Current state of penile rehabilitation after radical prostatectomy

Abstract

Erectile dysfunction is a major source of morbidity for many men who undergo radical prostatectomy for localized prostate cancer annually. Few areas of urology remain as controversial as penile rehabilitation postprostatectomy, an ill defined treatment strategy designed to minimize the incidence and severity of erectile dysfunction. Contemporary approaches to penile rehabilitation include oral phosphodiesterase type-5 inhibitors, vacuum constriction devices, intracavernous vasoactive injections and attempts at frequent sexual encounters. The intent of penile rehabilitation strategies is to facilitate the recovery of erectile function through preservation of cavernous smooth muscle, though none has definitive evidence of benefit. This review will evaluate the current theories of the cause of postprostatectomy erectile dysfunction, alterations in surgical technique to minimize it, and the application of erectogenic pharmaceuticals to improve recovery of erectile function, or maximize its preservation. A discussion of basic science evidence and clinical trials will be reviewed.