Improving Male Sexual Health
In 2008, the UW Department of Urology started its Male Sexual Health Program. Founders and co-directors David Paolone, MD and Daniel Williams, MD have had specialized training to offer state-of-the-art medical and surgical therapies to restore erectile function. One of the primary focuses of the program is penile rehabilitation therapy following radical prostatectomy. There may be irreversible damage occurring in cavernosal tissue during the period of erectile dysfunction that immediately follows a radical prostatectomy. This period may last up to two years as a result of neuropraxia experienced by the cavernous nerves.
Animal studies have demonstrated an increase in smooth muscle apoptosis within the corpus cavernosum following cavernous nerve injury. Collagen deposition has also been demonstrated in this model. Collagen content may also be influenced by oxygen tension in a chronically flaccid state. The goal of penile rehabilitation is to preclude these changes by minimizing the disruption of normal nocturnal erections and sexually stimulated erections, thereby increasing a man’s long-term prospects for re-establishing normal erectile function following prostatectomy.
Post-prostatectomy penile rehabilitation strategies have included use of phosphodiesterase type-5 inhibitors, vacuum erection devices and intracorporeal injection therapy. Many of the early studies regarding these treatments lacked randomization and placebo control. Nonetheless, there has been a suggestion of a greater return of spontaneous erections in those men who employ some form of treatment for their erectile dysfunction on a regular basis versus those men who pursue no early treatment.
UW Urology’s current strategy for penile rehabilitation includes a consultation with a urologist prior to surgery to discuss and develop individualized pre-treatment strategies for the preservation of post-prostatectomy erectile function. Approaches to this include the initiation of a daily phosphodiesterase type-5 inhibitor before and immediately following prostatectomy. Men who do not respond to oral medications are offered intracorporeal injections and vacuum erection device therapy. Eventually, some patients are able to stop daily therapy if spontaneous erections return while others continue to use medications on an as-needed basis but with better results than had they not performed the rehabilitation protocol. Finally, penile implants are offered to men who do not respond to medical therapy. Inflatable penile prostheses are the premier treatment of post-prostatectomy erectile dysfunction. They restore durable, long-term erectile function and result in both patient and partner satisfaction rates of over 90 percent.