Erection rehabilitation following prostatectomy - current strategies and future directions.

Despite continued advances in urological surgery, erectile dysfunction (ED) remains a serious adverse effect of radical prostatectomy. In this setting, ED is predominantly caused by injury to the neurovascular bundles, which lie alongside the prostate and are responsible for initiating and maintaining the erectile response.

Most men will experience some degree of ED after radical prostatectomy, although erectile function outcomes have already remarkably improved since the development of nerve-sparing surgical techniques. To further improve outcomes, erection rehabilitation strategies are being investigated, which emphasize early treatment regimens with the aim of preventing adverse remodelling after surgery and preserving erectile function. Strategies include pharmacological therapy, mechanical therapy and psychosocial support. In addition, novel therapeutic approaches involving new targets for small-molecule treatments and regenerative medicine therapies are being developed to aid in restoring erectile function. Although ED treatments can be effective following radical prostatectomy, no specific erection rehabilitation regimen has currently been shown to be superior to other investigated rehabilitation regimens. Nevertheless, the different strategies rightfully remain an area of intensive research, as preservation of erectile function is a critical part of providing comprehensive care for men with prostate cancer to ensure their overall well-being, in contrast to just treating a patient's tumour.

Nature reviews. Urology. 2016 Mar 15 [Epub ahead of print]

Nikolai A Sopko, Arthur L Burnett

The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, 1800 Orleans Street, Baltimore, Maryland 21287, USA., Department of Urology, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Baltimore, Maryland 21287-2411, USA.