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Penile Rehabilitation: the “Up”-date

  • J. Scott Gabrielsen
Male Sexual Dysfunction and Disorders (A Pastuszak and N Gupta, Section Editors)
  • 11 Downloads
Part of the following topical collections:
  1. Topical Collection on Male Sexual Dysfunction and Disorders

Abstract

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.

Recent Findings

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.

Summary

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.

Keywords

Erectile dysfunction Penile rehabilitation Radical prostatectomy PDE-5 inhibitors Vacuum erection device Intracavernosal injection 

Notes

Funding

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.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Rabbani F, Stapleton AM, Kattan MW, Wheeler TM, Scardino PT. Factors predicting recovery of erections after radical prostatectomy. J Urol. 2000;164:1929–34.CrossRefGoogle Scholar
  2. 2.
    Mohamad Al-Ali B, Ponholzer A, Augustin H, Madersbacher S, Pummer K. The long-term effect of radical prostatectomy on erectile function, urinary continence, and lower urinary tract symptoms: a comparison to age-matched healthy controls. Biomed Res Int. 2017;2017:9615080–5.CrossRefGoogle Scholar
  3. 3.
    Lee JK, Assel M, Thong AE, Sjoberg DD, Mulhall JP, Sandhu J, et al. Unexpected long-term improvements in urinary and erectile function in a large cohort of men with self-reported outcomes following radical prostatectomy. Eur Urol. 2015;68:899–905.CrossRefGoogle Scholar
  4. 4.
    User HM, Hairston JH, Zelner DJ, McKenna KE, McVary KT. Penile weight and cell subtype specific changes in a post-radical prostatectomy model of erectile dysfunction. J Urol. 2003;169:1175–9.CrossRefGoogle Scholar
  5. 5.
    •• Tal R, Heck M, Teloken P, Siegrist T, Nelson CJ, Mulhall JP. Peyronie's disease following radical prostatectomy: incidence and predictors. J Sex Med. 2010;7:1254–61 This meta-analysis summarizes the research through early 2017 and lays the foundation for this review.CrossRefGoogle Scholar
  6. 6.
    Liu C, Lopez DS, Chen M, Wang R. Penile rehabilitation therapy following radical prostatectomy: a meta-analysis. J Sex Med. 2017;14:1496–503.CrossRefGoogle Scholar
  7. 7.
    Schwartz EJ, Wong P, Graydon RJ. Sildenafil preserves intracorporeal smooth muscle after radical retropubic prostatectomy. J Urol. 2004;171:771–4.CrossRefGoogle Scholar
  8. 8.
    Ferrini MG, Davila HH, Kovanecz I, Sanchez SP, Gonzalez-Cadavid NF, Rajfer J. Vardenafil prevents fibrosis and loss of corporal smooth muscle that occurs after bilateral cavernosal nerve resection in the rat. Urology. 2006;68:429–35.CrossRefGoogle Scholar
  9. 9.
    Kovanecz I, Rambhatla A, Ferrini MG, Vernet D, Sanchez S, Rajfer J, et al. Chronic daily tadalafil prevents the corporal fibrosis and veno-occlusive dysfunction that occurs after cavernosal nerve resection. BJU Int. 2008;101:203–10.PubMedGoogle Scholar
  10. 10.
    Mulhall JP, Müller A, Donohue JF, Mullerad M, Kobylarz K, Paduch DA, et al. The functional and structural consequences of cavernous nerve injury are ameliorated by sildenafil citrate. J Sex Med. 2008;5:1126–36.CrossRefGoogle Scholar
  11. 11.
    Jo JK, Jeong SJ, Oh JJ, Lee SW, Lee S, Hong SK, et al. Effect of starting penile rehabilitation with sildenafil immediately after robot-assisted laparoscopic radical prostatectomy on erectile function recovery: a prospective randomized trial. J Urol. 2018;199:1600–6.CrossRefGoogle Scholar
  12. 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
  13. 13.
    Leungwattanakij S, Bivalacqua TJ, Usta MF, Yang D-Y, Hyun J-S, Champion HC, et al. Cavernous neurotomy causes hypoxia and fibrosis in rat corpus cavernosum. J Androl. 2003;24:239–45.CrossRefGoogle Scholar
  14. 14.
    Chiles KA, Staff I, Johnson-Arbor K, Champagne A, McLaughlin T, Graydon RJ. A double-blind, randomized trial on the efficacy and safety of hyperbaric oxygenation therapy in the preservation of erectile function after radical prostatectomy. J Urol. 2017;199:805–11.CrossRefGoogle Scholar
  15. 15.
    Wang R. Vacuum erectile device for rehabilitation after radical prostatectomy. J Sex Med. 2017;14:184–6.CrossRefGoogle Scholar
  16. 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
  17. 17.
    Siena G, Mari A, Canale A, Mondaini N, Chindemi A, Greco I, et al. Sexual rehabilitation after nerve-sparing radical prostatectomy: free-of-charge phosphodiesterase type 5 inhibitor administration improves compliance to treatment. J Sex Med. 2018;15:120–3.CrossRefGoogle Scholar
  18. 18.
    Mondaini N, Cai T, Sarti E, Polloni G, Gavazzi A, Conti D, et al. A case series of patients who underwent laparoscopic extraperitoneal radical prostatectomy with the simultaneous implant of a penile prosthesis: focus on penile length preservation. World J Mens Health. 2018;36:132–8.CrossRefGoogle Scholar
  19. 19.
    Matz EL, Pearlman AM, Terlecki RP. Safety and feasibility of platelet rich fibrin matrix injections for treatment of common urologic conditions. Investig Clin Urol. 2018;59:61–5.CrossRefGoogle Scholar
  20. 20.
    Yiou R, Hamidou L, Birebent B, Bitari D, Lecorvoisier P, Contremoulins I, et al. Safety of intracavernous bone marrow-mononuclear cells for postradical prostatectomy erectile dysfunction: an open dose-escalation pilot study. Eur Urol. 2016;69:988–91.CrossRefGoogle Scholar
  21. 21.
    Li M, Lei H, Xu Y, Li H, Yang B, Yu C, et al. Exosomes derived from mesenchymal stem cells exert therapeutic effect in a rat model of cavernous nerves injury. Andrology. 2018;34:601.Google Scholar
  22. 22.
    Park J, Cho SY, Park K, Chai JS, Son H, Kim SW, et al. Role of inhibiting LIM-kinase2 in improving erectile function through suppression of corporal fibrosis in a rat model of cavernous nerve injury. Asian J Androl. 2018;20:372–8.CrossRefGoogle Scholar
  23. 23.
    Angeloni NL, Bond CW, Tang Y, Harrington DA, Zhang S, Stupp SI, et al. Regeneration of the cavernous nerve by sonic hedgehog using aligned peptide amphiphile nanofibers. Biomaterials. 2011;32:1091–101.CrossRefGoogle Scholar
  24. 24.
    Choe S, Bond CW, Harrington DA, Stupp SI, McVary KT, Podlasek CA. Peptide amphiphile nanofiber hydrogel delivery of sonic hedgehog protein to the cavernous nerve to promote regeneration and prevent erectile dysfunction. Nanomedicine. 2017;13:95–101.CrossRefGoogle Scholar
  25. 25.
    Haney NM, Nguyen HMT, Honda M, Abdel-Mageed AB, Hellstrom WJG. Bilateral cavernous nerve crush injury in the rat model: a comparative review of pharmacologic interventions. Sex Med Rev. 2018;6:234–41.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Scott Department of Urology and Center for Reproductive MedicineBaylor College of MedicineHoustonUSA

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