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Penile Rehabilitation After Radical Prostatectomy

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The goal of penile rehabilitation is to lessen the unfavorable effects of radical prostatectomy on a man's sexual function and to speed recovery.

Medically reviewed by

Dr. Ramchandra Lamba

Published At July 5, 2023
Reviewed AtApril 12, 2024

Introduction:

Penile rehabilitation is a medical treatment that aims to improve the function and health of the penis following a surgical procedure, such as a radical prostatectomy (RP). The goal is to restore erectile function to pre-operative levels and achieve erections sufficient for satisfactory sexual intercourse. The concept of rehabilitation is based on implementing protocols that improve oxygenation, preserve the endothelial structure, and prevent smooth muscle structural alterations. The most commonly used approaches for penile rehabilitation after nerve-sparing RP are PDE5-Is, intracorporeal injection therapy, vacuum erection devices, and a combination of these therapies. Studies support the use of rehabilitation protocols early on as it is better than leaving the erectile tissues unassisted.

Why Is It Essential to Perform Penile Rehabilitation After a Radical Prostatectomy?

Penile rehabilitation is often performed after radical prostatectomy (RP) because this surgical procedure can cause damage to the nerves and blood vessels in the penis, leading to erectile dysfunction (ED). RP is a surgical procedure that involves the removal of the prostate gland and surrounding tissues to treat prostate cancer. During the surgery, the nerves and blood vessels that control erections are often damaged, which can lead to ED.

Penile rehabilitation aims to improve blood flow to the penis and restore erectile function by using various therapies such as phosphodiesterase type 5 (PDE5) inhibitors, vacuum erection devices (VEDs), and penile injections. Physical therapy and exercises, such as pelvic floor muscle exercises, can also improve the strength and function of the muscles involved in erections. In addition, addressing psychological issues such as anxiety, depression, or relationship issues that may be impacting sexual function is also important.

It is important to note that the success of penile rehabilitation varies from person to person and that it is an ongoing process that may take time to see results. However, with the right combination of therapies and a dedicated effort, many men can improve their erectile function and regain their sexual health after RP.

What Are the Different Approaches to Performing Penile Rehabilitation After a Radical Prostatectomy?

  • PDE-5 Inhibitor: Phosphodiesterase type-5 inhibitors (PDE5-Is) are a class of drugs commonly used to treat erectile dysfunction (ED) and to enhance the erectile response in men. PDE5-Is work by inhibiting the activity of the enzyme phosphodiesterase type-5 (PDE5), which is responsible for breaking down the compound cyclic guanosine monophosphate (cGMP) in the corpus cavernosum. cGMP is an important signaling molecule in the process of erection, as it is responsible for relaxing the smooth muscle of the corpus cavernosum and allowing blood flow to the penis. When PDE5 is inhibited, the level of cGMP in the corpus cavernosum increases, leading to increased blood flow to the penis. This results in an erection that is harder and lasts longer. The most widely used medications in the class of PDE5 inhibitors are Sildenafil, Tadalafil, Vardenafil, and Avanafil. Although they share similar effectiveness and safety characteristics, they differ in how long their effects last. Sildenafil, the first PDE5 inhibitor to be introduced in the market, takes 30 to 60 minutes to take effect and lasts for around four hours. Tadalafil, on the other hand, has a similar onset time but can last up to 36 hours, making it known as the 'weekend pill'. Vardenafil has an onset time of 25 to 40 minutes, and its effects last for around four to five hours. Avanafil has the quickest onset time at 15 to 30 minutes; its effects last about six hours.

  • Intracavernosal Injections: Intracavernosal injection therapy is a treatment option for men with erectile dysfunction that involves injecting medication directly into the corpus cavernosum of the penis. The medication used is typically Alprostadil, a synthetic version of the naturally occurring compound prostaglandin E1. The medication causes the smooth muscle in the corpus cavernosum to relax, allowing increased blood flow to the penis and resulting in an erection. Intracavernosal injection therapy is generally considered a second-line treatment option after oral medications, such as PDE5 inhibitors, have failed. It is important to note that this treatment requires proper training and guidance from a healthcare professional before the patient can self-administer the injections, and it is not recommended for men with certain medical conditions such as bleeding disorders.

  • Vacuum Devices: Vacuum erection devices (VEDs) are mechanical devices used to treat erectile dysfunction (ED). They work by creating a vacuum around the penis, which increases blood flow to the area, resulting in an erection. A constriction ring is then placed around the base of the penis to maintain the erection. VEDs are considered a non-invasive treatment option for ED, and they can be used by men who are unable to take oral medications or are unsuitable for surgery. They are relatively easy to use and can be used in the privacy of a patient's home. However, it is important to note that VEDs may not be suitable for men with certain medical conditions, such as severe Peyronie's disease, and may not be effective for men with severe erectile dysfunction. The efficacy of VEDs is improved when combined with other treatment options, such as PDE5 inhibitors.

Is Penile Rehabilitation Successful?

The efficacy of penile rehabilitation varies depending on the specific treatment modality used and the patient's individual characteristics, such as age, preoperative erectile function, and the surgical technique used. Additionally, the patient's adherence to the treatment and willingness to participate in the rehabilitation process are also important factors to consider when evaluating the success of penile rehabilitation.

Studies have shown that using phosphodiesterase type-5 inhibitors (PDE5-Is) and vacuum erection devices (VEDs) can be effective in improving erectile function following surgery for prostate cancer. For example, a meta-analysis of randomized controlled trials found that the use of PDE5-Is following surgery for prostate cancer was associated with an increased likelihood of achieving erections sufficient for intercourse. Intracavernosal injection therapy is also effective in improving erectile function following surgery for prostate cancer, but the evidence is less consistent compared to PDE5-Is and VEDs.

Conclusion:

In conclusion, penile rehabilitation is a treatment approach that aims to improve erectile function following surgery for prostate cancer, such as a radical prostatectomy (RP). The goal is to restore erectile function to pre-operative levels and achieve erections sufficient for satisfactory sexual intercourse. The most commonly used approaches for penile rehabilitation after nerve-sparing RP are PDE5-Is, intracorporeal injection therapy, vacuum erection devices, and a combination of these therapies. Studies have shown that early implementation of rehabilitation protocols can be beneficial in restoring erectile function. It is important to note that the success of penile rehabilitation varies from person to person and may take time to see results. However, with the right combination of therapies and a dedicated effort, many men can improve their erectile function and regain their sexual health after RP.

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Dr. Ramchandra Lamba
Dr. Ramchandra Lamba

Psychiatry

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penile rehabilitationradical prostatectomy
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