29
Aug

Data Supporting the Concept of Penile Rehabilitation

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In summary, as practicing physicians we appreciate that the consequences of ED are pro-found for many men. In a 55 year old men who was asymptomatic prior to his prostate biopsy, who had a mildly elevated PSA and ends up having a radical prostatectomy long-term ED is a major source of psychological distress in his life.

I believe that the above data shows that cavernosal smooth muscle alterations are common early after prostatectomy; that venous leak imparts a poor prognosis for recovery of natural and PDE5 inhibitor-assisted erections; that the animal evidence is robustly supportive of the concept that erectile function preservation can be achieved using PDE5 inhibitors; that there is a signal from human data that early erections after surgery and regular sildenafil citrate in Australia use is of some benefit to the recovery of erectile function. Despite this, there is yet to be conducted at large randomized controlled trial that definitively answers the role of injection therapy versus PDE5 inhibitors.

More recently, two other strategies have been explored for the purposes of penile rehabilitation postprostatectomy. Vacuum device therapy has been around for more than a century and has continued to assume a role in the management of men with erectile dysfunction treatment – look at here now. A number of centers have studied the role of vacuum device therapy for the preservation of penile length postprostatectomy as well as for rehabilitation.

It has been well documented that the pO2 and pCO2 levels in the cavernosal sinusoids following the application of a vacuum device remain in the venous range. Indeed the oxygen saturation is approximately 80%. If one believes that cavernosal oxygenation is critical to erectile tissue health and penile rehabilitation outcomes, this finding would undermine the role of vacuum device therapy as a rehabilitation strategy.

Raina et al. study 109 patients who were randomized to vacuum device use daily for 9 months versus observation. Thirty-two percent of patients in the vacuum device rehabilitation group versus 37% in the observation group had recovery of natural erections at 9 months after surgery. Seventy percent of the vacuum device patients and 29% of those not using vacuum device were able to have sexual intercourse at that time. Dalkin et al. studied 39 men with good preoperative erectile function who underwent nerve sparing radical prostatectomy. Stretched flaccid penile length was evaluated preoperatively and at 3-month postoperatively by a single examiner. The vacuum device was used daily starting the day after catheter removal and was continued for 90 days.

In men using the vacuum device on more than 50% of the possible days, only 3% had a decrease in stretched flaccid penile length of greater than 1 cm. Of the three men with poor vacuum device compliance 67% had a penile length reduction of more than 1 cm. Kohler et al. analyzed 28 men who were randomized to early vacuum device or a control group. The vacuum device group had therapy commenced 1 month after radical prostatectomy while the control group had vacuum therapy instituted 6 months after radical prostatectomy.