Penile Rehabilitation Research Articles

Loss of penile length following radical prostatectomy

Introduction. The majority of patients who undergo radical prostatectomy, apart from loss of sexual function, note a decrease in penis size which negatively affects their self-esteem. Penile rehabilitation is a set of measures aimed at recovery of sexual function to improve the quality of life.Objective. To analyze various options for penile rehabilitation in order to choose a method for preventing penis size reduction in patients undergoing nerve-sparing radical prostatectomy.Materials and methods. Patients who undergo radical prostatectomy (n = 83) at status flaccid and status erect were measured: length, circumference of the base, body and glans penis (mm) at different periods of penile rehabilitation. As a control, the tumescence coefficient was determined using pharmacodopplerography. All results were evaluated before, at the 6th and 12th months after radical prostatectomy.Results. Depending on the type of restoration of erectile function, the patients were divided into several groups: group 1 – men without penile rehabilitation; group 2 – patients treated with phosphodiesterase inhibitors of type 5; group 3 – using vacuum erection device (VED) and group 4 – taking combined penile rehabilitation. Medians of tumescence coefficient in group 1 on the 6th and 12th months was 2.7 (2.4; 3.1) and 2.6 (1.9; 2.9), in group 2 – 2.8 (2.2; 3.5) and 2.9 (2.2; 3.5), in group 3 – 2.7 (2.3; 3.3) and 2.8 (2.3; 3.3), in group 4 – 3.0 (2.2; 3.2) and 3.1 (2.1; 3.2), respectively (p <0.05).Conclusion. The determination of the tumescence coefficient in dynamics showed more significant results throughout the entire observation period. Combined penile rehabilitation is an effective method of restoring erectile function and also allows to maintain the size of the penis at all follow-up periods.

Curcumin slow-release membrane promotes erectile function and penile rehabilitation in a rat model of cavernous nerve injury.

Male erectile dysfunction (ED) caused by cavernous nerve injury is a common complication of pelvic surgery, radiotherapy, transurethral surgery or other operations. However, clinical treatment for iatrogenic or traumatic male ED is difficult and not satisfactory. Many studies have shown that curcumin can promote the repair and regeneration of peripheral nerves; however, whether curcumin can rescue cavernous nerve injury is unknown, and the poor bioavailability of curcumin limits its application in vivo. Hence, the study was conducted. A curved slow-release membrane was produced, and the properties were examined. In addition, the effects of the curcumin slow-release membrane on cavernous nerve-injured SD rats were studied. We found that polylactic acid-glycolic acid-polyethylene glycol (PLGA-PEG) can be used as a good carrier material for curcumin, and curcumin-loaded PLGA-PEG membranes can effectively rescue the cavernous nerve in SD rats, restore the continuity of the cavernous nerve, and increase the expression of nNOS mRNA and proteins in penile tissue, which can improve the penile erectile function of injured SD rats, reduce the degree of penile tissue fibrosis, and effectively promote penis rehabilitation. The curcumin slow-release membrane is proposed to be a new therapeutic approach for penile rehabilitation of cavernous nerve injury.

Comment on: Comparison of the efficacy of the early LI-SWT plus daily tadalafil with daily tadalafil only as penile rehabilitation for postprostatectomy erectile dysfunction.

Comment on: Comparison of the efficacy of the early LI-SWT plus daily tadalafil with daily tadalafil only as penile rehabilitation for postprostatectomy erectile dysfunction.

An EPO-loaded multifunctional hydrogel synergizing with adipose-derived stem cells restores neurogenic erectile function via enhancing nerve regeneration and penile rehabilitation.

Neurogenic erectile dysfunction (nED) is one of the most common and intractable postoperative complications of rectal and prostate cancer surgery and sometimes accompanies patients lifelong. The transplantation of stem cells has been proved a promising way for treatment. However, the therapeutic efficacy is severely impaired by excessive cell loss and death and poor accumulation in the injury site along with the traditional implantation strategy. Herein, an EPO‐loaded multifunctional hydrogel was designed. The hydrogels' adhesive property and mechanical strength were enhanced by adding catechol‐catechol adducts, thus significantly improving adipose‐derived stem cells (ADSC) retention and rescuing cell loss in the injury site. Meanwhile, the sustained release of EPO effectively ameliorated the viability and paracrine activity of ADSC, leading to enhanced migration of Schwann cells and differentiation of PC12 cells in vivo. On a bilateral cavernous nerve injury rat model, the present stem cell‐EPO‐hydrogel implanted strategy could significantly alleviate erectile dysfunction. The higher expression of Tuj1 and lower expression of GFAP in the major pelvic ganglia (MPG) indicated the acceleration of neural differentiation while the suppressing development of astrocytes. Also, the combined therapy restored the expression levels of eNOs, nNOs, and α‐SMA in penile tissues, suggesting the rehabilitation of the penis. Further analysis of Masson trichrome staining and apoptosis evaluation of the corpus cavernosum showed the preservation of vascular endothelium content and the prevention of penile fibrosis after denervation. Overall, we believe that this combined strategy presents a promising way not only for restoring neurogenic erectile function but also for the clinical translation of stem cell therapy.

