Ces Urol 2025, 29(3):141-145

Penile rehabilitation after radical prostatectomy

Marek Broul^1-3, Aneta Hujová³

¹ Sexuologické oddělení, Krajská zdravotní, a.s. – Masarykova nemocnice v Ústí nad Labem, o.z.

² Urologické oddělení, Krajská zdravotní, a. s. – Nemocnice Litoměřice, o.z.

³ Fakulta zdravotnických studií UJEP v Ústí nad Labem

Penile rehabilitation after radical prostatectomy is a multimodal approach aimed at supporting the recovery of erectile function through a combination of pharmacotherapy, mechanical devices, and other interventional methods. Available clinical studies suggest that early, structured protocols may help a subset of patients preserve or regain erectile function; however, the quality of evidence is uneven and findings are heterogeneous. The most commonly used modalities include phosphodiesterase type 5 inhibitors and vacuum erection devices. Other approaches - such as low-intensity extracorporeal shock wave therapy or penile vibratory stimulation - have been investigated mainly in small cohorts, and their routine use cannot yet be considered standard of care. Intracavernosal alprostadil remains an option for patients with insufficient response to oral therapy. Regenerative strategies, including the use of stem cells, are the subject of ongoing clinical research. From a practical standpoint, the timing and combination of modalities should be individualized with respect to surgical technique, comorbidities, patient preferences, and interim treatment response. Given the limited and inconsistent evidence, the potential benefits of penile rehabilitation should be interpreted with caution, and further robust, long-term studies are needed to clarify its true effect and to define optimal treatment strategies.

Keywords: erectile dysfunction – phosphodiesterase type 5 inhibitor – vacuum erection device – low-intensity extracorporeal shock wave therapy – nerve-sparing radical prostatectomy

Received: July 17, 2025; Revised: September 2, 2025; Accepted: September 4, 2025; Published: September 25, 2025