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Erection rehabilitation following prostatectomy — current strategies and future directions

Nature Reviews Urology volume 13, pages 216–225 (2016)Cite this article

Subjects

Key Points

  • Erection rehabilitation specifically treats erectile dysfunction (ED) following radical prostatectomy based on a regimented treatment plan implemented before, during and after surgery to mitigate adverse penile remodelling and protect erectile function

  • Nerve-sparing surgical technique during radical prostatectomy is essential to preserve erectile function; the use of biomaterials during surgery to protect the neurovascular bundle might further improve patient outcomes in the future

  • Most studies investigated vasoactive pharmacological therapy with phosphodiesterase type 5 inhibitors but no clear conclusion regarding the agents and schedules to be employed and their effectiveness can be drawn to date

  • Intracavernosal injections and vacuum erection devices are unlikely to be prescribed as monotherapeutics for erectile rehabilitation but might be useful in strategies for difficult-to-treat ED, particularly in men who did not undergo nerve-sparing procedures

  • Multidisciplinary approaches that also address psychological and general health parameters and involve a patient's partner are important to facilitate sexual recovery in men undergoing radical prostatectomy

  • No specific erection rehabilitation regimen has proven superior to date and combination of modalities in a scheduled fashion might emerge as providing optimal preservation of erectile function after radical prostatectomy

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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Authors and Affiliations

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

    Nikolai A. Sopko

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

    Arthur L. Burnett

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

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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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Sopko, N., Burnett, A. Erection rehabilitation following prostatectomy — current strategies and future directions. Nat Rev Urol 13, 216–225 (2016). https://doi.org/10.1038/nrurol.2016.47

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