An update on the current status and future prospects of erectile dysfunction following radical prostatectomy.

Radical prostatectomy (RP) and radiation treatment are standard options for localized prostate cancer. Even though nerve-sparing techniques have been increasingly utilized in RP, erectile dysfunction (ED) due to neuropraxia remains a frequent complication. Erectile function recovery rates after RP remain unsatisfactory, and many men still suffer despite the availability of various therapies. This systematic review aims to summarize the current treatments for post-RP-ED, assess the underlying pathological mechanisms, and emphasize promising therapeutic strategies based on the evidence from basic research. Evaluation and review of articles on the relevant topic published between 2010 and 2021, which are indexed and listed in the PubMed database. Phosphodiesterase type 5 inhibitors, intracavernosal and intraurethral injections, vacuum erection devices, pelvic muscle training, and surgical procedures are utilized for penile rehabilitation. Clinical trials evaluating the efficacy of erectogenic drugs in this setting are conflicting and far from being conclusive. The use of androgen deprivation therapy in certain scenarios after RP further exacerbates the already problematic situation and emphasizes the need for effective treatment strategies. This article is a detailed overview focusing on the pathophysiology and mechanism of the nerve injury developed during RP and a compilation of various strategies to induce cavernous nerve regeneration to improve erectile function (EF). These strategies include stem cell therapy, gene therapy, growth factors, low-intensity extracorporeal shockwave therapy, immunophilins, and various pharmacological approaches that have induced improvements in EF in experimental models of cavernous nerve injury. Many of the mentioned strategies can improve EF following RP if transformed into clinically applicable safe, and effective techniques with reproducible outcomes.

Efficacy of Low-Intensity Extracorporeal Shock Wave Treatment in Erectile Dysfunction Following Radical Prostatectomy: A Systematic Review and Meta-Analysis.

Erectile dysfunction (ED) is a well-known complication of radical prostatectomy (RP). Oral 5-phosphodiesterase inhibitors are currently the most widely used penile rehabilitation treatment for ED following RP, but they are less effective than for those with general ED. Low-intensity extracorporeal shock wave treatment (LI-ESWT), causing a biological change that induces neovascularization, has recently been used as a treatment for ED. Therefore, we conducted a systematic review and meta-analysis to investigate the efficiency of LI-ESWT in ED following RP. PubMed, Embase, and the Cochrane Library were searched up until December 2021. The endpoint was the change in IIEF scores after LI-ESWT. Five papers (460 patients) were included in the final analysis. In IIEF scores performed 3–4 months after LI-ESWT, the group receiving LI-ESWT showed statistically significantly better results than the control (WMD = −2.04; 95% CI, −3.72 to −0.35; p = 0.02). However, there were a total of two studies that measured the results after 9–12 months. There was no statistical difference between the two groups (WMD = −5.37; 95% CI, −12.42 to 1.69; p = 0.14). The results of this analysis indicate that LI-ESWT showed a statistically significant effect on early recovery in penile rehabilitation of ED following RP. However, the level of evidence was low. Therefore, careful interpretation of the results is required.

PD49-07 SEXUAL FUNCTION RECOVERY FOLLOWING OPEN AND ROBOTIC RADICAL PROSTATECTOMY: RESULTS OF AN ACADEMIC PENILE REHABILITATION PROGRAM

