatment Involving Tadalafil and Alprostadil Intraurethral Gel for Penile Rehabilitation After Radical Prostatectomy

“…Despite that, ED is still subsequent in 70.4% of the cases that underwent RALP and 74.7% of the RRP patients [2]. Taking into account that the majority of patients who benefit from surgical treatment are young or middleaged, it is likely to conclude that ED may produce long-term functional and psychological impairment [3,5,6]. In this regard, most patients that undergo nervesparing radical prostatectomy must follow postoperative penile rehabilitation (PRh) which includes any mean (drug or device) that can improve or restore the normal erectile function.…”

“…The centrepiece of PRh is the medical treatment represented by oral medication (phosphodiesterase-5 inhibitors -PDE5i) and locally injected or applied agents (prostaglandin E1 -PGE1). Other means include vacuum devices, penile vibratory stimulation or in extremis penile implants reserved for the cases were other therapeutic measures were unsatisfactory [3,[5][6][7][8][9]. Even though several studies researched the impact of various oral treatments based on PDE5i alone or combined with other drugs or devices, until now there is no consensus regarding a specific therapeutic protocol [7].…”