Perplexity of penile rehabilitation following radical prostatectomy

Abstract

Radical prostatectomy has significantly improved prostate cancer survival rates but continues to have a negative impact on the patient's erectile function (EF). In attempts to improve erectile dysfunction (ED), clinicians have incorporated different treatment modalities to restore EF. Penile rehabilitation consists of understanding the mechanisms that affect post-prostatectomy EF and utilizing pharmacologic agents, devices, and interventions to promote the male sexual function. This article aims to summarize the available scientific research involving penile rehabilitation. Even though the current literature lacks to prove its irrefutable effectiveness, penile rehabilitation has a positive impact at the molecular and cellular levels, and it is widely adopted in clinic practices.

Restoration of erectile function by a combination of antiapoptosis by JNK inhibitor and preservation of smooth muscle or endothelium by hepatocyte growth factor in a rat model of cavernous nerve injury

“…The major findings of our study were as follows: (1) The combination of the intraperitoneal administration of a JNK inhibitor and the intracavernosal administration of medium-or high-dose HGF to nerve-injured rats in the immediate post-injury period after CNCI restored erectile function generally to a level comparable to that observed in sham controls. (2) The suppression of cavernosal apoptosis by the JNK inhibitor and the improvement in the amount of SM or endothelium in the corpus cavernosum by the intracavernosal administration of HGF to nerve-injured rats appeared to be mediated through rectification of cJun, cMet, and eNOS phosphorylation.…”

“…Erectile dysfunction (ED) remains a major complication of radical prostatectomy (RP) and has a severely detrimental effect on the quality of life in men who undergo the surgery. 1,2 Furthermore, post-RP ED remains a very difficult condition to treat because of the structural alterations in the corpus cavernosum after RP. 3,4 These structural alterations in the corpus cavernosum are induced mainly by cavernosal nerve (CN) injury and include cavernosal apoptosis and fibrosis.…”

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

“…The post-prostatectomy ED is inflicted by neuropraxia secondary to intraoperative manipulation of the pudendal nerve bundles. Combined with local ischemia inflicted by the vascular ligation of iliac branches, the result is a hypoxic insult of the cavernosal cells that leads to fibrosis of the erectile tissue [21,22]. Both tadalafil and alprostadil gel prescribed to our patients in the postoperative period has been long studied and demonstrated their efficacy for ED treatment, although the pathways of their action are different.…”

Restoration of Cavernous Veno-Occlusive Function through Chronic Administration of a Jun-Amino Terminal Kinase Inhibitor and a LIM-Kinase 2 Inhibitor by Suppressing Cavernous Apoptosis and Fibrosis in a Rat Model of Cavernous Nerve Injury: A Comparison with a Phosphodiesterase Type 5 Inhibitor

“…Prostate cancer is the second common cancer in males globally with an increasing incidence [ 1 ]. Despite the efficacy of radical prostatectomy (RP) in treating prostate cancer, RP has a pernicious effect on the patient's erectile function, and hence, the patient's quality of life and general well-being [ 2 3 ]. Erectile dysfunction (ED) at one year after robot-assisted RP persists in up to 50% of the patients who underwent the surgery [ 4 ].…”