You have accessJournal of UrologyCME1 May 2022PD49-07 SEXUAL FUNCTION RECOVERY FOLLOWING OPEN AND ROBOTIC RADICAL PROSTATECTOMY: RESULTS OF AN ACADEMIC PENILE REHABILITATION PROGRAM Ugo Falagario, Michele Di Nauta, Andrea Checchia, Marco Recchia, Anna Ricapito, Nicola D'Altilia, Pasquale Annese, Gian Maria Busetto, Luigi Cormio, Giuseppe Carrieri, and Carlo Bettocchi Ugo FalagarioUgo Falagario More articles by this author , Michele Di NautaMichele Di Nauta More articles by this author , Andrea ChecchiaAndrea Checchia More articles by this author , Marco RecchiaMarco Recchia More articles by this author , Anna RicapitoAnna Ricapito More articles by this author , Nicola D'AltiliaNicola D'Altilia More articles by this author , Pasquale AnnesePasquale Annese More articles by this author , Gian Maria BusettoGian Maria Busetto More articles by this author , Luigi CormioLuigi Cormio More articles by this author , Giuseppe CarrieriGiuseppe Carrieri More articles by this author , and Carlo BettocchiCarlo Bettocchi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002620.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical prostatectomy (RP) is the gold standard treatment for clinically localized prostate cancer (PCa) in patients with a life expectancy 10 yr. Notwithstanding improvements in surgical techniques, erectile dysfunction (ED) is a common sequela of RP.The aim of the present study was to evaluate the effect of early penile rehabilitation in a dedicated Penile Rehabilitation Program on both assisted and unassisted erectile function (EF) in men who developed ED after open and robotic RP. METHODS: All patients undergoing open or robotic RP and early penile rehabilitation were included in the present study. All patients were treated and followed up at a single academic institution in a dedicated Penile Rehabilitation Program. Treatment included phosphodiesterase type 5 inhibitors (PDE5Is), intracavernous injections and vacuum erection devices (VEDs). EF recovery was defined as IIEF>20. Both assisted and unassisted EF was evaluated. Data were prospectively collected and retrospectively reviewed. Kaplan Mayer curves were used to evaluate EF recovery. Ethical Committee approval has been obtained. RESULTS: a total of 397 patients were eligible. 168 (42.3%) underwent robotic RP. Unilateral and bilateral nerve sparing was performed in 38 (9.6%) and 116 (29.2%) patients respectively.A combination of PDE5I and intracavernous injections was the most frequently used first line treatment (233, 59%). VEDs were used in 52 patients in addition to PDE5I and intracavernous injections (39, 10%) or intracavernous injections (23, 6%). In patients with a preoperative IIEF>21, assisted and unassisted EF recovery rates were 78% and 36% respectively.In patients with a preoperative IIEF<16, assisted and unassisted EF recovery rates were 46% and 18% respectively. Sub analysis showed a moderate benefit of penile rehabilitation also in patients with a preoperative IIEF<16 undergoing bilateral nerve sparing RP.Intensive penile rehabilitation with PDE5I, intracavernous injections and VEDs led to the best patient perceived results. CONCLUSIONS: Intensive penile rehabilitation programs improves EF recovery in patients undergoing radical prostatectomy. Preservation of Neurovascular bundles should be attempted also in patients with preoperative ED. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e832 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ugo Falagario More articles by this author Michele Di Nauta More articles by this author Andrea Checchia More articles by this author Marco Recchia More articles by this author Anna Ricapito More articles by this author Nicola D'Altilia More articles by this author Pasquale Annese More articles by this author Gian Maria Busetto More articles by this author Luigi Cormio More articles by this author Giuseppe Carrieri More articles by this author Carlo Bettocchi More articles by this author Expand All Advertisement PDF DownloadLoading ...

Impact of low-intensity extracorporeal shock wave therapy on sexual function after non-nerve-sparing robot-assisted laparoscopic radical prostatectomy

ABSTRACT Objective Considering the natural course of cavernous nerve recovery following robot-assisted laparoscopic radical prostatectomy (RARP), early intervention of low-intensity extracorporeal shockwave therapy (LIESWT) would be more effective for enhancing overall recovery of potency. We analyzed longitudinally alterations in sexual function in patients after RARP, with focus on the effect of early and delayed intervention with LIESWT. Method This study was open-label prospective study. Four patients after RARP were enrolled into this study's protocol over a period between January and June 2017. This early intervention was performed three times a week for two weeks in admission and one time per week in our out patient clinic for six weeks. For the purpose of setting a control group, the same surgeon performed RARP on 4 patients over a period between June 2012 and December 2014. These patients received LIESWT and this delayed protocol was same as that by Vardi et al. The same surgeon performed RARP on 100 patients over a period between April 2012 and February 2015. These patients were assigned to the non-LIESWT group for setting another control group. Sexual function (SF) was assessed with the Expanded Prostate Cancer Index Composite (EPIC). A validated form of self-reported questionnaire was administered to the inpatients before RARP, and mailed to all patients receiving RARP at 3, 6, 9, and 12 months after RARP. Results There was no significant inter-group difference in the baseline patient characteristics and surgical outcomes. The mean duration from RARP to the start of penile rehabilitation was 6 months for patients of the delayed LIESWT group. The SF score was significantly higher at preoperative, postoperative 6 and 9 months (p=0.0024, 0.0001, and 0.0004) in the early-LIESWT group. The SF score of early-LIESWT was significantly higher than that of delayed-LIESWT at postoperative 6 and 9 months (19.7 vs. 7.4; p = 0.0153, 26.2 vs. 6.1; p = 0.0154). On the other hand, there was no significant difference in the SF score between delayed and non-LIESWT groups at all time points. Conclusions Our findings show that penile rehabilitation with LIESWT immediately before urethral catheter removal improved sexual function scores. Our preliminary results suggest that LIESWT could be used as a treatment option in penile rehabilitation. Disclosure Work supported by industry: no.

PD49-11 THREE YEARS AFTER FINISHING PENILE REHABILITATION STUDY PROGRAMS AND 5 YEARS AFTER NERVE-SPARING RADICAL PROSTATECTOMY: WHAT`S UP WITH OUR PATIENTS?

