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     Early Penile Rehabilitation Helps Reduce Later Intractable Erectile
Dysfunction

     Alison Palkhivala
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     Oct. 21, 2005 (Montreal) - Early penile rehabilitation, particularly
use of intraurethral alprostadil (MUSE), can help maintain healthy penile
tissue after radical prostatectomy, allowing for improved responses to oral
erectile dysfunction (ED) treatments later on.

     "Early penile rehabilitation is a very new concept that has been going
on for one or two years now [that prostate surgery has advanced to the point
of consistently sparing the penile nerves] and maintaining continence
level," said study presenter Rupesh Raina, MD. "With aggressive screening of
prostate cancer, we are now picking up patients who are very young, like
aged 50 or 52, which was not the case before. With these new young patients,
when they get operated, their concerns are continence...but their main
concern is sexual activity." Dr. Raina is an attending physician in the
department of internal medicine and pediatrics at MetroHealth Medical
Center, Case Western Reserve University, in Cleveland, Ohio.

     Dr. Raina explained that oral ED therapies such as sildenafil are not
effective during the six to 12 months after radical prostatectomy surgery
because the penile neural pathway has not had time to regenerate. After 6 to
12 months, without early penile rehabilitation, the efficacy rate with
sildenafil is about 30%. Early penile rehabilitation is designed to improve
this efficacy rate, he said.

     Because of the damage to the neural pathway after radical
prostatectomy, patients lose their natural nocturnal erections, resulting in
less blood flow to the penis and eventually fibrosis of the penile tissue.
Early penile rehabilitation is designed to increase blood flow to the penis
so that the penile tissue is maintained while the neural pathway
regenerates, allowing for a much higher likelihood that oral therapy will be
effective.

     As part of a prospective nonrandomized study, patients who had
recently undergone radical prostatectomy for localized prostate cancer and
subsequently underwent one of three forms of early penile rehabilitation
were followed to determine which approach led to the best outcomes.

     Overall, 68 patients were offered MUSE, and 38 were compliant with
this therapy. Seventy-four patients were offered use of a vacuum
constriction device (VCD), and 60 were compliant. Twenty-two patients were
offered intracavernous injections (ICD), and all were compliant with this
treatment. In addition, 18 of the 22 patients using ICD also used
sildenafil. Thirty-five patients who did not undergo any early penile
rehabilitation were used as a comparison group. Dr. Raina presented the
results here this week at the annual meeting of the American Society of
Reproductive Medicine.

     While all early penile rehabilitation efforts were effective, MUSE
offered the best outcomes. After a mean follow-up of about six months, 39%
of patients compliant with MUSE were able to have a natural erection
sufficient for vaginal penetration, and 74% were sexually active. Among
those compliant with VCD, 32% had natural erections sufficient for vaginal
penetration, and all were sexually active. For patients using ICD with or
without sildenafil, 50% had natural erections, and 96% were sexually active.
In contrast, among patients who underwent no early penile rehabilitation,
11% were able to have natural erections and 37% were sexually active.

     Early penile rehabilitation did more than improve patients' ability to
have an erection up to a year after surgery. "The flip side of this study
was that patients can have sexual activity at two or three months after
surgery [with early penile rehabilitation], whereas before they had to wait
at least 12 to 18 months," said Dr. Raina.

     "Urologists should use these non-oral treatment options, MUSE, VCD,
and ICD," Dr. Raina said. "Most urologists are confused that you can give
sildenafil citrate early, [but] it doesn't work because...there is no neural
pathway. It will work after six to 12 months, not initially. To maintain the
vascular integrity, do these non-oral treatment options to maintain the
integrity of the penile tissue; then eventually you can switch to oral
therapy," he concluded.

     ASRM 2005 Annual Meeting: Abstract O-323. Presented Oct. 19, 2005.

     Reviewed by Gary D. Vogin, MD

     Related Links
     Conference Coverage
     American Society for Reproductive Medicine 61st Annual Meeting

     Resource Centers
     Erectile Dysfunction Resource Center

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           Alison Palkhivala is a freelance writer for Medscape.

           Medscape Medical News 2005. © 2005 Medscape

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