Penile rehabilitation after radical prostatectomy
Authors:
Marek Broul 1-3; Aneta Hujová 3
Authors‘ workplace:
Sexuologické oddělení, Krajská zdravotní, a. s. –, Masarykova nemocnice, v Ústí nad Labem, o. z
1; Urologické oddělení, Krajská zdravotní, a. s. –, Nemocnice Litoměřice, o. z.
2; Fakulta zdravotnických studií, UJEP v Ústí nad Labem
3
Published in:
Ces Urol 2025; 29(3): 141-145
Category:
Review article
doi:
https://doi.org/10.48095/cccu2025020
Overview
Penile rehabilitation after radical prostatectomy is a multimodal approach aimed at supporting the recovery of erectile function through a combination of pharmacotherapy, mechanical devices, and other interventional methods. Available clinical studies suggest that early, structured protocols may help a subset of patients preserve or regain erectile function; however, the quality of evidence is uneven and findings are heterogeneous. The most commonly used modalities include phosphodiesterase type 5 inhibitors and vacuum erection devices. Other approaches – such as low-intensity extracorporeal shock wave therapy or penile vibratory stimulation – have been investigated mainly in small cohorts, and their routine use cannot yet be considered standard of care. Intracavernosal alprostadil remains an option for patients with insufficient response to oral therapy. Regenerative strategies, including the use of stem cells, are the subject of ongoing clinical research. From a practical standpoint, the timing and combination of modalities should be individualized with respect to surgical technique, comorbidities, patient preferences, and interim treatment response. Given the limited and inconsistent evidence, the potential benefits of penile rehabilitation should be interpreted with caution, and further robust, long-term studies are needed to clarify its true effect and to define optimal treatment strategies.
Keywords:
erectile dysfunction – phosphodiesterase type 5 inhibitor – vacuum erection device – low-intensity extracorporeal shock wave therapy – nerve-sparing radical prostatectomy
Sources
1. EAU Guidelines on sexual and reproductive health. [online]. Available from: https://uroweb.org/guidelines/sexual-and-reproductive-health.
2. Šrámková T. Důsledky komplexní onkologické léčby na mužskou sexualitu. Ces Urol 2023; 27(4): 243–250. doi: 10.48095/cccu2023032.
3. Kubíček V. Sexuální dysfunkce po radikálních uroonkologických výkonech. Urol Praxi 2018; 19(5): 234–236.
4. Montorsi F, Guazzoni G, Strambi LF et al. Recovery of spontaneous erectile function after nerve-sparing radical retropubic prostatectomy with and without early intracavernous injections of alprostadil: results of a prospective, randomized trial. J Urol 1997; 158(4): 1408–1410.
5. Salter CA. Penile rehabilitation 2024: Where are we? AUA News 2024. [online]. Available from: https://auanews.net/issues/articles/2024/august-2024/aua2024-recaps-penile-rehabilitation-2024-where-are-we.
6. Prasad R, Wanjari M, Lamture YR et al. Penile rehabilitation effectiveness after prostate cancer treatment: a systematic review of randomized con-
trolled trials. Narra J 2023; 3(2): e174. doi: 10.52225/narra.v3i2.174.
7. Motlagh RS, Abufaraj M, Yang L et al. Penile rehabilitation strategy after nerve sparing radical prostatectomy: a systematic review and network meta-analysis of randomized trials. J Urol 2021; 205(4): 1018–1030. doi: 10.1097/JU.0000000000001584.
8. Hannan JL, Matsui H, Sopko NA et al. Caspase-3 dependent nitrergic neuronal apoptosis following cavernous nerve injury is mediated via RhoA and ROCK activation in major pelvic ganglion. Sci Rep 2016; 6 : 29416.
9. Latcu SC, Novacescu D, Buciu VB et al. The cavernous nerve injury rat model: a pictorial essay on post-radical prostatectomy erectile dysfunction research. Life 2023; 13(12): 2337. doi: 10.3390/life13122337.
10. Leungwattanakij S, Bivalacqua TJ, Usta MF et al. Cavernous neurotomy causes hypoxia and fibrosis in rat corpus cavernosum. J Androl 2003; 24(2): 239–245. doi: 10.1002/j.1939-4640.2003.tb02668.x.
11. Lin H, Wang R. The science of vacuum erectile device in penile rehabilitation after radical prostatectomy. Transl Androl Urol 2013; 2(1): 61–66. doi: 10.3978/j.issn.2223-4683.2013.01.04.
12. Kaltsas A, Zikopoulos A, Dimitriadis F et al. Oxidative stress and erectile dysfunction: pathophysiology, impacts, and potential treatments. Curr Issues Mol Biol 2024; 46(8): 8807–8834. doi: 10.3390/cimb46080521.
