cancel
Showing results for 
Search instead for 
Did you mean: 

BLOG: A novel penile rehabilitation approach

Chris_McNamara
Community Manager
Community Manager
0 0 97

A novel penile rehabilitation approach

Penile rehabilitation is a well-established concept and is thought to counter the effects of hypoxia (oxygen deprivation) in the penile tissue and cavernous nerve neuropraxia (damage to penile nerve supply) after a radical prostatectomy (RP) which leads to fibrosis (scarring) and atrophy (shrinkage) of the smooth muscle cells of the corpora cavernosum (erectile chambers) of the penis. The variations to tissue cause veno-occlusive dysfunction and lower the probability of long-term recovery of erectile function. Techniques utilised include tablets such as phosphodiesterase type 5 inhibitors (PDE5-I), injections directly into the corpora cavernosa, gels administered into the urethra and vacuum pump erection devices (VED). In the absence of success with these therapies the final option would be a penile prosthesis implantation. Meissner et al from Germany expanded on previous research which considered masturbation as a potential penile rehabilitation strategy. This study aimed to examine a correlation between masturbation and functional outcome after a nerve-sparing radical prostatectomy(nsRP).

Most studies examining this research use the International Index of Erectile Function (IIEF-EF). As this score only has application for those engaging in sexual intercourse, the researchers have used the erection hardness score (EHS) as well. By utilising the EHS the researchers could include 33% more potent men in their analysis. They noted improved rates of erectile function, morning erections, and urinary continence in participants who masturbated (m-patients) in the postoperative course after nsRP compared to those who refrained from masturbation (nm-patients). Rates of morning erections were assessed as a supplementary aspect of erectile function and can be an indicator for sleep-related erections. The influence of mental factors on erectile function is reduced during sleep compared to during sexual activity, which might explain the slightly elevated rates of morning erections compared to rates of erectile function using the IIEF-EF/EHS amongst study participants (48.1% vs. 43.6% after 24 months). The rate of erectile function (IIEF-EF/EHS) 24 months after nsRP was numerically greater in m-patients compared to nm-patients (47.5% vs. 37.5%). This differential of 10.0% between the two groups is clinically pertinent, but not statistically significant due to the small sample size of 184 patients at 24 months after nsRP. In addition, the rate of morning erections showed analogous results, with an even greater variance in rates between m-patients and nm-patients after 24 months (54.6% vs. 34.9%). These outcomes might be explained by similar molecular mechanisms that are known to improve penile rehabilitation when using VED. The researchers believe that a combination of PDE5-I and masturbation could reveal a similar result since they enhance the blood flow during sexual stimulus and arousal and could result in improved oxygenation. They were not able to verify whether masturbation is the reason for the better erectile function or if better erectile function leads to more masturbation. The advantage of this treatment is absence of costs and undesirable effects. In the study at 12 months after nsRP, continence was 78.3% among all participants. They observed that in the masturbation group there were superior rates of urinary continence 12 months after nsRP than the non-masturbation group (83.1% vs. 70.2%). Preservation of the neurovascular bundle through nerve-sparing techniques is highly interrelated with urinary continence. This endorses the idea that cavernous nerves play a vital role in urinary continence recovery. Masturbation could also improve urinary continence through increasing pelvic blood flow and oxygen supply, with a favourable effect on sphincter function.

The authors have reported numerous limits to their study. They report it is difficult to do a randomised trial and forbid the control group from masturbating. Another limitation is that data of the main outcome measures are self-reported and at risk for overstatement and falsification. In addition, although they asked patients about their regularity of masturbation, the researchers could not examine whether there are different erectile function results among the subgroups, due to the low number of participants in each category. Finally, they did not assess whether study participants masturbated with an erect or soft penis.

In conclusion, this is the first study which delved into a correlation between masturbation and both better erectile function and urinary continence of patients treated with nsRP. If masturbation is the rationale for the better functional outcome or if a better functional outcome leads to more masturbation remains indefinite and needs to be corroborated in future studies consisting of larger samples, since randomized controlled trials are difficult to achieve. Nonetheless, masturbation, which neither incurs any costs nor undesirable effects might be a promising approach for regaining erectile function and urinary continence, and patients could be encouraged to masturbate after nsRP.

