Post Prostatectomy Rehab

By /

As rehabilitation professionals, we must ask ourselves: Are we fully educating our patients on all available rehab techniques, beyond just Kegels? Here’s an evidence-based overview of penile rehabilitation following radical prostatectomy, emphasizing the importance of a comprehensive approach to restore erectile function and maintain overall penile health.

 

Understanding Penile Rehabilitation

Penile rehabilitation focuses on enhancing blood flow to the penis after radical prostatectomy (removal of the prostate). Even with nerve-sparing techniques, the cavernous nerves—essential for erections—can sustain trauma. This injury, known as neuropraxia, may require up to two years to recover, potentially leading to temporary or prolonged changes in erectile function.

 

Why Rehabilitation Is Critical

  • Preservation of Function: Rehabilitation helps sustain blood flow and minimizes the risk of venous leakage, where the veins fail to maintain blood within the penis.
  • Preventing penile atrophy: The “use it or lose it” principle is fundamental in penile rehabilitation.
  • Prevention of Fibrosis: Consistent treatment can reduce the formation of scar tissue (fibrosis), which may otherwise contribute to conditions such as Peyronie’s disease.
  • Maintenance of Penile Length: Emerging evidence suggests that a well-structured rehabilitation program may help restore or maintain penile length, which is compromised after surgery.

 

Key Rehabilitation Techniques

  1. Mechanical Devices:
    • Penile Pump/Vacuum Device: Utilizes negative pressure to draw blood into the penis, assisting in achieving an erection. 
  2. Medications:
    • Intracavernosal Injections: Direct injection of medications like Trimix or Caverject into the penis to induce an erection.
    • Low-Dose PDE5 Inhibitors: Daily administration of drugs such as Viagra or Cialis is used to enhance blood flow and protect the endothelial cells lining blood vessels. It’s important to note that these drugs depend on functional erectile nerves to produce an erection, so their role is primarily to provide vascular support.
  3. Sexual Activity:
    • Regular Arousal and Orgasm: Encouraging regular sexual activity, whether through masturbation or with a partner, is beneficial. Even without an erection, achieving orgasm (which will be dry post-surgery due to the removal of the prostate and seminal vesicles) can significantly improve blood flow.
  4. Pelvic Floor Exercises:
    • Strengthening Muscles: Targeting the pelvic floor muscles can enhance blood flow and support neural arousal signals, contributing to improved erectile function.
  5. Cardiovascular Exercise:
    • Overall Circulation: Regular cardiovascular workouts are crucial for heart health and circulation, which in turn supports erectile health.

Remember, as rehab professionals, education is our most important treatment. Educate patients on all the available options they can be utilizing

 

Final Considerations for Providers

While these strategies show considerable promise, recovery is a gradual process and patient outcomes may vary. It is essential to have open, detailed discussions with patients about these options. Tailoring a rehabilitation program that addresses each individual’s needs and recovery trajectory can significantly impact both their sexual function and overall vascular health after prostate surgery.

By expanding our education and ensuring our patients are well-informed about all available rehabilitation options, we can optimize recovery and improve long-term outcomes.

 

  1. Mechanical Devices (Penile Pump/Vacuum Devices)
    Tsujimura, A., Kiuchi, H., Soda, T., Takezawa, K., Okuda, H., Fukuhara, S., … & [Additional Authors]. (2024). Efficacy of a new vacuum erection device (Vigor 2020) for erectile dysfunction. International Journal of Urology. Advance online publication. https://doi.org/10.1111/iju.15574
  2. Mulhall, J. P. (2020). Penile rehabilitation: Preserving erectile function after radical prostatectomy. Current Urology Reports, 21(3), 14. https://doi.org/10.1007/s11934-020-00961-3

 

  1. Medications
    Intracavernosal Injections and PDE5 Inhibitors (also relevant to sexual activity)
    Burnett, A. L., Nehra, A., Breau, R. H., Culkin, D. J., Faraday, M. M., Hakim, L. S., Heidelbaugh, J., Khera, M., McVary, K. T., Miner, M. M., … & Shindel, A. W. (2018). Erectile dysfunction: AUA guideline. The Journal of Urology, 200(6), 633–641. https://doi.org/10.1097/JU.0000000000000626

 

  1. Sexual Activity (Regular Arousal and Orgasm)
    (This concept is also emphasized in the AUA guideline above, which supports the role of ongoing sexual activity in penile rehabilitation.)
    Burnett, A. L., Nehra, A., Breau, R. H., Culkin, D. J., Faraday, M. M., Hakim, L. S., Heidelbaugh, J., Khera, M., McVary, K. T., Miner, M. M., … & Shindel, A. W. (2018). Erectile dysfunction: AUA guideline. The Journal of Urology, 200(6), 633–641. https://doi.org/10.1097/JU.0000000000000626

 

  1. Pelvic Floor Exercises
    Myers, C., & Smith, M. (2019). Pelvic floor muscle training improves erectile dysfunction and premature ejaculation: A systematic review. Physiotherapy, 105(2), 235–243. https://doi.org/10.1016/j.physio.2019.01.002

Wong, C., Louie, D. R., & Beach, C. (2020). A systematic review of pelvic floor muscle training for erectile dysfunction after prostatectomy and recommendations to guide further research. The Journal of Sexual Medicine, 17(4), 737–748. https://doi.org/10.1016/j.jsxm.2020.01.008

Sivaratnam, L., Selimin, D. S., Abd Ghani, S. R., et al. (2021). Behavior-related erectile dysfunction: A systematic review and meta-analysis. The Journal of Sexual Medicine, 18(1), 121–143. https://doi.org/10.1016/j.jsxm.2020.09.009

  • Mulhall, J. P. (2020).Penile rehabilitation: Preserving erectile function after radical prostatectomy. Current Urology Reports, 21(3), 14. https://doi.org/10.1007/s11934-020-00961-3
      This review provides updated insights into penile rehabilitation strategies after radical prostatectomy, highlighting the early use of VEDs as a means to “exercise” the penile tissues, sustain blood flow, and prevent atrophy.
  • Hatzimouratidis, K., Giuliano, F., Moncada, I., et al. (2018).EAU guidelines on erectile dysfunction. European Urology, 76(1), 72–79. https://doi.org/10.1016/j.eururo.2018.01.024

 

  1. Cardiovascular Exercise (Physical Activity)
    Silva, A. B., Sousa, N., Azevedo, L. F., & Martins, C. (2017). Physical activity and exercise for erectile dysfunction: Systematic review and meta-analysis. British Journal of Sports Medicine, 51(20), 1419–1424. https://doi.org/10.1136/bjsports-2016-096418
Scroll to Top