title: Penile rehabilitation after radical prostatectomy: what the evidence really says.
abstract: The pathophysiology of erectile dysfunction after radical prostatectomy (RP) is believed to include neuropraxia, which leads to temporarily reduced oxygenation and subsequent structural changes in penile tissue. This results in veno-occlusive dysfunction, therefore, penile rehabilitation programmes focus on tissue oxygenation. Animal studies support the use of phosphodiesterase type 5 inhibitors (PDE5Is) after cavernous nerve damage but results from human studies are contradictory. The largest study to date found no long-term effect of either daily or on-demand PDE5I administration after RP compared with placebo. The effects of prostaglandin and vacuum erection devices are questionable and high-quality studies are lacking. Better documentation for current penile rehabilitation and/or better rehabilitation protocols are needed. One must be careful not to repeat the statement that penile rehabilitation improves erectile function after RP so many times that it becomes a truth even without the proper scientific backing.
authors.affiliation: Department of Urology, Herlev University Hospital, Herlev, Denmark.
authors.forename: Mikkel
authors.initials: M
authors.lastname: Fode
authors.forename: Dana A
authors.initials: DA
authors.lastname: Ohl
authors.forename: David
authors.initials: D
authors.lastname: Ralph
authors.forename: Jens
authors.initials: J
authors.lastname: Sønksen
mesh_terms: D000527:Alprostadil / Q000008:administration & dosage; D000818:Animals; D002986:Clinical Trials as Topic; D007172:Erectile Dysfunction / Q000209:etiology* / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D010410:Penile Erection; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use; D011468:Prostatectomy / Q000009:adverse effects* / Q000534:rehabilitation*; D013811:Psychotherapeutic Processes; D014618:Vacuum
chemical_list: D058986:Phosphodiesterase 5 Inhibitors; D000527:Alprostadil
keywords: erectile dysfunction; penile rehabilitation; prostate cancer; radical prostatectomy