scholarly journals Penile rehabilitation in patients after radical prostatectomy

2021 ◽  
Vol 14 (3) ◽  
pp. 73-79
Author(s):  
A.E. Osadchinskii ◽  
◽  
I.S. Pavlov ◽  
S.V. Kotov ◽  
◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Treatment Modalities ◽  
Nerve Sparing ◽  
Combined Approach ◽  
Shock Wave Therapy ◽  
Psychosocial Status ◽  
Rehabilitation Programs ◽  
Main Components ◽  
Penile Rehabilitation

Introduction. Prostate cancer (PCa) is one of the most common cancers in men. Radical prostatectomy (RP) is one of the main treatment modalities for localized PCa. Erectile dysfunction (ED), being a consequence of surgical treatment, can have detrimental effects on both physical health and psychosocial status and significantly impair the quality of life of patients and their partners. The risk of ED in the postoperative period in patients undergoing RP, according to the modern literature, is about 60–70%. Materials and methods. The paper describes in detail the pathogenesis of ED after RP. The main components of penile rehabilitation (PR) and their mechanism of action are described, literature data confirming their effectiveness is presented. Results. Currently, after nerve-sparing radical prostatectomy, the following penile rehabilitation methods are used - the use of inhibitors of PDE-5 type, shock wave therapy, vacuum erection therapy (VED), intracavernous injections, penile prosthetics and a combination of these methods. Combined rehabilitation programs promote EF recovery after RP with better results compared to monotherapy. Conclusion. We see a perspective in the development of combined approach strategies for the rehabilitation of erectile funktion (EF) after RP. Further improvement of the surgical technique of nerve-sparing RP, as well as a deeper understanding of the implementation of the postoperative process is crucial to develop an algorithm for the EF restoration program.

scholarly journals Penile Rehabilitation and Neuromodulation

2009 ◽  
Vol 9 ◽  
pp. 652-664 ◽  
Author(s):  
Fernando Facio ◽  
Arthur L. Burnett
Keyword(s):  
Prostate Cancer ◽  
Nerve Sparing ◽  
Prostate Cancer Treatment ◽  
Definitive Evidence ◽  
Rehabilitation Programs ◽  
Clinical Trial Evidence ◽  
Trial Evidence ◽  
Penile Rehabilitation

Erectile dysfunction (ED) following treatment for clinically localized prostate cancer, particularly radical prostatectomy (RP), is a major quality of life issue that remains unsatisfactorily addressed. With the introduction and use of cavernous nerve–sparing procedures over the past 25 years, many men recover erections postoperatively that enable sexual intercourse unlike in the prior surgical era, when permanent ED postoperatively was certain. Despite this advance, 26–100% of these patients may never recover normal erectile function (EF). Recent advances in the understanding of ED after RP have stimulated great attention to develop penile rehabilitation programs and neuromodulation. The purpose of penile rehabilitation is to prevent adverse corpus cavernosal tissue structural alterations and thereby maximize the chances of recovering functional erections. Rehabilitation programs are common in clinical practice, but there is no definitive evidence to support their efficacy. Neuromodulation represents another strategy for promoting erection recovery postoperatively. This therapy involves the application of neuroprotective interventions, conceivably targeting biological elements involved in the erection response that are affected by neuropathic injury. Well-conducted, controlled trials with adequate follow-up are required in order to determine the erection preservative benefits of these therapeutic strategies. The purpose of this essay is to describe the mechanisms related to post-RP ED, assess the need for penile rehabilitation and neuromodulation following surgery, and analyze the basic science and clinical trial evidence associated with these applications for preserving EF following prostate cancer treatment.

scholarly journals Is There a Rationale for Penile Rehabilitation Following Radical Prostatectomy?

