title: Local therapies to heal the penis: fact or fiction?
abstract: 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.
authors.affiliation: 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
authors.forename: Edward D
authors.initials: ED
authors.lastname: Kim
mesh_terms: 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
chemical_list: D058986:Phosphodiesterase 5 Inhibitors; D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate; D000527:Alprostadil