Penile Rehabilitation After Radical Prostatectomy

Erectile dysfunction (ED) is the main and most frequent side effect after radical prostatectomy. Also, ED is the primary impact factor for quality of life after radical prostatectomy. ED post radical prostatectomy is mainly due to lesions in the neurovascular bundles which can occur by partial or total sectioning, by stretching (the most common), or by thermal lesion of the nervous fibers, leading to a condition called “neuropraxia”. The term penile rehabilitation (PR) after prostatectomy has been defined as any intervention with the intent of reestablishing preoperative erectile function and includes the isolated or combined use of phosphodiesterase 5 inhibitors (PDE5i), intracavernous injection, vacuum erectile device therapy, and use of intraurethral drugs. The use of intracavernous drugs, of intraurethral prostaglandin and the use of vacuum therapy have a poorly defined role regarding postoperative penile rehabilitation and must be better investigated through further studies. The use of PDE5i as PR is strongly supported by experimental research, but most clinical trials found controversial results.