Penile Rehabilitation

Yang, Dae Yul

Abstract

Erectile dysfunction following radical prostatectomy is significant quality of life issue even with increased understanding of the anatomy and advancement of surgical skills such as nerve sparing prostatectomy, laproscopic, and robotic surgery. The changes of neuropraxia, ischemic and hypoxic injury vascular damage, fibrotic remodeling, and venous leak are all believed to contribute to erectile dysfunction. Penile rehabilitation is the use of any drug or device at or after radical prostatectomy to preserving penile function and earlier return of potency. There are no generally accepted guidelines for penile rehabilitation regiments. There exist several popular options such as PDE5I (phosphodiesterase type 5 inhibitor), intracorporeal injection of vasoactive agent, vacuum device, intraurethral alprostadil, and combination of these modalities. Current animal and human data support the primary use of PDE5I (phosphodiesterase type 5 inhibitor) for nerve sparing and injection of vasoactive agent for supposed nerve injury patients. Some experimental modalities including hyperbaric oxygen therapy, neuromodulator, and stem cell strategies are under preclinical study. This paper will review the literatures involving both basic and clincial evidences for rehabilitation approaches following radical prostatectomy.