You have accessJournal of UrologyCME1 May 2022PD49-11 THREE YEARS AFTER FINISHING PENILE REHABILITATION STUDY PROGRAMS AND 5 YEARS AFTER NERVE-SPARING RADICAL PROSTATECTOMY: WHAT`S UP WITH OUR PATIENTS? Andreas Bannowsky, Daniar Osmonov, Viktoria Märker, and Stefan Ückert Andreas BannowskyAndreas Bannowsky More articles by this author , Daniar OsmonovDaniar Osmonov More articles by this author , Viktoria MärkerViktoria Märker More articles by this author , and Stefan ÜckertStefan Ückert More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002620.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Several strategies are published for postoperative erectile function rehabilitation after nerve-sparing radical prostatectomy (nsRP). The aim of our study was to evaluate the use of any ED-treatment or the adherence to study protocol medication 3 years after the end of the initiated rehabilitation program. METHODS: 124 patients (mean age 69 years) from 3 different rehabilitation studies after nsRP with a regular dose of different PDE5-inhibitors (sildenafil/vardenafil/tadalafil) were enrolled for this evaluation. The regular initial follow-up of all of the 3 studies was 24 months. We performed a questionnaire sent to all enrolled patients of these studies 3 years after the end of the study / 5 years after nsRP. The survey consists of different questions, e.g. if and what kind of ED-treatment the patients still use. Further questions dealt with the reasons to end the study medication or switch to any other treatment. RESULTS: 99 patients (79.8%) completed and returned the questionnaire. 51 patients (52%) had stopped medical ED-treatment therapy completely at the time of the survey because of different reasons (completely restored erectile function without any medication 11%, subsequent ineffectiveness of the medication 8%, progressive disease of prostate cancer 7%, subsequent comorbidities 25%). From the remaining 48 patients only 21 patients (21%) still using only PDE5-inhibitors (daily or on demand). 16 patients (16%) using penile injection therapy, 3 patients MUSE (3%) and 8 patients VCD (with/without PDE5-inhibitors) (8%). CONCLUSIONS: 5 years after nsRP / 3 years after the end of the different rehabilitation studies most of the patients (52%) don´t use any ED-medication anymore due to different reasons. Only 11% of the patients after being enrolled in rehabilitation programs for 24 months are still reporting a restored erectile function 5 years after nsRP without any medication. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e834 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andreas Bannowsky More articles by this author Daniar Osmonov More articles by this author Viktoria Märker More articles by this author Stefan Ückert More articles by this author Expand All Advertisement PDF DownloadLoading ...

Remodeling of extracellular matrix cell elements in Peyronie's disease experimentally induced by TGF-beta and treated with mycophenolate mofetil

ABSTRACT Introduction Peyronie´s disease(PD) is a common disease among men which causes tortuosity in the penis, making it difficult and sometimes even preventing sexual activity. PD corresponds to the presence of fibrotic disorder in the tunica albuginea of the corpus cavernosum.This disorder is characterized by excessive accumulation of collagen fibers and other components of the extracellular matrix(ECM).The metalloproteimases(MMP) are involved in the reinforcement and debilitation of many processes that influence the development of fibrosis. PD can be conducted initially with clinical treatment, but the literature does not show an adequate resolution of this condition. Mycophenolate mofetil(MMF) belongs to a class of immunosuppressants drugs and has been used to treat patients with some fibrotic disorders as retroperitoneal fibrosis. A previous study evaluating the use of Mycophenolate Mofetil showed an important improvement in the arrangement of collagen fibers after experimental induction of peyronie´s disease. This experimental model, where the penile anatomy of rats is similar to the men, promote the ability to study fibrosis at its various levels and the effects of new drug for penile rehabilitation. Objectives The aim of this research is to investigate the alterations in the elements of extracelular matrix promoted by the antifibrotic action of Mycophenolate Mofetil in rats with TGF-Beta induced peyronie-s disease Methods Thirty male Wistar rats will be used,divided into 6 groups.Group 1- control group. Group 2 - rats that will receive injection of saline in the tunica albuginea. Group 3- rats that will receive only injection of TGF-beta. Group 4- rats that will receive TGF-beta and will be treated with MMF during 7 daysy. Group 5- rats that will receive TGF-beta and will be treated with MMF por 30 days. Group 6- rats that will receive only MMF. All rats‘penises will be collected after euthanasia for histochimical assesmente of collagen fibers with picrossirius and immunohistochewmistry of metalloproteinases(MMP2, MMP3 and MMP9). Five random fields from the region of the tunica albuginea will bew captured for each penile sample with Olyvia software and measurements will be performed with ImageJ software of the elements of the extracellular matrix. To compare groups will be used the paired sample T test. Data will be checked for normality using th kolmogorov-Smirnov test. When non-parametric, the Kruskal-Wallis test followed by Dunn´s test will be used.Differences will be considered statiscally significant when p&amp;lt;0,05.This experimente was approved and will be conducted according to the ethics committee rules on the use of animals. Hypothesis MMF promotes na improvement in fibrotic disorder preventing peyronie´s disease. Disclosure Work supported by industry: no.

