How long should you continue to do penile rehabilitation after radical Prostatectomy?

1. Stop when erections return.

Penile rehabilitation in part refers to the creation of erections to keep blood flow going to prevent scar tissue buildup, prevent shrinkage, and essentially keep the penile tissue in as good health as possible while you don't have erections.

Therefore, once you are noticing consistent morning erection, nocturnal erection activity, and also spontaneous erections from arousal, you can stop using vacuum devices and injections for regular blood flow exercise (when it comes to medication such as Viagra or Cialis, please ask your prescribing practitioner for advice).

2. This can take two years - or more.

But do you keep in mind, penile rehabilitation exists because, after radical prostatectomy, the erection nerves, otherwise the cavernous nerves around the prostate, are in a traumatized state. Even when you've had a nerve-sparing procedure, the heat and light alone from the surgical procedure can send these nerves into this state of trauma, and they're in a state of recovery called neuropraxia.

We know from the literature this can take up to two years for what nerve potential there is to come back online. What's really interesting is the evidence shows we then see erection function change and progress even from two to five years out

"Unexpected Long-term Improvements in Urinary and Erectile Function in a Large Cohort of Men with Self-reported Outcomes Following Radical Prostatectomy" (Lee et al, 2013)

What this indicates is that there are so many factors involved in erectile function beyond the nerve. There's psychological factors, there's cardiovascular and hormone factors.

So if it's been over two years without any erectile function, make an appointment with your urologist or whoever you're seeing for penile rehabilitation to check in on the other factors at play.

3. Think of it like going to the gym.

Even if you're a few years down the line and you are not experiencing any spontaneous erectile function as you were hoping, it's still worth doing some activity to keep blood flow in the penis. This is to avoid developing fibrosis in the penis, which could lead to Peyronie's Disease.

In this instance, think of it less as rehabilitation and more as ongoing penile health, just like you go to the gym and have an exercise routine to keep all of your muscles in the best possible condition.