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T A B L E O F C O N T E N T S
[Intervention Protocol]
Penile rehabilitation for post-prostatectomy erectile dysfunction
A B S T R A C TThis is a protocol for a Cochrane Review (Intervention). The objectives are as follows:To assess the effects of penile rehabilitation interventions for post-prostatectomy erectile dysfunction.
B A C K G R O U N DProstate cancer is the most common non-skin cancer in men in the UK, accounting for about 23% of all new diagnoses and 13% of deaths (or about 35,000 new diagnoses and 10,000 deaths each year) in England and Wales (Bolland 2008). In the US, it accounts for 186,320 new diagnoses and 28,660 deaths each year and is the second leading cause of mortality in men (Jamal 2008; Goluboff 2013). Early stage prostate cancer is essentially a symptomless disease, particularly if the disease is confined to the prostate. For organ-confined prostate cancer, treatment options with curative intent include radical retropubic prostatectomy (RRP), robotic-assisted radical prostatectomy (RARP), brachytherapy, and external beam radiation therapy with or without concomitant hormone treatment. Active surveillance of prostate cancer also falls into the category of treatments with curative intent. This treatment approach consists of an active decision not to treat the prostate cancer at the time of diagnosis but rather to monitor the patient closely to enable the proper timing of curative treatment, taking into account the patient's life expectancy. It is advocated by European and American urological guidelines in patients with low risk organ-confined prostate cancer (Heidenreich 2014). Radical prostatectomy (RP) has the potential to completely remove the tumour and remains a preferred and effective treatment modality utilised as a first option in approximately 33% of prostate cancer cases and in 52% of cases in men aged 62 years of age (Lalong-Muh 2012; American Cancer Society 2014). In 2010 in the US alone, 11,290 prostatectomies were performed, two-thirds of which were robotic-assisted. These figures compared to the data from 2004, when 6188 prostatectomies were performed, of which only eight per cent were robotic-assisted, suggests that RP rates have risen exponentially since the introduction of RARP (Lowrance 2012).The common side-effects of RRP include erectile dysfunction (ED) and urinary incontinence (Bolland 2008). Despite attempts to preserve the neurovascular bundles with nerve-sparing surgery, ED remains common. Even with nerve-sparing surgery, there is a period of neuropraxia during which the man has no spontaneous erections, which can lead to penile hypoxia and long-lasting damage to the erectile tissue (Burnett 2005;Raina 2010). It is difficult to predict the length of time that neuropraxia will last, with some researchers suggesting it is between 9 and 24 months (Zippe 2001). A goal of ED management is therefore to restore blood flo...
