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Review
. 2024 Nov 15;26(1):19.
doi: 10.1007/s11934-024-01249-x.

Management of Post-RALP SUI and ED - What are and What Should we be Doing?

Thairo A Pereira  1 , Jacob O Rust  1 , Helen L Bernie  2
Affiliations
Review

Management of Post-RALP SUI and ED - What are and What Should we be Doing?

Thairo A Pereira et al. Curr Urol Rep. .

Abstract

Purpose of review: Although there have been advancements in minimally invasive surgical techniques for radical prostatectomy, surgery can still significantly impact continence and erectile function (EF), resulting in considerable quality-of-life impairment. This review critically evaluates existing treatment options for male stress urinary incontinence (SUI) and erectile dysfunction (ED) post-robotic-assisted laparoscopic prostatectomy (RALP), alongside exploring emerging trends and discussing future directions for managing and preventing both conditions.

Recent findings: Patient history is pivotal in guiding surgical decisions, with the intensity of symptoms and their impact on the patient's life being primary influences for deciding the best treatment options for both SUI and ED. Penile rehabilitation strategies (PR) show promise in mitigating the effects of prostate cancer treatments on EF and improving overall health, though consensus is lacking on specific programs or initiation of timing for optimal recovery post-surgery. All patients undergoing RALP should receive preoperative counseling about SUI and early pelvic floor physical therapy. Fixed and adjustable slings effectively treat mild-to-moderate post-RALP SUI, while the artificial urinary sphincter is the gold standard for men with moderate or severe SUI. EF recovery after RALP faces obstacles such as patient characteristics, compliance, and cost, with no standardized PR approach. Future research should prioritize studies aiming to optimize treatment methods and enhance patient compliance.

Keywords: Erectile dysfunction; Penile rehabilitation; Prostate cancer; Stress urinary incontinence.

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Conflict of interest statement

Declarations Human/Animal Studies Informed Consent Statement This article does not contain any studies with human or animal subjects performed by any of the authors. Competing Interests The authors declare no competing interests.

References

    1. Ajay D, Mendez MH, Wang R, Westney OL. Treatment of Urinary Incontinence in Patients With Erectile Dysfunction. Sex Med Rev. 2021;9(4):593–604. This article, published in the Sexual Medicine Reviews Journal, offers a thorough summary of the epidemiology, diagnostic processes, and management strategies for postprostatectomy urinary incontinence, particularly in patients dealing with concomitant erectile dysfunction. This extensive review was essential to our work, providing a foundational understanding of the concurrent challenges and considerations in treating these conditions. The article was crucial also due to its detailed exploration of the most relevant treatment options for urinary incontinence in the context of erectile dysfunction. It described various surgical techniques and included high-quality imaging, offering practical insights and visual aids that greatly supported the development and depth of our research.
    1. Braun AE, Washington SL, Cowan JE, Hampson LA, Carroll PR, Impact of Stress Urinary Incontinence After Radical Prostatectomy on Time to Intervention., Quality of Life and Work Status. Urology. 2023;180:242–8. This article highlights the incidence of stress urinary incontinence following radical prostatectomy, its treatment, and its significant negative impact on patient’s quality of life one year post-surgery. It provided essential data on the negative effects of SUI and the need for timely intervention. This study also revealed a concerning median time of 48 months before patients received an SUI procedure, a delay not supported by existing literature. This finding emphasizes the necessity for more personalized, patient-centered care. It supports the recommendation for early intervention strategies, such as preoperative discussions and the incorporation of pelvic floor physical therapy shortly after surgery.
    1. Bock M, Burns RT, Pereira TA, Bernie HL. A contemporary review of the treatments and challenges associated with penile rehabilitation after radical prostatectomy including a proposed optimal approach. Int J Impot Res. 2023;1–6. This article provides an overview of the various approaches to penile rehabilitation and highlights the lack of a standardized penile rehabilitation pathway. It further proposes a protocol to maximize erectile function recovery utilizing both pre and post-surgical interventions and a multidisciplinary approach to improve patient adherence and education.
    1. Zganjar A, Toussi A, Ziegelmann M, Frank I, Boorjian SA, Tollefson M et al. Efficacy of RestoreX Post Prostatectomy: Open-label Phase of a Randomized, Controlled Trial. BJU Int. 2023. This trial introduces a novel traction device with evidence demonstrating preserved erectile function and length with use in the post radical prostatectomy setting. It determined that benefits were not only achieved but preserved following cessation of device usage, and the importance of avoiding a delayed start to therapy. This promising device may represent a valuable addition to penile rehabilitation protocols moving forward. References.
    1. Culp MB, Soerjomataram I, Efstathiou JA, Bray F, Jemal A. Recent global patterns in prostate Cancer incidence and mortality rates. Eur Urol. 2020;77(1):38–52. - PubMed - DOI

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