Erectile Dysfunction and Penile Rehabilitation After Rarp

Erectile dysfunction (ED) represents one of the most common long-term sequelae after radical prostatectomy (RP) and it is a medical condition encompassing both the physical and mental wellness aspects of the patients. To overcome these issues, the concept of penile rehabilitation has been introduced: it is defined as any possible intervention aimed at maximizing the spontaneous EF recovery to obtain satisfactory sexual intercourse. In the last years, several efforts were made to improve the outcomes of these patients, but which is the optimal rehabilitation program is still debeated. There is a lack of homogeneity in the definition of ED, patient selection, surgical techniques, management strategies, and follow-up schedules. Moreover, several works showed that penile rehabilitation programs significantly increase EF during treatments, however current evidence does not support that penile rehabilitation can improve the recovery of spontaneous EF. According to international guidelines, the use of minimally invasive penile rehabilitation protocols such as concomitant use of PDE5Is and VED should be considered as first-line options, whereas the more invasive procedures such as ICI, intraurethral suppository, and penile implant should be considered second-line choices. However, the evidence is low and future randomized clinical trials are needed to define the optimal penile rehabilitation program.