Penile rehabilitation is defined as the use of vacuum therapy device at or after radical prostatectomy to maximize erectile function recovery. This is an up-to-date review of the current state of science supporting penile rehabilitation after radical prostatectomy.
Penile Rehabilitation
After pelvic cancer (e.g., prostate, bladder, rectal) treatment, the normal physiology of penile erections can be altered. Nerve and blood vessel injury or manipulation can impair normal erections, penile oxygenation, and long term penile and sexual health.
The goal of penile rehabilitation is to help minimize the negative impacts on a mans sexual function and expedite recovery of sexual function. Our program begins either weeks before your surgery or afterwards.
We know that daily erections are natural and necessary and that without erections atrophy and scarring can develop. Thus, interventions aimed at preserving sexual function must allow regular erections. We tailor a specific treatment regimen to each patient based on baseline erectile function and the patients own goals. We welcome input and assistance from the patients partner in order to help maximize rehabilitation success.
Clinical studies support early and aggressive therapies for post therapy erectile dysfunction which can help more rapid and complete recovery of sexual function. Using an evidence-based approach, therapies incorporated into the Stanford Penile Rehabilitation Program include:
Oral medications
Injection therapy
Urethral suppositories
Vacuum erection devices
Testosterone replacement
What is Penile Rehabilitation?
One of the exciting developments in urology that occurred over the last decade has been the improvements in treating erectile dysfunction after radical prostatectomy for prostate cancer through a process called penile rehabilitation. Patients who have erectile dysfunction after prostate cancer surgery can see spontaneous improvement in their erectile dysfunction up to three years after the surgery, but often the erection that they do get are inadequate for intercourse.
Why Should I do Penile Rehabilitation?
Penile rehabilitation has been shown to shorten the time for recovery of erections and give firmer longer lasting erections over the long run for patients. It may also minimize penile shortening after radical prostatectomy that many patients complain of.
How is Penile Rehabilitation done?
Penile rehabilitation is typically done in two different ways, which can be combined. One is to take a low dose tablet such as Viagra, Cialis, or Levitra everyday to increase the blood flow to the penis. This prevents scar tissue from forming in the two cylinders that create erections, called the corpora cavernosa. This scar tissue prevents the normal functioning of the corpora and makes erections more difficult to obtain. The advantage this regimen is that tablets are very easy to take and the patient requires very little training to do this. This works even if patients do not get erections from taking these tablets. The disadvantage is the cost can be fairly high, particularly if insurance coverage is a problem for patients.
An alternative way of doing penile rehabilitation is to have patient get a good erection using medications at least 2 or 3 times a week. If oral tablets do not work, then this can be done using MUSE, which is a intraurethral suppository or injection of medications into the side of the penis (intracorporeal injections) at least two to three times a week to get a good erection. This also increases the blood flow into the penis, prevents the scar tissue from forming and has been demonstrated to have maximize long term outcomes.
As mentioned earlier, both of these daily dose medicines as well as injections or MUSE can be combined in a penile rehab regimen. The exact regimen that is best for you should be determined by a doctor after evaluation of your overall medical condition and after careful evaluation.