The goal of penile rehabilitation is to stimulate blood flow to the penis right after radical prostatectomy to help improve sexual function.
During radical prostatectomy, delicate nerves that play an important role in the health of penile tissue may be:
Damage or trauma can occur when the surgeon divides the nerves to gain access to the prostate gland to remove it. This is why you want a highly skilled and well-trained surgeon!
Erection problems or impotence can also result from:
Some physicians suggest that if a man’s penis stays soft and limp (or flaccid) for a long period of time after his surgery, it may lead to permanent damage to the sponge-like regions of erectile tissues (called cavernous tissue). These tissues contain most of the blood when a man has an erection.
Increasing blood flow to the penis right after surgery is believed to help maintain the penile tissue while the neural pathway regenerates.
How is penile rehabilitation done?
Penile rehabilitation involves the regular use of either:
Some physicians suggest that men should masturbate to increase blood flow, but this form of penile rehabilitation has not been studied.
What do clinical studies report about penile rehabilitation?
Men who had penile injections of alprostadil one month after bilateral nerve-sparing radical prostatectomy (which means that both nerve bundles were saved) had:
In another study of 73 men (Gontero et al):
In a study of 54 men following bilateral nerve-sparing radical prostatectomy (McCullough et al):
After 48 weeks (all men stopped treatment at 40 weeks), the men who took sildenafil were five times more likely to have return of natural erections firm enough for intercourse than the men taking placebo.
In a trial of 43 men following nerve-sparing radical prostatectomy (Bannowski et al):
In a study of 76 men (Padma-Nathan et al):
In the first large, randomized, prospective study (McCullough et al) of 139 men comparing nightly intraurethral alprostadil (urethral pellets) to oral sildenafil citrate:
In another study of 132 men (Mulhall et al):
In a study of 91 men who had nerve-sparing radical prostatectomy (Raina et al):
Vacuum pump devices:
In a study that followed 141 sexually active men who had radical prostatectomy (Raina et al):
In an earlier study of 109 men (Raina et al):
What do the clinical study results mean?
These studies suggest that early use of oral ED medications, penile injections, urethral pellets, and a vacuum erection device for penile rehabilitation may all help improve sexual function in men following radical prostatectomy.
Even if your man takes an ED medication and sees no result, some in the medical community believe there may still be benefits in continuing to use an ED drug for penile rehabilitation.
While these studies report that men had erections "sufficient" for intercourse, unfortunately they do not reveal whether these men were able to maintain an erection long enough to complete the act of intercourse.
The promise of gene therapy
Advances in molecular biology have allowed the transfer of genetic material to humans and animals and this technology is being researched to see how it can affect ED.
Gene therapy has shown some promise in animal studies and human trials are currently underway.
Bannowski A, Schulze H, van der Horst C, et al. Recovery of erectile function after nerve-sparing radical prostatectomy: improvement with nightly low-dose sildenafil. BJU International.2008;101(10):1279-1283.
Dall’era JE, Mills JN, Koul HK, Meacham RB. Penile rehabilitation after radical prostatectomy: important therapy or wishful thinking? Reviews in Urology. 2006;8(4):209-215.
Gontero P, Fontana F, Bagnasacco A, et al. Is there an optimal time for intracavernous prostaglandin E1 rehabilitation following non-nerve-sparing radical prostatectomy? Results from a hemodynamic prospective study. Journal of Urology. 2003;169:2166-2169.
Hinh P, Wang R. Overview of contemporary penile rehabilitation therapies. Advances in Urology.2008. http://www.hindawi.com/GetArticle.aspx?doi=10.1155/2008/481218. Accessed January 25, 2009.
McCullough AR, Levine LA, Padma-Nathan H. Return of nocturnal erections and erectile function after bilateral nerve-sparing radical prostatectomy in men treated nightly with sildenafil citrate: subanalysis of a longitudinal randomized double-blind placebo-controlled trial. The Journal of Sexual Medicine. 2008; 5(2):476-484.
McCullough AR, Hellstrom WG, Wang R, Lepor H, Wagner KR, Engel JD. Recovery of erectile function after nerve sparing radical prostatectomy and penile rehabilitation with nightly intraurethral alprostadil versus sildenafil citrate. J Urol. 2010. 183(6):2451-6. Epub 2010 Apr 18.
Montorsi F, Guazzoni G, Strambi LF, et al. Recovery of spontaneous erectile function after nerve-sparing retropubic prostatectomy with and without early intracavernous injections of alprostadil: results of a prospective, randomised trial. Journal of Urology. 1997;158:1408-1410.
Mullhall J, Land S, Parker M, et al. The use of erectogenic pharmacotherapy following radical prostatectomy improves recovery of spontaneous erectile function. Journal of Sexual Medicine.2005;2:532-540.
Padma-Nathan H, McCullough AR, Giuliano F, et al. Postoperative nightly administration of sildenafil citrate significantly improve the return of normal spontaneous erectile function after bilateral nerve-sparing radical prostatectomy [abstract 1402]. Journal of Urology. 2003;169:375.
Raina R, Agarwal A, Ausmundson S. Early use of vacuum constriction device following radical prostatectomy and the role of postoperative sexual function. The Journal of Urology.2007;178(2):602-607.
Raina R, Pahlajani G, Agarwal A, Jones S, Zippe C. Long-term potency after early use of a vacuum erection device following radical prostatectomy. BJU Int. 2010;106(11):1719-22.
Raina R, Agarwal A, Allimaneni SSR, et al. Sildenafil citrate and vacuum constriction device combination enhances sexual satisfaction in erectile dysfunction after radical prostatectomy.Urology. 2005;65:360-364.
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