V12-05 WHAT TREATMENT OPTIONS ARE THERE FOR PEYRONIE'S DISEASE?

You have accessJournal of UrologyCME1 May 2022V12-05 WHAT TREATMENT OPTIONS ARE THERE FOR PEYRONIE'S DISEASE? Consuelo Conde Redondo, Alejandro García Viña, María Núñez, Ana Ruano Mayo, Álvaro Zamora Horcajada, Fernando Natal Rodriguez, and Luis Cuellar Martín Consuelo Conde RedondoConsuelo Conde Redondo More articles by this author , Alejandro García ViñaAlejandro García Viña More articles by this author , María NúñezMaría Núñez More articles by this author , Ana Ruano MayoAna Ruano Mayo More articles by this author , Álvaro Zamora HorcajadaÁlvaro Zamora Horcajada More articles by this author , Fernando Natal RodriguezFernando Natal Rodriguez More articles by this author , and Luis Cuellar MartínLuis Cuellar Martín More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002638.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Peyronie’s disease (PD) is a relatively common progressive fibrotic disorder that affects the tunica albuginea. Traditionally, men will present with a new penile curvature, which may be associated with pain in the acute phase. Prevalence is 0.4–20%, increasing in cases of diabetes mellitus. The treatment must be carried out when the plate is stabilized. METHODS: In this video we present a review of the different therapeutic approaches to Peyronie's disease. RESULTS: Non-surgical treatment. Non-surgical therapies include the penile extender, The reduction in curvature was enhanced when increasing the usage time. Greater than 6 hours ’use daily resulted in a 36.2 ° reduction compared to baseline (51.4%), whilst less than 4 hours produced a 19.7 ° improvement (28.8%). Intraplaque therapy with clostridium histoliticum collagenase which is used to dissolve the plaques. The therapy is based on four cycles with two injections per cycle. Under local anesthesia we perform an erection and a controlled fracture of the plaque. Treatment with xiapex has a cost of eight times the treatment of simple plication, the use of 6 to 7 months of treatment of 8 vials and 14 consultations, the success rate is 34 to 40%. Treatment of Peyronie's disease with bovine pericardium. Corporoplasty with a bovine pericardium graft with a total or partial incision of the plaque is a technique that shortens the surgical time by avoiding obtaining autologous tissue. The published success rate is 41-93% with a satisfaction rate close to 100% if a residual curvature rate of less than 10% is obtained. Treatment of Peyronie's disease with tachosil patch. The advancement of the surgery leads us to look for alternatives that are easy to perform and that shorten surgical times, the total or partial incision of the peyronie plate plus tachosil graft leads us to obtain surgical results with a success rate of 83.8%. Tachosil is a sealing fibrin patch that is placed over the wound made, then covered with a compress moistened with warm saline for three minutes. Treatment of Peyronie's disease with Vivostat. Activated autologous fibrin is also being used as a sealant. During anesthetic induction, 120 ml of blood from the patient is obtained to which citrate is added, subsequently it is put for 25 minutes in the processor unit and a solution of 5 to 6 ml of autologous fibrin is obtained ready for use. We make some transverse incisions in the plate without having to resect it, later with the help of the vivostat applicator we fill the incisions made with the autologous fibrin solution we have obtained. Regardless of the surgical technique used, all patients should undergo penile rehabilitation with the help of vacuum device or an extender, to avoid shrinkage and shortening. CONCLUSIONS: There is no single approach to peyronie disease, it depends on the surgical skills of the surgeon and the involvement of the patient to achieve success Source of Funding: anyone © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e968 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Consuelo Conde Redondo More articles by this author Alejandro García Viña More articles by this author María Núñez More articles by this author Ana Ruano Mayo More articles by this author Álvaro Zamora Horcajada More articles by this author Fernando Natal Rodriguez More articles by this author Luis Cuellar Martín More articles by this author Expand All Advertisement PDF DownloadLoading ...

Efficacy of Tadalafil in Penile Rehabilitation Started Before Nerve-Sparing Robot-Assisted Radical Prostatectomy: A Double-Blind Pilot Study.

