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

Rehabilitation Program for Urinary Continence

At the University of Chicago Medical Center and 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 our 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*