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Penile Rehabilitation Following Radical Prostatectomy

  • Authors: John P. Mulhall, MSc, MD
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Target Audience and Goal Statement

This activity is intended for urologists.

The goal of this activity is to bring clinicians who treat men who have undergone radical prostatectomy up to date with the latest research into expediting and optimizing recovery of erectile function.

Upon completion of this activity, participants will be able to:

  1. Review the probable mechanisms of erectile function and sexual dysfunction after radical prostatectomy
  2. Recognize current strategies in expediting the recovery of erectile function after radical prostatectomy
  3. Evaluate recent data on the rehabilitation of sexual function after RP


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  • John P. Mulhall, MSc, MD

    Associate Attending Physician, Memorial Sloan-Kettering Cancer Center, New York, NY


    Disclosure: John P. Mulhall, MSc, MD, has disclosed no relevant financial relationships.


  • David McNeel

    Editorial Director, Medscape Urology


    Disclosure: David McNeel has disclosed no relevant financial relationships.

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Penile Rehabilitation Following Radical Prostatectomy

Authors: John P. Mulhall, MSc, MDFaculty and Disclosures



Until relatively recently, men undergoing radical prostatectomy (RP) faced the distressing prospect of significant -- if not total -- loss of erectile function. Although the development of nerve-sparing techniques in recent years has improved the long-term prospects that a man might regain a somewhat normal sexual life, some compromise of erectile function is still common. In recent years, researchers have increasingly directed their efforts toward searching for interventions that might improve the speed and extent of recovery of sexual function.

The factors influencing the pace and overall success of rehabilitation are still uncertain. Growing evidence suggests that rehabilitation may be expedited by the early use of vacuum devices, phosphodiesterase (PDE)-5 inhibitors, and intracavernosal and transurethral agents. The push to shorten postsurgical recovery time is not mere impatience -- there is a growing recognition that the sooner the tissues regain function, the less damage they sustain from prolonged disuse. In other words, the earlier that effective measures for rehabilitation are undertaken, the more complete the recovery of sexual function. A number of studies have been done to clarify these issues, and some data are available, but we're still awaiting the release of definitive results. The purpose of this Clinical Update is to acquaint clinicians with progress in this area and with ongoing research.

To appreciate the strategy of penile rehabilitation after RP, several concepts need to be understood -- namely, the pathophysiology of erectile dysfunction (ED) after RP; cavernosal oxygenation; venous leak; the animal data supporting the use of PDE-5 inhibitors as a rehabilitation strategy; and the human data supporting use of PDE-5 inhibitors and intracavernosal injections as a means of preserving erectile tissue health and function.