13. Song G, Hu P, Song J et al. Molecular pathogenesis and treatment of cavernous nerve injury-induced erectile dysfunction: a narrative review. Front Physiol 2022; 13 : 1029650. doi: 10.3389/fphys.2022.1029650.
14. Li M, Yuan YM, Yang BC et al. Comparative study of intracavernous pressure and cavernous pathology after bilateral cavernous nerve crushing and resection in rats. Asian J Androl 2020; 22(6): 629–635. doi: 10.4103/aja.aja_10_20.
15. Qian SQ, Qin F, Zhang S et al. Vacuum therapy prevents corporeal veno-occlusive dysfunction and penile shrinkage in a cavernosal nerve injured rat model. Asian J Androl 2020; 22(3): 274–279. doi: 10.4103/aja.aja_57_19.
16. Perez DM. Current developments on the role of α1-adrenergic receptors in cognition, cardioprotection, and metabolism. Front Cell Dev Biol 2021; 9 : 652152. doi: 10.3389/fcell.2021.652152.
17. Davis BJ, Chapple CR, Sellers DJ et al. α1L-adrenoceptors mediate contraction of human erectile tissue. J Pharmacol Sci 2018; 137(4): 366–371. doi: 10.1016/j.jphs.2018.08.003.
18. Sezen SF, Lagoda G, Burnett AL. Neuronal nitric oxide signaling regulates erection recovery after cavernous nerve injury. J Urol 2012; 187(2): 757–763. doi: 10.1016/j.juro.2011.09.146.
19. Cho MC, Lee J, Park J et al. Restoration of cavernous veno-occlusive function through chronic administration of a Jun-amino terminal kinase inhibitor and a LIM-kinase 2 inhibitor by suppressing cavernous apoptosis and fibrosis in a rat model of cavernous nerve injury: a comparison with a phosphodiesterase type 5 inhibitor. World J Mens Health 2021; 39(3): 541–549. doi: 10.5534/wjmh.200085.
20. Salter CA, Tin AL, Bernie HL et al. Predictors of worsening erectile function in men with functional erections early after radical prostatectomy. J Sex Med 2022; 19(12): 1790–1796. doi: 10.1016/j.jsxm.2022.08.193.
21. Miranda EP, Benfante N, Kunzel B et al. A randomized, controlled, 3-arm trial of pharmacological penile rehabilitation in the preservation of erectile function after radical prostatectomy. J Sex Med 2021; 18(2): 423–429. doi: 10.1016/j.jsxm.2020.10.022.
22. Broul M, Štrbavý M, Skála P. Hodnocení erektilní dysfunkce po roboticky asistované radikální prostatektomii. Ces Urol 2014; 18(4): 324–333. doi: 10.48095/cccu2014046
23. Pirola GM, Naselli A, Maggi M et al. Vacuum erection device for erectile function rehabilitation after radical prostatectomy: which is the correct schedule? Results from a systematic, scoping review. Int J Impot Res 2024; 36(3): 194–200. doi: 10.1038/s41443-023-00700-w.
24. Kohada Y, Babasaki T, Goto K et al. Long-term efficacy of penile rehabilitation with low-intensity extracorporeal shock wave therapy for sexual and erectile function recovery following robotic-assisted radical prostatectomy: a single-cohort pilot study. Sex Med 2023; 11(2): qfad023. doi: 10.1093/sexmed/qfad023.
25. Fode M, Borre M, Ohl DA et al. Penile vibratory stimulation in the recovery of urinary continence and erectile function after nerve-sparing radical prostatectomy: a randomized, controlled trial. BJU Int 2014; 114(1): 111–117. doi: 10.1111/bju.12501.
26. Jeon SH, Shrestha KR, Kim RY et al. Combination therapy using human adipose-derived stem cells on the cavernous nerve and low-energy shockwaves on the corpus cavernosum in a rat model of post-prostatectomy erectile dysfunction. Urology 2016; 88 : 226.e1–9. doi: 10.1016/j.urology.2015.10.021.
27. Motlagh RS, Abufaraj M, Yang L et al. Penile rehabilitation strategy after nerve sparing radical prostatectomy: a systematic review and network meta-analysis of randomized trials. J Urol 2021; 205(4): 1018–1030. doi: 10.1097/JU.0000000000001584.
28. ISSM. Penile rehabilitation after radical prostatectomy. [online]. Available from: https://www.issm.info/sexual-health-headlines/penile-
rehabilitation-after-radical-prostatectomy.
Labels
Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
2025 Issue 3
Most read in this issue
- Editorial
- Modeling human kidney in vitro – the potential of renal organoids and tubuloids for urology
- Penile rehabilitation after radical prostatectomy
- Incidental finding of prostate cancer during surgery for benign prostatic hyperplasia – how to proceed?