Impact of penile rehabilitation with low-dose vardenafil on recovery of erectile function in Japanese men following nerve-sparing radical prostatectomy

Erectile dysfunction （ED） is a major complication after radical prostatectomy （RP）; however, debatecontinues regarding the efficacy of penile rehabilitation in the recovery of the postoperative erectile function （EF）. This study includeda total of 103 consecutive sexually active Japanese men with localized prostate cancer undergoing nerve-sparing RP, and analyzed the postoperative EF, focusing on the significance of penile rehabilitation. In this series, 24 and 79 patients underwent bilateral and unilateral nerve-sparing RPs, respectively, and 10 or 20 mg of vardenafil was administered to 35 patients at least once weekly, who agreed to undergo penile rehabilitation. Twelve months after RP, 48 （46.6%） of the 103 patients were judged to have recovered EF sufficient for sexual intercourse without any assistance. The proportion of patients who recovered EF in those undergoing penile rehabilitation （60.0%） was significantly greater than that in those without penile rehabilitation （38.2%）. Of several parameters examined, the preoperative International Index of Erectile Function-5 （IIEF-5） score and nerve-sparing procedure were significantly associated with the postoperative EF recovery rates in patients with and without management by penile rehabilitation, respectively. Furthermore, univariate analysis identified the preoperative IIEF-5 score, nerve-sparing procedure and penile rehabilitation as significant predictors of EF recovery, among which the preoperative IIEF-5 score and nerve-sparing procedure appeared to be independently associated with EF recovery. Considering these findings, despite the lack of independent significance, penile rehabilitation with low-dose vardenafil could exert a beneficial effect on EF recovery in Japanese men following nerve-sparing RP.

A review of regenerative therapies as penile rehabilitation in men following primary prostate cancer treatment:Evidence for erectile restoration and cavernous nerve regeneration

Objective:The following article explores our evolving understandings of the role of regenerative technology as an effective penile rehabilitation tool in men with erectile dysfunction(ED)in the setting of prostate cancer(PCa)treatment and PCa survivorship.Methods:This narrative clinical review paper summarizes what is currently known about various modalities of regenerative therapy in restoring spontaneous erectile function(EF)in men following PCa treatment with an emphasis on penile rehabilitation strategies.Results:Conventional medical therapy often does not reverse underlying endothelial dysfunction or promote neuro-vasculogenesis to preserve penile health in men with ED.Over the past decade,there has been considerable interest in the role of regenerative therapy to restore endothelial dysfunction and ED without future dependency on medical therapy.Regenerative therapy can be classified into cellular-based(immunomodulators,stem cells,and platelet-rich plasma),biomaterials(nerve graft transfer),and device-related technology(low-intensity shockwave).Although published literature shows early promise in the role of regenerative technology for ED,there is a paucity of high-quality clinical trials in the setting of penile rehabilitation and PCa survivorship to support their use as standard care and be adopted in clinical guidelines.

Vacuum therapy in penile rehabilitation after radical prostatectomy： review of hemodynamic and antihypoxic evidence

Generally, hypoxia is a normal physiological condition in the flaccid penis, which is interrupted by regular nocturnal erections in men with normal erectile function.1 Lack of spontaneous and nocturnal erections after radical prostatectomy due to neuropraxia results in persistent hypoxia of cavernosal tissue, which leads to apoptosis and degeneration of cavernosal smooth muscle fibers. Therefore, overcoming hypoxia is believed to play a crucial role during neuropraxia. The use of a vacuum erectile device （VED） in penile rehabilitation is reportedly effective and may prevent loss of penile length. The corporal blood after VED use is increased and consists of both arterial and venous blood, as revealed by color Doppler sonography and blood gas analysis. A similar phenomenon was observed in negative pressure wound therapy （NPWT）. However, NPWT employs a lower negative pressure than VED, and a hypoperfused zone, which increases in response to negative pressure adjacent to the wound edge, was observed. Nonetheless, questions regarding ideal subatmospheric pressure levels, modes of action, and therapeutic duration of VED remain unanswered. Moreover, it remains unclear whether a hypoperfused zone or PO2 gradient appears in the penis during VED therapy. To optimize a clinical VED protocol in penile rehabilitation, further research on the mechanism of VED, especially real-time PO2 measurements in different parts of the penis, should be performed.