2014 ◽  
Vol 9 (1) ◽  
pp. 35-43 ◽  
Author(s):  
Yagil Barazani ◽  
Peter J. Stahl ◽  
Harris M. Nagler ◽  
Doron S. Stember
Keyword(s):  
Radical Prostatectomy ◽  
Erectile Function ◽  
Tissue Injury ◽  
Conclusive Evidence ◽  
Nerve Sparing ◽  
Erectile Tissue ◽  
Function Recovery ◽  
Actual Use ◽  
Penile Rehabilitation

Erectile function recovery after radical prostatectomy (RP) is an increasingly prominent quality-of-life outcome following surgery. Following RP many men, despite the advent of cavernous nerve-sparing surgical technique, have moderately or significantly impaired erectile function (EF). The term penile rehabilitation (PR) is used to define interventions that maintain the health of erectile tissue in the context of nervous, vascular, and structural tissue injury. The goal of PR is to regain, as closely re-approximate, preoperative erectile function. PR is based on an increasing volume of preclinical and clinical data, but conclusive evidence of efficacy has not been established, and therefore the concept of PR remains controversial. The optimal PR regimen has not been established, but all strategies rely on one or more erectile dysfunction treatments to be administered on a regular basis regardless of actual use for sexual activity. This review highlights recent studies and evidence related to PR.

QUALITY OF LIFE AFTER RADICAL PROSTATECTOMY - THE INFLUENCE OF THE NERVE-SPARING TECHNIQUE

2006 ◽  
Vol 5 (2) ◽  
pp. 321
Author(s):  
D. Seiler ◽  
M. Kwiatkowski ◽  
J. Gregorin ◽  
B. Arndt ◽  
P. Bueschel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Radical Prostatectomy ◽  
Nerve Sparing

Quality of life after brachytherapy or bilateral nerve-sparing robot-assisted radical prostatectomy for prostate cancer: a prospective cohort

2017 ◽  
Vol 121 (4) ◽  
pp. 540-548 ◽  
Author(s):  
Pierre Blanchard ◽  
John W. Davis ◽  
Steven J. Frank ◽  
Jeri Kim ◽  
Curtis A. Pettaway ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Prospective Cohort ◽  
Nerve Sparing ◽  
Robot Assisted

Rationale for early penile rehabilitation following nerve-sparing radical prostatectomy

2007 ◽  
Vol 4 (3) ◽  
pp. 101-106
Author(s):  
Rupesh Raina ◽  
Geetu Pahlajani ◽  
Craig D. Zippe ◽  
Ashok Agarwal
Keyword(s):  
Radical Prostatectomy ◽  
Nerve Sparing ◽  
Penile Rehabilitation

Topical alprostadil (Vitaros©) in the treatment of erectile dysfunction after non-nerve-sparing robot-assisted radical prostatectomy

2017 ◽  
Vol 85 (2) ◽  
pp. 55-59 ◽  
Author(s):  
Pier Andrea Della Camera ◽  
Simone Morselli ◽  
Gianmartin Cito ◽  
Giovanni Tasso ◽  
Nicola Laruccia ◽  
...  
Keyword(s):  
Erectile Dysfunction ◽  
Radical Prostatectomy ◽  
Sexual Intercourse ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Nerve Sparing ◽  
Robot Assisted ◽  
Ecog Performance Status ◽  
Comorbidity Index

Objective: The aim of the study is the evaluation of the efficacy and safety of the treatment with topical alprostadil (Vitaros©) in post-robot assisted radical prostatectomy (RARP) rehabilitation therapy of patients with erectile dysfunction (ED). Methods: Seventy-four patients were enrolled and underwent non-nerve-sparing RARP. Inclusion criteria: age <75, preoperatively International Index of Erectile Function (IIEF-5) >16, erection hardness score (EHS) ⩾2, weekly sexual intercourse ⩾1, affirmative answers to Sexual Encounter Profile Question (SEP-Q) 2 and SEP-Q3, Charlson Comorbidity Index (CCI) ⩽5, Eastern Cooperative Oncology Group (ECOG) performance status ⩽1, no moderate/severe cardiovascular disease. Results: Vitaros was administered ⩾2 twice a week. At month 6, the IIEF-5 decreased from 20.5 preoperative to 18.1 post-treatment. EHS score decreased from a mean of 3.3 to a mean of 3.0. The quality of life score decreased from an average of 5.1 to 2.3. Weekly sexual intercourse decreased from an average of 2.1 to 1.7. Six patients dropped out; 89.7% patients showed a positive SEP-Q2 and 77.8% a positive SEP-Q3. All patients responded positively to Global Assessment Questions (GAQ)-1 and 97% to GAQ-2. Of all 68 analyzed patients, 13 (17.6%) switched to intracavernous injection therapy. Conclusions: In conclusion, Vitaros may become a viable alternative to common injective therapies in well-selected patients after RARP.

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