Controversies in Sexual Medicine: Penile Rehabilitation Should Become the Norm for Radical Prostatectomy Patients

Authors

  • John P. Mulhall MD,

    Corresponding author
    1. Sexual Medicine Program, Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA;
      John P. Mulhall, MD, Weill Medical College of Cornell University—Department of Urology, 525 E 68th Street, New York, NY 10021, USA. Tel: (+1) 212 746 0097; Fax: (+1) 212 746 0403; E-mail: jpm2005@med.cornell.edu
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  • Abraham Morgentaler MD, FACS

    1. Men's Health Boston, Department of Urology, Harvard Medical School, Boston, MA, USA
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John P. Mulhall, MD, Weill Medical College of Cornell University—Department of Urology, 525 E 68th Street, New York, NY 10021, USA. Tel: (+1) 212 746 0097; Fax: (+1) 212 746 0403; E-mail: jpm2005@med.cornell.edu

ABSTRACT

Introduction. The Journal of Sexual Medicine (JSM) held a debate at the annual fall meeting of the Sexual Medicine Society of North America (SMSNA). The motion was “Penile Rehabilitation Should Become the Norm for Radical Prostatectomy Patients.” At the suggestion of several SMSNA members, it was requested that this debate might be of interest to JSM readers in the form of a published controversy.

Methods.  Two debate speakers with expertise and/or strong opinions in the area of penile rehabilitation submitted their literature-review, evidence-based opinions on the topic.

Main Outcome Measure.  Literature review of laboratory basic science and clinical research studies on penile rehabilitation.

Results.  Penile rehabilitation involves prophylactic procedures designed to improve oxygen delivery to penile erectile tissues, aimed at preserving erectile tissue health and minimizing erectile tissue damage that otherwise occurs during the period of neural recovery to the autonomic cavernosal nerve following radical prostatectomy. There are several studies in the sexual medicine literature on penile rehabilitation after radical prostatectomy, and the positive results appear to support this concept, the rationale, and mechanism. The use of prophylactic penile rehabilitation programs has not been fully elucidated, nor have the results been replicated in large multicenter placebo-controlled trials.

Conclusion.  Penile rehabilitation may be performed along with counseling with the couple, vacuum erection therapy, and vacuum erection device therapy if it is the patient and partner's preference, provided that it is undertaken in a safe and effective manner and is monitored closely. Mulhall JP, and Morgentaler A. Penile rehabilitation should become the norm for radical prostatectomy patients. J Sex Med 2007;4:538–543.

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