 

Reference

Meissner VH, Dumler S, Kron M, et al. Association between masturbation and functional outcome in the postoperative course after nerve-sparing radical prostatectomy. Transl Androl Urol. 2020;9(3):1286-1295.

 

 

Chris_McNamara_0-1622520551637.jpeg

 

 

About the Author

Kalli Spencer

MBBCh, FC Urol (SA), MMed (Urol), Dip.Couns (AIPC)

Kalli is an internationally renowned Urological Surgeon, specialising in oncology and robotic surgery. He trained and worked in South Africa, before relocating to Australia where he has worked at Macquarie University Hospital and Westmead Hospital. His passion for what he does extends beyond the operating room, through public health advocacy, education and community awareness of men’s health, cancer and sexuality.

Kalli has been involved with the Prostate Cancer Foundation of Australia for many years, advocating for improved cancer care and facilitating community prostate cancer support groups.

 

 

Help is Available
 

Prostate Cancer Specialist Telenursing Service:

If your life has been impacted by prostate cancer, our Specialist Telenursing Service is available to help. If you would like to reach out to the PCFA Prostate Cancer Specialist Telenurse Service for any questions you have about your prostate cancer experience, please phone 1800 22 00 99 Monday - Friday 9am - 5pm, Wednesday 10am-8pm (AEST).

 

Prostate Cancer Support Groups:

PCFA is proud to have a national network of affiliated support groups in each state and territory of Australia consisting of men and women who have a passion for assisting others who encounter prostate cancer. This network is made up of over 170 affiliated groups who meet locally to provide one-to-one support, giving a vision of life and hope after treatment. Call us on 1800 22 00 99 to find your local group.

 

MatesCONNECT Telephone-based peer support:

MatesCONNECT is a telephone-based peer support program for men affected by prostate cancer. If you’ve recently been diagnosed with prostate cancer, our MatesCONNECT service can connect you to a trained volunteer who understands what you’re going through. All of our volunteers have been through prostate cancer. Simply call us on 1800 22 00 99 to be connected with a volunteer.

 

Newly diagnosed? or need to find more information -Access the PCFA resources here!

 

House Rules

To help keep this community a welcoming, supportive and caring place we have put together a small list of dos and don'ts for you to think about when posting on our forum, research blog or video gallery. For further information please see our  terms and conditions.

Adhere to PCFA’s five core values of Integrity, Optimism, Compassion, Respect and Commitment.

Our online forum is for you to share experiences with others and does not contain specific medical, counselling or legal advice.  If you require professional advice specific to your individual circumstances we encourage you to see a medical professional, legal professional or counsellor.

No commercial or promotional activity. While members may share information about resources they have found helpful, the PCFA Online Community forum should not be used for the promotion of goods and services. This includes commercial entities passing themselves off as individuals and people who frequently post links to external health professionals or other services.

Be kind to each other - many people using the community are going through a difficult time. A few kind words can go a long way. Please welcome new posters – it can be very nerve-wracking to post on the forum for the first time.

If you or someone you know is suffering from mental health issues, such as depression or anxiety, we encourage you to seek assistance and contact Beyond Blue Tel:1300 224 636 or Lifeline Tel:13 11 14

Speak your mind freely, but please be sensitive to the feelings and experiences of others - you might not always agree, but you can agree to disagree in a peaceful manner.

Don't use offensive language -if a user is found to be using offensive language during their conversations the moderators reserve the right to edit the thread, without warning.

Don't use all capital letters in your posts - it's considered ‘shouting' online and it makes posts difficult to read.

Give each other the benefit of the doubt - please remember that it is all too easy for the tone and meaning of posts to be misinterpreted. Think carefully before replying to a discussion. it It is important to remember that things written rather than said can feel much stronger, so please bear this in mind when reading other people's messages.

Please respect the moderators - their job is to keep the forum safe and constructive so that everybody gets to have his or her fair say.

Stay on topic - try to focus on the original topic. In particular, don't change subject in the middle of an existing thread - just start a new thread.

Read what's already on the forum before posting - you may be repeating what others have already said or asked.

We want PCFA's Online Community to be a secure and helpful environment for all of the community. So please remember that by using PCFA's Online Community you are agreeing to follow our terms and conditions.