(PNM-11) Penile rehabilitation after radical prostatectomy: current trends and novel algorithm

Abstract Purpose Radical prostatectomy (RP) is the standard curative treatment for localized prostate cancer. However, despite advances in surgical techniques, many patients experience erectile dysfunction (ED) and urinary incontinence postoperatively, significantly affecting quality of life. Penile rehabilitation emerged over two decades ago as a strategy to enhance erectile function recovery. Despite surgical evolution, there is no consensus on the optimal rehabilitation protocol. Materials and Methods A comprehensive literature search was conducted in PubMed and Embase up to September 28, 2024, using the MeSH terms: radical prostatectomy, erectile dysfunction, and penile rehabilitation. Clinical trials, meta-analyses, systematic reviews, and relevant guidelines were reviewed without language restrictions. Results Multiple strategies were identified. Phosphodiesterase type 5 inhibitors (PDE5i) are widely used, with evidence supporting daily and on-demand regimens. Vacuum erection devices (VED) help preserve penile length and stimulate early erections. Penile traction therapy (PTT) shows promising results, especially in combination with other treatments. Intracavernosal injections (ICI) are effective but less accepted due to invasiveness. Penile prostheses (PP) are reserved for refractory cases or placed simultaneously with RP in selected high-risk prostate cancer patients with severe preoperative ED. Early initiation appears beneficial, though study heterogeneity limits comparisons and standardization. Conclusion Penile rehabilitation is essential for improving quality of life post-RP by promoting erectile recovery. While further studies are needed to define optimal protocols, a multimodal and individualized approach is supported. We propose an interinstitutional algorithm to guide clinical decisions. After ethics committee approval, we began implementing this algorithm in March 2025, with excellent initial results. Financing No conflict.