Is the Vacuum Erection Device (VED) better than the ICI (Intra-Cavernous Injection) in preventing penile shortening after non nerve-sparing radical prostatectomy?
Objective
Penile length after radical prostatectomy has significant impact on patients and their partners. In addition, corporal fibrosis is associated with difficult penile prosthesis implantation (1). Vacuum erection device is a common device used for the treatment of the erection dysfunction (2). The aim of this study was to compare the penile shortening after non nerve-sparing radical prostatectomy, in the patients that underwent sexual rehabilitation with ICI and VED. In addiction, the study analyse the rate of significant penile fibrosis in the patients that underwent penile prosthesis implantation.
Materials and Methods
We enrolled 40 consecutive patients that underwent a non nerve-sparing laparoscopic radical prostatectomy (RP) at our department from June 2015 to June 2016. The patients were randomized into two groups (Group A=sexual rehabilitation with ICI and Group B= sexual rehabilitation with VED). Androbath Med VED was used in all patients of the Group B for 15-20 minutes daily. All patients underwent an early penile rehabilitation (initiated within 2-4 weeks after RP). The stretched flaccid penile length (SFPL) was evaluated before and after 6 months of rehabilitation. 18 out of 40 patients underwent a penile prosthesis implantation 12.83 months after the surgery. We considered “significant fibrosis” if during the surgery we needed the help of additional straightening procedures like incision or excision of the scar, multiple corporotomies with or without grafting, the use of the Rossello dilator, implant downsizing, and transcorporeal resection (1). Arduos dilatation has not been considered as a parameter of “significant fibrosis” because it can be related to the surgeon experience. Mean values with standard deviations (±SD) were computed and reported for all items.
Results
The mean±SD pre-operative SFPL was similar in the two groups (Group A= 8.42±1.82; Group B=8.21±1.74; p= 0.7112 ). After 6 months of treatment, we did not observed significant increase in SFPL in the Group A (post-operative SFPL=8.61±1.95; p=0.7518). After 6 months of treatment, we observed significant increase in SFPL in the Group B (post-operative SFPL=9.36±1.79; p=0.0463).
Significant fibrosis during the penile prosthesis implantation was found in 10 out 18 patients (8 patients of the Group A and 2 patients of the Group B.
Discussions
Nowadays there is no standard protocol or guideline for penile rehabilitation after RP. In our experience the use of VED Androbath Med achieved a median increase in SFPL of 1.15 centimeter after six month of therapy, while the use of ICI achieved a median increase in SFPL of 0.40 centimeter. The VED mechanism depends on its ability to increase arterial inflow and the oxygenation of the corpora. Moreover, VED increases NO release (3), reduces the hypoxia inducible factor-1 and transforming growth factor beta-1 and increases smooth muscle/collagen ratio (4). The ICI therapy also increases arterial inflow but the chronic intracavernous injection of vasoactive drugs can be associated to an increase of corporal fibrosis (5).
Conclusion
In conclusion, the penile rehabilitation after non nerve-sparing radical prostatectomy using a new vacuum erection device (Androbath Med) is related to a good increase in SFPL after six months of therapy. In addiction the patients whose underwent VED therapy before surgery had corpora that were more suitable for dilation during the penile prosthesis implantation.
Reference
1. Yafi FA, Sangkum P, McCaslin IR, Hellstrom WJ.Strategies for penile prosthesis placement in Peyronie's disease and corporal fibrosis. Curr Urol Rep. 2015 Apr;16(4):21.
2. Brison D, Seftel A, Sadeghi-Nejad H.The resurgence of the vacuum erection device (VED) for treatment of erectile dysfunction. J Sex Med. 2013 Apr;10(4):1124-35.
3. Li E, Hou J, Li D, Wang Y, He J, Zhang J.The mechanism of vacuum constriction devices in penile erection: the NO/cGMP signaling pathway? Med Hypotheses. 2010 Nov;75(5):422-4.
4. Yuan J, Lin H, Li P, Zhang R, Luo A, Berardinelli F, Dai Y, Wang R.Molecular mechanisms of vacuum therapy in penile rehabilitation: a novel animal study. Eur Urol. 2010 Nov;58(5):773-80.
5. Egydio PH, Kuehhas FE Treatments for fibrosis of the corpora cavernosa. Arab J Urol. 2013 Sep;11(3):294-8.