A new review article in the journal Sexual Medicine Reviews has addressed current knowledge on the topic of penile rehabilitation after surgery for localized prostate cancer.
The abstract of this new article by Osmonov et al. (who specialize in male andrology and erectile/sexual function at institutions at Kiel and Rendsburg in Germany) is currently available on line but once it is available in print it is an article that support group leaders and others may want to get a copy of for their files.
Osmonov et al. provide a careful and thorough review of the reasons why erectile and sexual function are usually so significantly affected after surgery — even among younger men who are given bilateral nerve-sparing procedures by highly skilled and experienced specialists. They also discuss the available data related to the use of drug therapies in the rehabilitation of penile function post-surgery.
The authors are clear that we still have no one “best” way to ensure recovery of good erectile function, but they are also clear that they believe certain forms of management can be helpful in assuring recovery of erectile function as soon as possible in those men for whom recovery of good erectile function will be possible. In doing this, they emphasize the following:
- The potential recovery of good erectile function is highest in men who have high-quality, bilateral nerve-sparing procedures carried out by skilled and experience surgeons.
- While the probability of recovery of good erectile function will be lower, it is also possible in men who have unilateral nerve-sparing (again carried out by skilled and experienced surgeons).
- Early initiation of rehabilitative treatment is key, and Osmonov et al. state that, in their experience, it should be initiated immediately following removal of the post-surgical catheter.
- There is no one “right” way to ensure recovery of good erectile function, but they state that they have had a high success level using procedures that are based on daily treatment with low-dose PDE-5 inhibitor therapy (e.g., with sildenafil/Viagra, tadalafil/Cialis, etc.) given each evening so as to help to stimulate spontaneous, nocturnal erections.
- The occurrence of spontaneous, nocturnal erection appears to be a key factor in the early recovery of erectile function.
The authors also emphasize that:
… the main principle is always the same: the increase of local oxygenation can achieve maximum rehabilitation of [erectile function] after [nerve-sparing radical prostatectomy]. Full erectile rehabilitation takes up to 24 months after surgery. However, the fact that it can take a long time until the first erection occurs should not lead the doctors to wait passively. Rehabilitation should should begin with supportive medication as soon as possible.
They refer to this strategy for penile rehabilitation as “the Kiel concept.”
Clearly this type of therapy is much less likely to be effective among patients who have not had at least unilateral nerve-sparing. For such patients other strategies may be required — up to and potentially including penile implants. We should also be clear that the quality of post-surgical erectile function is also likely to be highly dependent on the quality of pre-surgical erectile function.
Editorial note: The “New” Prostate Cancer InfoLink thanks Dr. Daniar Osmonov for providing us with a copy of the full text of this article that is currently in press in Sexual Medicine Reviews.