Evidence for Erection Recovery After Radical Prostatectomy
Evidence for Erection Recovery After Radical Prostatectomy
Despite the certainty of support brought to the concept of erection rehabilitation, far less is certain about the best strategy for carrying out this practice. Continued investigation into the pathophysiologic derangements associated with ED after RP and additionally advancement of scientifically targeted treatments are imperatives for this field of endeavor. Current work in the field is encouraging and testifies to the earnestness of investigators to address the problem. Not unexpectedly, ED-specific therapies have been brought forward initially for this purpose, although their applicability is assuredly better gauged by how well they restore or prevent the loss of erection mechanisms rather than by their erectogenic effects alone. The challenge is to investigate and establish the effectiveness of these therapies as much as that for innovative, up-and-coming interventions with respect to their EF restorative and preventative roles. Predictably in time, treatments will be developed beyond the current armamentarium of indefinitely effective options to options that are truly effective. Clinical availability and tolerability will not suffice as primary criteria for acceptance of any particular therapy, and these variables will be minimally expected of all therapies. It is also anticipated that combination therapies will be used in accordance with a likely multifactorial etiology for ED after RP. Presumably, the best scheme of therapy for EF preservation following RP will require proficiently performed anatomic nerve-sparing RP when indicated coupled with health and physical fitness optimization by the patient, to which are added multimodal pathophysiology-specific clinical interventions.
Several specific therapeutic prospects carry high interest for erection rehabilitation purposes in the future. Forms of intervention may include not just familiarly used pharmacotherapies, but also growth factor therapies, gene therapy, tissue engineering, stem cell therapy, and possibly local energy-based technologies, any of which may be smartly applied before or possibly in the course of RP surgery aiming for maximal therapeutic benefit. In this article, several novel therapies were mentioned, including statins, erythropoietin and ARBs. Further development and implementation of these promising agents and other technologies are eagerly anticipated, although it is well acknowledged that great effort and expense are associated with their establishment at a standardized level of scientific rigor: randomized, placebo-controlled clinical trial study design. Other touted erection rehabilitative pharmacotherapeutic options have garnered interest in the recent past but have not shown early success at least in the formulations and dosages thus far investigated, e.g., corticosteroids, immunophilin ligands. Further definition of these agents, which have held such promise at preclinical levels as well as others that have only been investigated at preclinical levels, e.g., rho kinase inhibitors, is encouraged.
Forward Perspective
Despite the certainty of support brought to the concept of erection rehabilitation, far less is certain about the best strategy for carrying out this practice. Continued investigation into the pathophysiologic derangements associated with ED after RP and additionally advancement of scientifically targeted treatments are imperatives for this field of endeavor. Current work in the field is encouraging and testifies to the earnestness of investigators to address the problem. Not unexpectedly, ED-specific therapies have been brought forward initially for this purpose, although their applicability is assuredly better gauged by how well they restore or prevent the loss of erection mechanisms rather than by their erectogenic effects alone. The challenge is to investigate and establish the effectiveness of these therapies as much as that for innovative, up-and-coming interventions with respect to their EF restorative and preventative roles. Predictably in time, treatments will be developed beyond the current armamentarium of indefinitely effective options to options that are truly effective. Clinical availability and tolerability will not suffice as primary criteria for acceptance of any particular therapy, and these variables will be minimally expected of all therapies. It is also anticipated that combination therapies will be used in accordance with a likely multifactorial etiology for ED after RP. Presumably, the best scheme of therapy for EF preservation following RP will require proficiently performed anatomic nerve-sparing RP when indicated coupled with health and physical fitness optimization by the patient, to which are added multimodal pathophysiology-specific clinical interventions.
Several specific therapeutic prospects carry high interest for erection rehabilitation purposes in the future. Forms of intervention may include not just familiarly used pharmacotherapies, but also growth factor therapies, gene therapy, tissue engineering, stem cell therapy, and possibly local energy-based technologies, any of which may be smartly applied before or possibly in the course of RP surgery aiming for maximal therapeutic benefit. In this article, several novel therapies were mentioned, including statins, erythropoietin and ARBs. Further development and implementation of these promising agents and other technologies are eagerly anticipated, although it is well acknowledged that great effort and expense are associated with their establishment at a standardized level of scientific rigor: randomized, placebo-controlled clinical trial study design. Other touted erection rehabilitative pharmacotherapeutic options have garnered interest in the recent past but have not shown early success at least in the formulations and dosages thus far investigated, e.g., corticosteroids, immunophilin ligands. Further definition of these agents, which have held such promise at preclinical levels as well as others that have only been investigated at preclinical levels, e.g., rho kinase inhibitors, is encouraged.