BackgroundDespite the widespread practice of nerve-sparing robot-assisted radical prostatectomy (nsRARP) for the treatment of localized prostate cancer (PCa), erectile dysfunction remains a significant sequela of radical prostatectomy.AimThis study aimed to compare the efficacy of tadalafil 5 mg once daily for erectile function recovery in patients who underwent nsRARP according to the timing of rehabilitation initiation.MethodsIn this double-blind, prospective pilot study, a total of 41 patients who underwent nsRARP were randomly assigned into 2 groups according to the timing of rehabilitation initiation. In the preRARP group (n = 20), tadalafil was started 2 weeks before nsRARP, and in the postRARP group (n = 21), it was started 4 weeks after nsRARP. Erectile function recovery after nsRARP was defined as an International Index of Erectile Function (IIEF-5) score of ≥17.OutcomesThe measures of EF recovery were the changes in IIEF-5 score.ResultsThe rate of erectile function recovery at 12-month follow-up was 80.0% and 71.4% in the preRARP and postRARP groups, respectively. The mean differences between baseline and postoperative IIEF-5 scores at 1-, 3-, 6-, and 12-month follow-up were −11.7 ± 3.2, −7.4 ± 3.2, −5.6 ± 1.5, and −4.1 ± 1.1 in the preRARP group and −14.7 ± 4.7, −12.0 ± 5.0, −9.7 ± 3.9, and −6.0 ± 3.1 in the postRARP group, respectively (1-month, P = .259; 3-months, P = .077; 6-months, P = .014; 12-months, P = .007).Clinical implicationsPreoperative tadalafil 5 mg once a day could be used effectively and safely as a strategy for penile rehabilitation after nsRARP.Strengths and LimitationsThis study is the first prospective trial of penile rehabilitation with tadalafil 5 mg once a day prior to nsRARP. This is a pilot study with the limitations of a small sample; further and large-scale studies with multiple cohorts, such as an untreated control group and an early immediate rehabilitation group for EF recovery, are needed.ConclusionThis study suggests that preoperative penile rehabilitation using tadalafil may lead to better erectile function recovery than postoperative penile rehabilitation using tadalafil.Noh T, Shim JS, Kang SG, et al. Efficacy of Tadalafil in Penile Rehabilitation Started Before Nerve-Sparing Robot-Assisted Radical Prostatectomy: A Double-Blind Pilot Study. Sex Med 2022;10:100508.

Comparison of the efficacy of the early LI-SWT plus daily tadalafil with daily tadalafil only as penile rehabilitation for postprostatectomy erectile dysfunction

This study compares the efficacy of the early low-intensity shock wave therapy (LI-SWT) plus daily tadalafil with daily tadalafil only therapy as penile rehabilitation for postprostatectomy erectile dysfunction in patients with prostate cancer who underwent bilateral interfascial nerve-sparing radical prostatectomy (robotic or open). From April 2019 to March 2021, 165 patients were enrolled, and 80 of them successfully completed this prospective study. Daily tadalafil were administered to all the patients. LI-SWT consisted of a total of six sessions. Each session was performed on days 4, 5, 6, and 7, and on the second and fourth weeks after surgery. Each LI-SWT session consisted of 300 shocks at an energy density of 0.09 mJ/mm2 and a frequency of 120 shocks per minute that were delivered at each of the five treatment points for 15 min. Thirty-nine patients were treated with tadalafil-only (group A) while 41 were treated with tadalafil and LI-SWT simultaneously (group B). At postoperative 6 months, the proportion of patients with erection hardness scores (EHS) ≥ 3 (4/39 vs. 12/41) was significantly higher in group B (p = 0.034), and LI-SWT was the only independent factor for predicting EHS ≥ 3 (OR, 3.621; 95% CI, 1.054–12.437; p = 0.041). There were no serious side effects related to early LI-SWT. Early LI-SWT plus daily tadalafil therapy as penile rehabilitation for postprostatectomy erectile dysfunction is thought to be more efficacious than tadalafil only. Further large-scaled randomized controlled trials will be needed to validate these findings.

Low-Intensity Electrostimulation Enhances Neuroregeneration and Improves Erectile Function in a Rat Model of Cavernous Nerve Injury

Neurogenic erectile dysfunction (ED) following radical prostatectomy (RP) is a frequent complication often leading to erectile tissue remodeling and permanent ED. Low-intensity electrostimulation (LIES) has been shown to enhance peripheral nerve regeneration, however, its application on cavernous nerves (CN) has never been investigated. To investigate whether LIES enhances CN regeneration, improves erectile function (EF) recovery, and prevents corpora cavernosal remodeling after CN injury, which is a principal factor for ED following RP. Adult male Sprague-Dawley rats were divided into Sham, Bilateral Cavernous Nerve Injury (BCNI), and BCNI + LIES (1V, 0.1ms, 12Hz, 1h/day). After 7days, EF was assessed (ICP measurement). Penes and CN were collected for molecular analyses of TGF-β1, Il-6, CRP, eNOS, ERK and AKT protein levels in corpus cavernosum (CC), and immunohistological analysis of DHE, total collagen and α-SMA in CC and S-100, Tub-III, DAPI, TUNEL, and nNOS in CN. Effects of LIES on EF, erectile tissue remodeling and CN structure. EF was decreased (P < .05) 7 days after BCNI and increased (P < .05) by LIES. Intracavernosal reactive oxygen species (DHE) was increased (P < .05) after BCNI and normalized by LIES. Protein expressions of TGF-β1, IL-6, and CRP were increased in the penis (P < .05) after BCNI and normalized by LIES. The α-SMA and/or total collagen ratio was decreased (P < .05) after BCNI in the penis and normalized by LIES. Protein expression ratio of p-ERK/ERK and p-AKT/AKT did not change after BCNI but increased (P < .05) in LIES group. Myelination and number of nNOS positive cells in the CN were decreased (P < .05) after BCNI and normalized by LIES. The number of apoptotic nerve cells within the dorsal penile nerve was increased (P < .05) after BCNI and decreased (P < .05) by LIES compared to the BCNI group. There were no differences in eNOS expression in the penis between study groups. LIES may offer a potential new tool for penile rehabilitation and ED management following RP, potentially enhancing EF recovery and minimizing the side effects of this surgery. This study provides evidence of the protective effect of LIES on EF and tissue remodeling following CN injury; nevertheless, this study has been conducted on animals and the translation to humans remains to be demonstrated. Further research to identify the underlying mechanisms of action is required. This study demonstrates that LIES of the CN after CN injury protects CN structure, enhances EF recovery, and prevents corpora cavernosal remodeling.

