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Post-Operative Functional Rehabilitation Programs

Following radical prostatectomy, the recovering patient will experience temporary stress urinary incontinence and erectile dysfunction.

View post-operative rehabilitation resources.

Rehabilitation Program for Urinary Continence

At Weiss Memorial Hospital, we employ a pre-operative Kegel exercise program to improve the time to pad-free continence. This is a pelvic floor rehabilitation program to strengthen the muscles to contract the urethra closed and prevent urinary leakage.

Below is a summary table of published continence rates following the various surgical approaches to radical prostatectomy.

Series

Year

Patients (n)

Continence definition

Data collection method

Continence rates (%))

1-mo

3-mo

6-mo

12-mo

Radical Retropubic Prostatectomy (RRP)

Catalona

1999

1870

0 pads

Questionnaire

-

 

 

92

Walsh

2000

64

0 pads

Questionnaire

-

54

80

93

Kundu, Catalona

2005

2737

0 pads

Questionnaire

-

 

 

93

Penson

2005

1291

0 pads

Questionnaire

-

 

38.6

60.5

Laparoscopic Radical Prostatectomy (LRP)

Turk

2001

150

0-1 pad (safety)

Interview

 

75

86

92

Guillonneau

2002

550

0 pads

Questionnaire

-

-

73.3

82.3

Stolzenburg

2005

700

0 pads

Questionnaire

-

73.8

83.8

92

Rassweiler

2006

5824

0 pads

Questionnaire

-

-

-

84.9

Robotic-assisted Laparoscopic Radical Prostatectomy (RLRP)

Patel

2005

200

0 pads

Questionnaire

-

82

89

98

Joseph

2006

325

0  pads

Interview

-

93

96

 

Zorn, Shalhav

2007

300

0-1 pad (safety)

Questionnaire

23

47

68

90

Patel

2007

500

0 pads

Interview

27*

89

95

97

Menon

2007

2652

0-1 pad (safety)

Interview

50

90

-

95.2

Rehabilitation Program for Sexual Function Recovery

Despite nerve sparing radical prostatectomy, the nerve tissue following surgery does not initially function well. Inflammation related to the dissection and blood, as well as the stretch on the nerve tissue is likely related to the delay in sexual function recovery. Regular use of oral medication (such as Viagra, Levitra and Cialis) during the initial 6-12 months following surgery has been demonstrated in non-randomized studies to improve the potency outcomes at 18 months. The concept of aggressive rehabilitation following surgery stems from the loss of night-time penile erections which the average male gets 3-6/night. The arterial blood flow, rich in oxygen is lost for several weeks after nerve-sparing surgery which ultimately leads to penile tissue scarring (corporal fibrosis) and penile shortening.

The objective of regular medication rehabilitation and the patient’s attempt to achieve >3 penile tumescences (erections) per week is to prevent penile tissue scarring while the cavernosal nerves are healing. Upon their functional recovery, there is a greater chance for improved erection rigidity and better long-term chance for drug-free, unassisted erections.

Below is a table summarizing the sexual function outcomes according to surgical approach following bilateral nerve-sparing prostatectomy.

Series

Year

Mean age

(years)

Patients (n)

Mean follow-up (mo)

Potency rate at mean f/u (%)

Potency rates (%) (Vaginal potency rate with or without adjuvant PDE-5-inhibitors)

3-mo

6-mo

12-mo

Radical Retropubic Prostatectomy (RRP)

Walsh

2000

64 (36-67)

657

2
18

73
86

38

54

73

Kundu,
Catalona

2004

>50
50-59
60-69
>70

125
675
794
176

18
18
18
18

93
85
71
52

 

 

 

Penson

2005

63 (39-79)

1291

>18

44

 

 

 

Laparoscopic Radical Prostatectomy (LRP)

Guilloneau

2002

<70

47

4

66

 

 

 

Katz

2002

64

143

12

87.5

 

 

87.5

Anastasiadis

2003

<60

77

12

81

 

 

81

Su

2004

-

177

12

76

 

 

76

Rozet

2005

62

89

6

43

 

43

 

Rassweiler

2006

<55

-

12

78

 

 

78

Curto

2006

62

137

12

59

 

 

59

Robotic-assisted Laparoscopic Radical  Prostatectomy (RLRP)

Menon

2005

57.4

58

12

74
97

 

 

74
97

Ahlering

2005

<66

23

3

43

43

 

 

Joseph

2006

 

325

 

 

46

 

 

Zorn, Shalhav

2007

59.4

300

17.3

 

53

61

80

Patel

2007

63.2

500

9.7

 

 

 

78

Menon

2007

60.2

480/377*

36

73/93*

 

 

59/70*