Penile Rehabilitation Following Radical Prostatectomy

• Autor(a) principal: Faustino, Maria Madalena Gouveia
• Data de Publicação: 2021
• Tipo de documento: Dissertação
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.6/11335
• topic: Cancro da Próstata; Disfunção Erétil; Prostatectomia Radical; Reabilitação Peniana; Domínio/Área Científica::Ciências Médicas::Ciências da Saúde::Medicina

Background. Radical prostatectomy is a first-line treatment for localised prostate cancer. Despite refinements in the operative techniques, sexual dysfunction, namely erectile dysfunction, remains an important possible complication. Penile rehabilitation aims to maximally improve the speed and extent of sexual function recovery and is now considered an integral part of patient management after radical prostatectomy with continued use in clinical practice. Yet, clear recommendations remain to be presented. Methods. A comprehensive literature search was conducted to identify publications relevant to penile rehabilitation following radical prostatectomy using PubMed and other databases. Both free text and MeSH terms were employed in a search restricted to English-language studies published until February of 2021. Only full-text articles were included in the final analysis. Additional relevant sources encompassed books of interest and articles found in reference lists. Results. Patients undergoing radical prostatectomy should be informed about the risk of sexual dysfunction, and not only erectile dysfunction. Early penile rehabilitation may elevate the potential of both erectile function recovery and dysfunction treatment, yet this trend remains controversial, and some patients may incur in significant financial expenditure without experiencing clear benefits. No recommendation for the use of any specific regimen is possible. First-line treatments include oral PDE5 inhibitors, alprostadil-based therapies, and vacuum devices. Penile prosthesis implantation is reserved for failure of conservative measures. Li-ESWT, and stem cell, gene and PRPbased therapies are promising novel modalities still under investigation. Both psychological and sexual counselling are advisable. Better quality research transcending the usual heteronormative standards is needed, including questions on libido and sexual bother or satisfaction. Clinicians should promote the involvement of both partners and encourage sexual adaptation as a goal of rehabilitation besides erectile recovery. Conclusion. Current evidence does not explicitly support any penile rehabilitation program. Oral PDE5 inhibitors remain the first-line choice, but treatment selection should ultimately reflect patient preference. Future directions should explore the potential of regenerative medicine and adopt sexual adaptation as the main goal of rehabilitation.