Erectile Function Rehabilitation in the Radical Prostatectomy Patient

Abstract

Introduction Prostate cancer is common and is being diagnosed in younger men now compared with two decades ago. Long-term functional outcomes are of significant importance to patient and impact upon the patient decision-making process regarding choice of therapy. Erectile function preservation (rehabilitation) has gained significant traction worldwide despite the absence of definitive evidence in its favor. Aim To define the role of rehabilitation in the prostate cancer patient who has undergone radical prostatectomy (RP). Methods A committee of five experts in the field from three countries was convened, and using a thorough analysis of the literature and the Delphi approach to expert opinion, recommendations were arrived at for clinicians treating men with prostate cancer before and after definitive surgical management. Results Recommendations arrived at included: that clinicians should discuss prevalence rates, the pathophysiology of erectile dysfunction after RP and the predictors of erectile function recovery, that validated instruments should be used using the published cut-offs for normalcy, that rehabilitation be discussed with patients, and that they be informed that significant potential benefits may be associated with rehabilitation. Conclusions The International Consensus of Sexual Medicine (ICSM) 2001 committee on rehabilitation after radical prostatectomy recommended that a discussion occur regarding rehabilitation in all patients undergoing or who have undergone RP. However, the committee recognized the absence of definitive data to date and could not comment on the optimal approach to rehabilitation at this time.

Experience with intracavernous injection in the treatment of erectile dysfunction after radical prostatectomy: dose considerations

“…1,2,5,9,10 Various treatments for ED after RP, such as vacuum constriction devices, intraurethral and intracorporal alprostadil, PDE5 inhibitors and prothesis, might serve to facilitate recovery of erectile function. 11,12 Since the introduction of oral PDE5 inhibitors, oral therapy has become the first-line treatment option for ED, irrespective of etiology. The efficacy of sildenafil citrate after RP correlated with the degree of neurovascular bundle preservation, preoperative erectile function status, age and interval before starting treatment.…”

“…23 Reviews of the literatures have shown that age, obesity and urinary tract symptoms are the mostimportant factors attributed to the occurrence of ED. 1,5,[8][9][10]12,23 The appropriate dose of PGE1 used for ED treatment depends on the etiology. For instance, men with peripheral vascular causes for ED require higher IC dosing than men with neurogenic causes.…”

Stem Cell Therapy for Erectile Dysfunction: A Critical Review

“…The purpose of a radical prostatectomy is to remove the cancerous prostate; however, the procedure can damage the CN, which run alongside the prostate [5]. The short-term consequence of CN injury is neurogenic ED, which is reversible, whereas the long-term consequence is atrophy of CSMCs, which can lead to irreversible ED [6].…”

Erektil disfonksiyon tedavisinde penil protez implantasyonunun uzun dönem klinik sonuçları

“…Fosfodiesteraz Tip-5 inhibitörleri, intrakavernöz enjeksiyonlar, intraüret-ral alprostadil ve vakum cihazları, hastaların %80 gibi bir oranda tedaviyi bırakmaları nedeniyle başarısız olabilir. [6,7] Oral ve cerrahi dışı tedavilerden yanıt alınamayan veya herhangi bir nedenle bu tedavileri kullanamayan erektil disfonksiyonlu (ED) hastalarda üçüncü basamak tedavi olarak penil protez implantasyonu önerilmektedir.…”