A0545 - 5 years after nerve-sparing radical prostatectomy and 3 years after finishing penile rehabilitation study programs: What´s up with our patients?

A0545 - 5 years after nerve-sparing radical prostatectomy and 3 years after finishing penile rehabilitation study programs: What´s up with our patients?

A0544 - Sexual function recovery following open and robotic radical prostatectomy: Results of an academic penile rehabilitation program

A0544 - Sexual function recovery following open and robotic radical prostatectomy: Results of an academic penile rehabilitation program

Update on the Penuma® an FDA-cleared penile implant for aesthetic enhancement of the flaccid penis.

The Penuma® implant is a medical-grade silicone implant surgically inserted subcutaneously to provide cosmetic improvement of the penile aesthetic. The principal author was invited to provide an update on the usage of the Penuma® implant for penile aesthetics. He collected as yet unpublished data, which is undergoing synchronous submission to Urologic meetings and peer-reviewed publications by a variety of authors for this communication. The objective of this article is to provide updated information regarding the Penuma® aesthetic penile implant. A new scrotal method of implantation named "concealed" is emerging. Through physician comparison of various factors prior to and after the scrotal method intervention, early findings suggest this approach seems to have less visible scar, is quicker and is followed by less seroma formation. As the device is now surgically implanted by surgeons other than its inventor, new developments have appeared authenticating the original published paper in 2018. Patients were contacted via phone and were asked five questions regarding satisfaction with the responses recorded. This new multicenter study shows findings of high patient and partner satisfaction coupled with acceptable adverse outcomes similar to the single-surgeon study. A new penile rehabilitation program has been developed with the aim for the penis appearance to be restored to its pre-operative state if the Penuma® is removed. 12 patients who underwent penile implant removal were followed for 6 months while participating in the penile rehabilitation program. The discipline worked in patients who desired removal for dissatisfaction and is currently under evaluation in patients who require device removal for medical reasons, e.g., infection or suture-related issues. Through new developments, the acceptance of Penuma® in the prosthetic community seems to be further solidified.

Justification of vacuum prophylaxis as part of the penile rehabilitation in patients after nerve-sparing radical prostatectomy

Introduction. In healthy men, a significant increase in pO2 in the cavernous tissue occurs during episodes of nocturnal erections. This process ensures sufficient oxygenation and high-pressure substances such as prostaglandin-E1 and nitric oxide. These substances suppress the expression of transforming growth factor β1, thereby preventing collagen synthesis and the development of cavernous fibrosis. In patients undergoing nerve-sparing radical prostatectomy, nocturnal erections are absent, hypoxia inhibits the production of PGE-i, and neuropraxia inhibits NO. Thus, cavernous fibrosis develops through the production of pro-apoptotic and profibrotic factors, resulting in persistent erectile dysfunction. The importance of a vacuum in penile rehabilitation for the prevention of penile cavernous hypoxia is not fully understood. This is due to the deficiency of data on the gas composition of cavernous blood when a vacuum-induced erection is achieved.Purpose of the study. To investigate the cavernous blood at the time of vacuum-induced erection, to analyze the obtained results with the International Index of Erectile Function score and with the values of penile hemodynamics.Materials and methods. The study included i5 patients with prostate cancer and preserved sexual function. The average age of all men was 57.87 ±4.36 years. All patients underwent a preoperative comprehensive assessment of erectile function: International Index of Erectile Function questionnaire, dynamic duplex penile ultrasound. Immediately prior to the surgery, penile blood was collected at the time of achieving a vacuum-induced erection. The gas composition and oxygenation were assessed using the values of the partial oxygen pressure, carbon dioxide and saturation in accordance with the approved standards to differentiate arterial and venous blood. Statistical data processing was carried out using the PASW Statistics 22 software (IBM SPSS, IBM Corp., Chicago, IL, USA)Results. All patients were divided into 3 groups depending on the gas composition and oxygen level of the cavernous blood. Group I included 4 (26.6%) patients with a predominance of arterial blood, group II — 4 patients (26.6%) with venous blood and group III — 7 patients (46.6%) with a mixed composition of cavernous blood. The average International Index of Erectile Function score in group I was 23.5 [2i.0; 25.0], in group II — 22.0 [2i.0; 24.0] and in group III — 24.0 [i9.0; 25.0]. Peak systolic velocity (cm/s) in group I was 40.i [35.i; 45.2], in group II — 35.9 [29.5; 50.2], in group III — 32.5 [32.5; 34.4]. End-diastolic velocity (cm/s) in group I was 2.52 [0.55; i0.5], in group II — 8.3 [2.9; i0.8], in group III — 7.5 [7.5; 9.0]. Resistive index in group I was 0.87 [0.77; 0.98], in group II — 0.75 [0.63; 0.94], in group III — 0.75 [0.73; 0.75].Conclusions. Vacuum prophylaxis may be the method of choice for penile rehabilitation in patients after nerve-sparing radical prostateectomy, especially in the early postoperative period during neuropraxia. The use of vacuum devices should be prescribed to patients with preserved veno-occlusive mechanism, which should be confirmed by dynamic duplex penile ultrasound.