Penile rehabilitation following prostate cancer treatment： review of current literature

Radical prostatectomy （RP） and radiotherapy （RT） are highly effective in improving prostate cancer survival. However, both have a detrimental effect on erectile function （EF）. Penile rehabilitation consists of understanding the mechanisms that cause erectile dysfunction （ED） and utilizing pharmacologic agents, devices or interventions to promote male sexual function. For the past decade, many researchers have pursued to define effective treatment modalities to improve ED after prostate cancer treatment. Despite the understanding of the mechanisms and well-established rationale for postprostate treatment penile rehabilitation, there is still no consensus regarding effective rehabilitation programs. This article reviews a contemporary series of trials that assess penile rehabilitation and explore treatment modalities that might play a role in the future. Published data and trials related to penile rehabilitation after RP and RT were reviewed and presented. Although recent trials have shown that most therapies are well-tolerated and aid in some degree on EF recovery, we penile rehabilitation algorithm. However, advancements in options for penile rehabilitation. currently do not have tangible evidence to recommend an irrefutable research and technology will ultimately create and refine management

Rehabilitation of erectile function following radical prostatectomy

The concept of muscle rehabilitation after nerve injury is not a novel idea and is practiced in many branches of medicine, including urology. Bladder rehabilitation after spinal cord injury is universally practiced. The erectile dysfunction （ED） experienced after radical prostatectomy （RP） is increasingly recognized as being primarily neurogenic followed by secondary penile smooth muscle （SM） changes. There is unfortunately no standard approach to penile rehabilitation after RP because controlled prospective human studies are not available. This article reviews the epidemiology, experimental pathophysiological models, rationale for penile rehabilitation, and currently published rehabilitation strategies.

Vacuum therapy prevents corporeal veno-occlusive dysfunction and penile shrinkage in a cavernosal nerve injured rat model

Erectile dysf un ction and penile shri nkage are the comm on complications after radical prostatectomy.Penile rehabilitati on is widely applied after the surgery.Vacuum therapy is one of the three penile rehabilitation methods used in the clinical setting,but its mechanism is not well known.This study was designed to investigate whether vacuum erectile device(VED)can prevent corporeal veno-occlusive dysfunction and penile shrinkage in the bilateral cavernous nerve crush(BCNC)rat model.Adult male Sprague-Dawley rats were randomly assigned into three groups:sham group,BCNC group,and BCNC+VED group.After 4 weeks,penile length and intracavernosal pressure(ICP)were measured,and then the middle part of the penis was harvested after dynamic inf usion caver no sometry to complete the followi ng items:smooth muscle/collage n ratios and collagenⅠ/Ⅲratios;ultramicrostructure of the tunica albuginea,endothelial cell,and smooth muscle cell;and the expression of calponin・l and osteopontin.The penile shortening,peak ICP and ICP drop rate after alprostadil injection were significantly improved with vacuum therapy after 4-week treatme nt.Compared with BCNC group,VED sign ifica ntly in creased smooth muscle/collagen ratios,decreased collagenⅠ/Ⅲratios,and preserved the ultramicrostructure of the tunica albuginea,endothelial cell,and smooth muscle cell.The data also showed that an imals exposed to VED could partially reverse the expression of calp onin・l and osteop ontin induced by BCNC.In conclusion,vacuum therapy is effective to prevent penile shrinkage and veno-occlusive dysfunction in penile rehabilitation,which may be associated with well-preserved structure and function of the tunica albuginea,endothelial cell,and smooth muscle cell.