Early penile rehabilitation following radical prostatectomy: Cleveland clinic experience

Abstract

Erectile dysfunction is one of the most important quality of life issues following radical prostatectomy. The potency rates reported following nerve-sparing technique varies between 40 and 86%, and the time period required for complete recovery of erectile function varies from 6 to 24 months. The literature evidence suggests that lack of natural erections during this period of time produces cavernosal hypoxia. Prolonged periods of cavernosal hypoxia induce fibrosis, which later increases the incidence of venous leak. Recently, there is a growing interest among the physicians to interrupt these events by preventing cavernosal hypoxia during the period of neuropraxia. Initial studies using intracavernosal injection appears to be beneficial. In this article, we reviewed the pathophysiology of cavernosal hypoxia following radical prostatectomy with currently available evidence for the interventions to promote the nerve recovery and regeneration.

Systematic Review and Meta-Analysis of the Use of Phosphodiesterase Type 5 Inhibitors for Treatment of Erectile Dysfunction following Bilateral Nerve-Sparing Radical Prostatectomy

“…It has also been well documented in several studies that smooth muscle and endothelium undergo structural changes resulted from neurapraxia [15]. Of note, smooth muscle apoptosis and upregulation of collagen expression are the primary conditions resulting in venous leak [16]–[18].…”

Laparoszkópos radikális prostatectomia utáni pénisz-rehabilitáció eredményei avanafil hatóanyaggal

“…Ebben az időszakban kívánatos, hogy hetente kb. 3-szor létrejöjjön erekció (20,21 kifejtette a hatását, és egyes betegeknél 6 órán túl is hatásos maradt, ami arra utal, hogy megfelelő lehet az enyhe-súlyos ED-k szükség szerinti kezelésére (23,24). A 100 mg avanafil hatóanyaggal végzett pénisz-rehabilitáció jelen felmérés eredményei alapján minden vizsgálati végpon-ton (közösüléshez szükséges erekció létrejötte, sikeres közö-sülés, műtét utáni MMM-pontszám növekedése, életminő-ségi mutatók javulása) szignifikáns különbség volt kimutatható a gyógyszeres csoport javára.…”

Synergistic Effect of Mesenchymal Stem Cells Infected with Recombinant Adenovirus Expressing Human BDNF on Erectile Function in a Rat Model of Cavernous Nerve Injury

“…Therefore, nerve-sparing radical prostatectomy with preservation of the cavernous nerve was introduced to help in recovery of erectile function following surgery. Bilateral nerve sparing shows superior spontaneous recovery of erectile function compared with that after surgery without nerve sparing [6-8]. However, 20 to 80% of these patients may never return to normal erectile function despite undergoing bilateral nerve-sparing radical prostatectomy [9].…”