Penile Rehabilitation Following Radical Prostatectomy

Abstract

With the emergence of prostate-specific antigen testing, a substantial drop in patient age at the diagnosis of prostate cancer is well recognized, and the detection of lower-volume and relatively more localized cancers has elevated biochemical cure rates of prostate cancer when treated by radical prostatectomy (RP). After operation, erectile dysfunction (ED) can become a troublesome issue affecting significantly the quality of life of some patients. The concept of early penile rehabilitation following RP started in the 1990s. There is evidence suggesting that lack of erections after RP will produce cavernous hypoxia resulting in cavernous fibrosis causing subsequent penile shrinkage and veno-occlusive dysfunction, which taken together will hinder the recovery of spontaneous erection. The main goal of penile rehabilitation is thus to prevent the unwelcome cascade. Various treatment modalities for ED have been attempted to serve the purpose. Initial studies showed that intracavernous injection of vasoactive agents was beneficial. Later, the use of vacuum constriction devices (VCDs) and phosphodiesterase type 5 (PDE5) inhibitors were also found to be of help. These treatment options have their own advantages and disadvantages. The present article gives a brief overview of penile rehabilitation following RP.