Evidence for Erection Recovery After Radical Prostatectomy
Evidence for Erection Recovery After Radical Prostatectomy
Intraoperative interventions have been sought to extend concepts of anatomic RP surgery applying novel ways that protect or promote the function of nerves, vasculature and erectile tissue itself required for penile erection. Specific strategies have included refinements in surgical technique (e.g., visual magnification, high anterior release of the levator fascia, intrafascial neurovascular bundle preservation), procedures for neurovascular bundle localization and preservation (e.g., electrostimulation, mapping technologies), cavernous nerve reconstitution (e.g., nerve grafting), and cavernous nerve and erectile tissue health protection (e.g., growth factors, corticosteroids, erythropoietin). Similarly, intraoperative preservation of accessory pudendal vasculature supplying the penis has been proposed. Although all of these approaches are rational and possibly offer benefit, for many their roles have been suggested based on preliminary, uncontrolled investigations such that their therapeutic impacts remain unclear. Some strategies are also implausible based on their onerous administrations and limited indications amid current surgical-oncologic scenarios.
Postoperative strategies have amply suited the aims of erection rehabilitation. Broadly viewed, this practice encompasses the institution of any form of ED treatment that momentarily or permanently overcomes erection loss resulting from an EF insult (e.g., RP), irrespective of EF preservation or recovery considerations. However, an alternative, more exclusive premise is associated with erection rehabilitation: the implementation of an early post-EF insult (e.g., post-operative) program of intervention with the intention of facilitating the return of natural EF and resumption of medically unassisted sexual activity.
Proponents of the latter perception identify a role for penile rejuvenative interventions, which theoretically aim to maintain EF by activating normal physiologic processes of penile erection. These interventions typically exploit sexual stimulatory or blood flow conditions in the penis, which theoretically exert: (I) preserved cavernosal oxygenation, (II) protected endothelial function, and (III) reduced erectile tissue damage resulting from cavernous nerve injury. Therapy conceptually consists of a finite course of administration according to a specific protocol. Pharmacological interventions, among standard ED treatments, have been most frequently borrowed for this purpose, owing to their clinical availability, tolerability and general safety. These options include oral treatments, intracavernosal injections, and intraurethral suppositories. Other conventional ED interventions such as vacuum erection devices (VED) have also been proposed. Besides these "ED-specific" treatments, several conceptually "outside-the-box" therapeutic prospects targeting dysfunctional erection physiologic components have also been recently developed and explored.
Strategic Concepts for Improving Erectile Function Recovery
Intraoperative interventions have been sought to extend concepts of anatomic RP surgery applying novel ways that protect or promote the function of nerves, vasculature and erectile tissue itself required for penile erection. Specific strategies have included refinements in surgical technique (e.g., visual magnification, high anterior release of the levator fascia, intrafascial neurovascular bundle preservation), procedures for neurovascular bundle localization and preservation (e.g., electrostimulation, mapping technologies), cavernous nerve reconstitution (e.g., nerve grafting), and cavernous nerve and erectile tissue health protection (e.g., growth factors, corticosteroids, erythropoietin). Similarly, intraoperative preservation of accessory pudendal vasculature supplying the penis has been proposed. Although all of these approaches are rational and possibly offer benefit, for many their roles have been suggested based on preliminary, uncontrolled investigations such that their therapeutic impacts remain unclear. Some strategies are also implausible based on their onerous administrations and limited indications amid current surgical-oncologic scenarios.
Postoperative strategies have amply suited the aims of erection rehabilitation. Broadly viewed, this practice encompasses the institution of any form of ED treatment that momentarily or permanently overcomes erection loss resulting from an EF insult (e.g., RP), irrespective of EF preservation or recovery considerations. However, an alternative, more exclusive premise is associated with erection rehabilitation: the implementation of an early post-EF insult (e.g., post-operative) program of intervention with the intention of facilitating the return of natural EF and resumption of medically unassisted sexual activity.
Proponents of the latter perception identify a role for penile rejuvenative interventions, which theoretically aim to maintain EF by activating normal physiologic processes of penile erection. These interventions typically exploit sexual stimulatory or blood flow conditions in the penis, which theoretically exert: (I) preserved cavernosal oxygenation, (II) protected endothelial function, and (III) reduced erectile tissue damage resulting from cavernous nerve injury. Therapy conceptually consists of a finite course of administration according to a specific protocol. Pharmacological interventions, among standard ED treatments, have been most frequently borrowed for this purpose, owing to their clinical availability, tolerability and general safety. These options include oral treatments, intracavernosal injections, and intraurethral suppositories. Other conventional ED interventions such as vacuum erection devices (VED) have also been proposed. Besides these "ED-specific" treatments, several conceptually "outside-the-box" therapeutic prospects targeting dysfunctional erection physiologic components have also been recently developed and explored.
