Penile Rehabilitation: the “Up”-date
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Purpose of Review
The purpose of this review is to review the penile rehabilitation literature published since the beginning of 2017. Specific emphasis was placed on determining how the new findings increase our understanding of the mechanisms leading to recovery of erectile function after pelvic surgery and to identify potential focus areas for future studies.
A meta-analysis of penile rehabilitation after prostatectomy was published in early 2017 reporting that PDE-5 inhibitors, intracavernosal injection (ICI) therapy, and vacuum erection devices (VED) improved erectile function; however, the benefit was not observed after a washout period. Preclinical studies have identified potential regenerative therapies after cavernous nerve injury.
While significant methodological challenges remain, recent literature suggests benefits to starting penile rehabilitation immediately after surgery, but not extending past 1 year postoperatively. The cost-benefit ratio of penile rehabilitation remains unclear; however, decreasing costs of PDE-5 inhibitors as well as improvements in characterizing post-surgical erectile dysfunction may help to personalize penile rehabilitation, improve outcomes, and improve the cost-benefit ratio. Better and more consistent trial design is needed to develop the optimal regimen(s) for restoring sexual function in men. Finally, future studies to translate promising preclinical regeneration therapies to humans are also needed.
KeywordsErectile dysfunction Penile rehabilitation Radical prostatectomy PDE-5 inhibitors Vacuum erection device Intracavernosal injection
JSG is supported in part by NIH K12 DK083014 Multidisciplinary K12 Urologic Research (KURe) Career Development Program (awarded to Dolores J. Lamb).
Compliance with Ethical Standards
Conflict of Interest
The author declares no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 12.• Kim S, Sung GT. Efficacy and safety of tadalafil 5 mg once daily for the treatment of erectile dysfunction after robot-assisted laparoscopic radical prostatectomy: a 2-year follow-up. Sex Med. 2018;6:108–14 This study performed penile duplex ultrasound in most of the patients and found that over 50% of the men who had either arterial insufficiency or a normal exam would respond to PDE-5 inhibitors. By contrast, only 1 individual with venous leak responded.CrossRefGoogle Scholar
- 16.• Deng H, Liu D, Mao X, Lan X, Liu H, Li G. Phosphodiesterase-5 inhibitors and vacuum erection device for penile rehabilitation after laparoscopic nerve-preserving radical proctectomy for rectal Cancer: a prospective controlled trial. Am J Mens Health. 2017;11:641–6 This study was done in rectal cancer patients undergoing radical proctectomy and demonstrated that VED promoted early erectile recovery. This suggests that attaining an erection as soon as possible may yield the best results and supports combination therapy for penile rehabilitation.CrossRefGoogle Scholar
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