The role and structure of a postradical prostatectomy penile rehabilitation program

Erectile dysfunction (ED) is common after radical prostatectomy (RP). ED has a negative impact on health-related quality of life. Penile rehabilitation is defined as the use of any drug or device at or after RP to maximize erectile function recovery. The purpose of penile rehabilitation is the prevention of corpus cavernosal smooth muscle structural alterations not only to maximize the chances of a man having recovery of functional erections but also returning him to his preoperative erectile function level. Appreciating the value of penile rehabilitation requires understanding five concepts: the pathophysiology of ED after RP, cavernosal oxygenation, venous leak, and both the animal and human data supporting this strategy. This paper gives an overview of these factors and attempts to give a common-sense, practical guide to a rehabilitation program.