Current penile-rehabilitation strategies: Clinical evidence

Peer review under responsibility of Arab Association of Urology.

Abstract

We review the current strategies used for penile rehabilitation (PR) after a radical prostatectomy, where PR is defined as the attempt to restore spontaneous erectile function so that the patient can generate erections with no need for erectile aids. We searched PubMed for relevant reports, using the keywords ‘radical prostatectomy’, ‘penile rehabilitation’, ‘phosphodiesterase inhibitors’, ‘vacuum erection device’, ‘injection therapy’, ‘urethral suppository’, and ‘erectile dysfunction’. In all, 155 articles were identified and reviewed, and had a level of evidence ranging from 1b-4. The use of PR strategies should be based on the patient’s goals after a thorough explanation of realistic expectations, and the risks and consequences of the various treatment options. While a multitude of studies suggest a benefit with PR strategies, there are no established, proven regimens. Further research is needed to establish the optimal approaches to PR.

Keywords:

• Erectile dysfunction
• Radical prostatectomy
• Phosphodiesterase inhibitor
• Vacuum erection device
• Injection therapy

Abbreviations:

• PR, penile rehabilitation
• RP, radical prostatectomy
• ED, erectile dysfunction
• PDE-5, phosphodiesterase-5
• IIEF-EF, international index of erectile function-erectile function domain
• CCI, Charlson comorbidity index
• ICI, intracavernous injection
• VED, vacuum erection device
• IUA, intraurethral alprostadil
• SHIM, sexual health in men (questionnaire)

Notes

Peer review under responsibility of Arab Association of Urology.