Erection rehabilitation following prostatectomy — current strategies and future directions

Journal name:
Nature Reviews Urology
Volume:
13,
Pages:
216–225
Year published:
DOI:
doi:10.1038/nrurol.2016.47
Published online

Abstract

Despite continued advances in urological surgery, erectile dysfunction (ED) remains a serious adverse effect of radical prostatectomy. In this setting, ED is predominantly caused by injury to the neurovascular bundles, which lie alongside the prostate and are responsible for initiating and maintaining the erectile response. Most men will experience some degree of ED after radical prostatectomy, although erectile function outcomes have already remarkably improved since the development of nerve-sparing surgical techniques. To further improve outcomes, erection rehabilitation strategies are being investigated, which emphasize early treatment regimens with the aim of preventing adverse remodelling after surgery and preserving erectile function. Strategies include pharmacological therapy, mechanical therapy and psychosocial support. In addition, novel therapeutic approaches involving new targets for small-molecule treatments and regenerative medicine therapies are being developed to aid in restoring erectile function. Although ED treatments can be effective following radical prostatectomy, no specific erection rehabilitation regimen has currently been shown to be superior to other investigated rehabilitation regimens. Nevertheless, the different strategies rightfully remain an area of intensive research, as preservation of erectile function is a critical part of providing comprehensive care for men with prostate cancer to ensure their overall well-being, in contrast to just treating a patient's tumour.

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Affiliations

  1. The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, 1800 Orleans Street, Baltimore, Maryland 21287, USA.

    • Nikolai A. Sopko
  2. Department of Urology, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Baltimore, Maryland 21287–2411, USA.

    • Arthur L. Burnett

Contributions

Both authors researched data for the article, substantially contributed to discussion of the content, wrote and reviewed/edited the manuscript before submission.

Competing interests statement

N.A.S. declares no competing interests. A.L.B. is a consultant and/or advisor for Astellas and Genomic Health, is involved in scientific study and/or trial for Acorda Therapeutics, American Medical Systems, Auxilium, Coloplast, Endo Pharmaceuticals, Medispec, National Institutes of Health, Pfizer, Reflexonic and Vivus, is a member of the steering committee of the New England Research Institute, has a leadership position with The Center for Intimacy after Cancer Therapy, and is editorial board member for Andrology, European Urology, International Urology and Nephrology, The Journal of Sexual Medicine and Faculty Member of Practical Reviews in Urology.

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  • Nikolai A. Sopko

    Nikolai A. Sopko is a Resident in the James Brady Buchanan Urological Institute and Department of Urology at the Johns Hopkins School of Medicine in Baltimore, Maryland, USA. He received his PhD in stem cell biology and his MD from Case Western Reserve University in Cleveland, Ohio, USA, in 2012 through the NIH-funded Medical Scientist Training Program. His research interests include the molecular biology of erectile dysfunction with attention to the role of nerve injury and rehabilitation.

  • Arthur L. Burnett

    Arthur L. Burnett received his medical degree from Johns Hopkins University in Baltimore, Maryland, USA, in 1988. He is a Professor in the Department of Urology at Johns Hopkins Medical School. He is also the Director of the Basic Science Laboratory in Neurourology and the Male Sexual Dysfunction Clinic in the Department of Urology at Johns Hopkins University Hospital.

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