Rationale for early penile rehabilitation following nerve-sparing radical prostatectomy

Erectile dysfunction is one of the most important quality-of-life issues following radical prostatectomy. The potency rates reported following nerve-sparing technique varies between 40% and 86%, and the time period required for complete recovery of erectile function varies from 6 to 24 months. The literature evidence suggests that lack of natural erections during this period of time produces cavernosal hypoxia. Prolonged periods of cavernosal hypoxia induce fibrosis, which later increases the incidence of venous leak. Recently, interest has grown among the physicians to interrupt these events by preventing cavernosal hypoxia during the period of neuropraxia. Initial studies using intracavernosal injection appear to be beneficial. This article reviews the pathophysiology of cavernosal hypoxia following radical prostatectomy with currently available evidence for the interventions to promote the nerve recovery and regeneration.