Penile rehabilitation after radical prostatectomy
Radical prostatectomy in any of its forms (open, laparoscopic or robotic) is an intervention that is performed in patients with clinically localized prostate cancer who have a life expectancy of at least 10 years. This intervention may resolve with specific sequelae that will affect the quality of life related to sexual health. This functional result has become increasingly important considering that the the diagnosis of prostate cancer is becoming more frequent in younger patients. Research has revealed that around 25% -75% of men have post-operative erectile dysfunction.
Radical post-prostatectomy erectile dysfunction is multifactorial. Cavernous nerve injury induces pro-apoptotic (smooth muscle loss) and pro-fibrotic changes (collagen increase) to the cavernous bodies. These changes could also be due to insufficient oxygenation secondary to alterations in the irrigation of the cavernous bodies.
Treatment for penile rehabilitation after radical prostatectomy
The concept of penile rehabilitation arose in the 90’s decade with the evolution in the diagnosis and treatment of prostate cancer. Among its objectives, it aims to develop several erections per week that allow oxygenation of the cavernous bodies, preventing fibrosis, decreasing penile length and “venous drainage”. The final objective will be the prevention of a structural damage in order to improve the ability to recover the basal erectile function. For this, we use a strategy of multimodal treatment that combines oral medication, vasoactive drugs and vacuum devices. It is important to strictly follow up these patients as they will require dosing adjustments during their evolution.