title: Penile rehabilitation after radical prostatectomy: does it work?
abstract: BACKGROUND
  Erectile dysfunction (ED) represents one of the most common long-term side effects in patients with clinically localized prostate cancer (PCa) undergoing nerve-sparing radical prostatectomy (RP).
  
  
  OBJECTIVE
  To analyze the role of penile rehabilitation in the recovery of erectile function (EF) after nerve-sparing RP.
  
  
  RESULTS
  Penile rehabilitation is defined as the use of any intervention or combination with the goal not only to achieve erections sufficient for satisfactory sexual intercourses, but also to return EF to preoperative levels. The concept of rehabilitation is based on the implementation of protocols aimed at improving oxygenation, preserving endothelial structure, and preventing smooth muscle structural alterations. Nowadays, the most commonly adopted approaches for penile rehabilitation after nerve-sparing RP are represented by the administration of phosphodiesterase type-5 inhibitors (PDE5-Is), intracorporeal injection therapy, vacuum erection devices (VED), and the combination of these therapies. Several basic science studies support the rational for the adoption of penile rehabilitation protocols. Particularly, rehabilitation, set as early as possible, seems to be better than leaving the erectile tissues unassisted. On the other hand, results from solid prospective randomized trials finally assessing the long-term beneficial effects of PDE5-Is, intracavernosal injections, or VED on EF recovery after surgery are still lacking.
  
  
  CONCLUSIONS
  Although preclinical evidences support the rationale for penile rehabilitation after nerve-sparing RP, clinical studies reported conflicting results regarding its efficacy on long-term EF recovery. Nowadays, which is the optimal rehabilitation program still represents a matter of debate.
authors.affiliation: 1 Unit of Urology/Department of Oncology, URI, IRCCS San Raffaele Hospital, Milan, Italy ; 2 Department of Urology, Medical University of Vienna, Vienna, Austria ; 3 Academic Department of Urology of La-Pitié-Salpétrière, Assistance-Publique Hôpitaux de Paris (AP-HP), University Paris 6, Paris, France.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gandaglia
authors.affiliation: 1 Unit of Urology/Department of Oncology, URI, IRCCS San Raffaele Hospital, Milan, Italy ; 2 Department of Urology, Medical University of Vienna, Vienna, Austria ; 3 Academic Department of Urology of La-Pitié-Salpétrière, Assistance-Publique Hôpitaux de Paris (AP-HP), University Paris 6, Paris, France.
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.affiliation: 1 Unit of Urology/Department of Oncology, URI, IRCCS San Raffaele Hospital, Milan, Italy ; 2 Department of Urology, Medical University of Vienna, Vienna, Austria ; 3 Academic Department of Urology of La-Pitié-Salpétrière, Assistance-Publique Hôpitaux de Paris (AP-HP), University Paris 6, Paris, France.
authors.forename: Vito
authors.initials: V
authors.lastname: Cucchiara
authors.affiliation: 1 Unit of Urology/Department of Oncology, URI, IRCCS San Raffaele Hospital, Milan, Italy ; 2 Department of Urology, Medical University of Vienna, Vienna, Austria ; 3 Academic Department of Urology of La-Pitié-Salpétrière, Assistance-Publique Hôpitaux de Paris (AP-HP), University Paris 6, Paris, France.
authors.forename: Marco
authors.initials: M
authors.lastname: Bianchi
authors.affiliation: 1 Unit of Urology/Department of Oncology, URI, IRCCS San Raffaele Hospital, Milan, Italy ; 2 Department of Urology, Medical University of Vienna, Vienna, Austria ; 3 Academic Department of Urology of La-Pitié-Salpétrière, Assistance-Publique Hôpitaux de Paris (AP-HP), University Paris 6, Paris, France.
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.affiliation: 1 Unit of Urology/Department of Oncology, URI, IRCCS San Raffaele Hospital, Milan, Italy ; 2 Department of Urology, Medical University of Vienna, Vienna, Austria ; 3 Academic Department of Urology of La-Pitié-Salpétrière, Assistance-Publique Hôpitaux de Paris (AP-HP), University Paris 6, Paris, France.
authors.forename: Morgan
authors.initials: M
authors.lastname: Roupret
authors.affiliation: 1 Unit of Urology/Department of Oncology, URI, IRCCS San Raffaele Hospital, Milan, Italy ; 2 Department of Urology, Medical University of Vienna, Vienna, Austria ; 3 Academic Department of Urology of La-Pitié-Salpétrière, Assistance-Publique Hôpitaux de Paris (AP-HP), University Paris 6, Paris, France.
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
authors.affiliation: 1 Unit of Urology/Department of Oncology, URI, IRCCS San Raffaele Hospital, Milan, Italy ; 2 Department of Urology, Medical University of Vienna, Vienna, Austria ; 3 Academic Department of Urology of La-Pitié-Salpétrière, Assistance-Publique Hôpitaux de Paris (AP-HP), University Paris 6, Paris, France.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: 1 Unit of Urology/Department of Oncology, URI, IRCCS San Raffaele Hospital, Milan, Italy ; 2 Department of Urology, Medical University of Vienna, Vienna, Austria ; 3 Academic Department of Urology of La-Pitié-Salpétrière, Assistance-Publique Hôpitaux de Paris (AP-HP), University Paris 6, Paris, France.
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
keywords: Prostate cancer (PCa); penile rehabilitation; phosphodiesterase type-5 inhibitors (PDE5-Is); radical prostatectomy (RP); sexual function
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