- The controversy surrounding penile rehabilitation after radical prostatectomy
- Penile rehabilitation for post prostatectomy erectile dysfunction
The controversy surrounding penile rehabilitation after radical prostatectomy
The search strategy included the terms prostate cancer, penile rehabilitation, sexual function, radical prostatectomy, erectile dysfunction, phosphodiesterase.streaming
Generally, hypoxia is a normal physiological condition in the flaccid penis, which is interrupted by regular nocturnal erections in men with normal erectile function. Therefore, overcoming hypoxia is believed to play a crucial role during neuropraxia. The use of a vacuum erectile device VED in penile rehabilitation is reportedly effective and may prevent loss of penile length. The corporal blood after VED use is increased and consists of both arterial and venous blood, as revealed by color Doppler sonography and blood gas analysis. A similar phenomenon was observed in negative pressure wound therapy NPWT.
Central to discussions of penile rehabilitation after radical prostatectomy is evidence demonstrating significant fibrotic changes in the corpus cavernosum that occur postoperatively. Several studies have been published evaluating the efficacy of various pro-erectogenic agents. The limited data regarding intracavernous injections and vacuum constriction devices suggest that an increased percentage of treated patients experienced a return of natural erections compared with patients who received no treatment. Longer, prospective, randomized, placebo-controlled studies will be needed to confirm the utility of these treatments. Data from contemporary studies evaluating the chronic use of oral phosphodiesterase type 5 inhibitors suggest a beneficial effect on endothelial cell function among men suffering from erectile dysfunction due to a variety of causes. Limited data suggest that this effect might be seen among post-prostatectomy patients, implying a possible role for these agents in enhancing the return of sexual function in such individuals.
The American Cancer Society estimated that about 1 out of 7 men will be diagnosed with prostate cancer during his lifetime 1. The improvement and refinement in prostate cancer detection and treatment modalities have contributed to a younger patient population undergoing radical prostatectomy RP 2 , 3. Since the introduction of nerve-sparing techniques by Dr. We currently have a better understanding of the distribution of the neurovascular bundles NVBs and cavernous nerves. Walsh initially stated that the NVBs had a symmetrical course through the posterolateral surface of the prostate 5. Later on, others discovered that NVBs may have either an anterolateral distribution or, occasionally, a posterolateral and lateral distribution on each side, respectively. These new concepts led to the technique of incision of the periprostatic fascia anteriorly and parallel to the NVBs to preserve both the posterolateral and anterolateral cavernous nerves covering the prostate 6 - 8.
Based on mostly very-low and some low-quality evidence, penile rehabilitation strategies consisting of scheduled PDE5I use following radical.
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Think rehab, and you may conjure up the image of an athlete working his way back from a torn ligament or an older guy getting back on his feet after a total hip replacement. Penile rehabilitation is harder to picture. Indeed, it may sound more like a creative pick-up line than serious therapy, but it's a real, if unproven, program advanced by many urologists. Before you decide that penile rehabilitation sounds like fun, remember that it's triggered by a diagnosis of prostate cancer. About , American men will receive that diagnosis this year, and all will face the difficult decision of what to do next. Some men will choose to defer treatment "watchful waiting" and active surveillance programs. Others will decide to have radiation therapy external beam radiation or brachytherapy with implanted seeds.
Penile rehabilitation for post prostatectomy erectile dysfunction
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