Local therapies to heal the penis: fact or fiction?
Penile rehabilitation has been an area of intense study and debate over the last decade. Interest in this topic was stimulated by the observation that erectile dysfunction remained a significant problem after radical prostatectomy despite meticulous nerve-sparing technique. Smooth muscle alterations and fibrotic changes in the penis were identified as the underlying causes of penile atrophy, veno-occlusive dysfunction, and Peyronie's-like changes that were observed after surgery. Initial observations that intracavernous injection therapies used on a regular basis postoperatively resulted in improvements in the return of spontaneous erectile function led to the development of penile rehabilitation protocols. Chronic dosing of oral type V phosphodiesterase inhibitors is now commonly used by urologists after radical prostatectomy despite a lack of convincing evidence from randomized, placebo-controlled clinical trials. Use of local therapies to heal the penis may have applications beyond the postprostatectomy patient. This article reviews the current evidence behind penile rehabilitation therapy.
Kim
Edward D
ED
Division of Urology, Department of Surgery, University of Tennessee Graduate School of Medicine, 1928 Alcoa Hwy, Suite 222, Knoxville, TN 37920, USA. ekim@mc.utmck.edu
D000527:Alprostadil / Q000627:therapeutic use; D000818:Animals; D002986:Clinical Trials as Topic; D006801:Humans; D008297:Male; D010410:Penile Erection / Q000187:drug effects; D010413:Penis / Q000187:drug effects / Q000601:surgery*; D058986:Phosphodiesterase 5 Inhibitors; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D010879:Piperazines / Q000627:therapeutic use; D011468:Prostatectomy / Q000009:adverse effects / Q000534:rehabilitation*; D011687:Purines / Q000627:therapeutic use; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000627:therapeutic use
D058986:Phosphodiesterase 5 Inhibitors; D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate; D000527:Alprostadil