The Role of Long Term Label-Retaining Cells in the Treatment of Erectile Dysfunction by Vacuum Erectile Device.

IntroductionVacuum erectile device (VED) therapy is commonly used for penile rehabilitation after radical prostatectomy, however, the underlying mechanism of this effect is not fully understood.AimTo evaluate the presence of label-retaining cells (LRCs), cells with long-term retention of 5-ethynyl-2-deoxyuridine (EdU) labeling and recognized as adult stem cells or progenitor-like cells, in cavernous tissue after VED treatment using a BCNC rat model.MethodsPostnatal pups (1 day old) of Sprague Dawley (SD) rats were intraperitoneally injected with EdU (50 ug/g, BID for 3 days) and BCNC surgery was conducted at 6 weeks old (designated as natal-labeled rats). Adult SD rats underwent BCNC surgery and EdU injection (50 ug/g, once) after surgery (designated as adult-labeled rats). One week after surgery, both natal- and adult-labeled rats received daily VED treatment for 4 weeks. Intracavernous pressure (ICP) and mean arterial pressure (MAP) were measured for all rats and then the penile tissue was harvested. The ratio of ICP/MAP was calculated to represent erectile function. Penile tissue was examined by immunofluorescence staining to detect EdU positive cells.Main Outcome MeasuresThe ratio of Intracavernous pressure (ICP) /MAP and the percentage of EdU positive cells were measured.ResultsThe erectile function was impaired after BCNC and partially restored after VED treatment in both natal- and adult-labeled rats (P < .05). There was no difference in the percentage of EdU positive cells in natal-labeled rat cavernous tissue in BCNC group compared with VED group. Among the adult-labeled rats, the percentage of EdU positive cells increased in BCNC group (P < .05) but didn't change significantly after VED treatment (P = .35).ConclusionLRCs may play a limited role in the restoration of erectile dysfunction through VED treatment after BCNC.Yang B, Luse D, Cao Y, et al. The Role of Long Term Label-Retaining Cells in the Treatment of Erectile Dysfunction by Vacuum Erectile Device. Sex Med 2021;9:100442.

Sexual rehabilitation recommendations for prostate cancer survivors and their partners from a biopsychosocial Prostate Cancer Supportive Care Program.

This study aimed to highlight the biopsychosocial recommendations provided to prostate cancer survivors and their partners during sexual rehabilitation. Retrospective analysis of a prospectively maintained patient database was conducted for visits between 2013 and 2019. The sexual health rehabilitation action plan (SHRAP) is a standardized 29-item list of biopsychosocial recommendations. The frequency of biopsychosocial recommendations provided to patients via their SHRAPs was assessed. Among 913 patients, across 2671 appointments, nearly 74% of patients underwent radical prostatectomy. Other treatments included combination therapy (surgery, radiation, and/or androgen deprivation therapy (ADT)) (13%), radiation (external beam radiation or brachytherapy) (5%), and active surveillance (2%). Each patient had a median of 2 (SD 2.06) appointments and received a mean of 10.0 (SD 3.9) recommendations at each visit. Educational recommendations (penile rehabilitation, orgasmic guidelines, and climacturia management) were provided in 84% of visits followed by psychosexual recommendations (pleasure-focused, dedicated time, simmering, sexual aids, and sensate focus) in 71% of all appointments. The top recommendations (total n, frequency of recommendation) were penile rehabilitation (2253, 84%), pleasure-focus (1887, 71%), phosphodiesterase inhibitors (1655, 62%), clinical counselor (1603, 60%), vacuum erectile device (1418, 53%) and intracavernosal injections (1383, 52%). Biopsychosocial programs are evolving to be a key part of prostate cancer survivorship. This study's insight suggests that prostate cancer survivors require education around their sexual consequences and psychosexual counseling alongside proven biomedical strategies for erectile dysfunction. Cancer survivorship programs should integrate educational and psychosocial strategies alongside biological strategies for prostate cancer survivors and their partners.