How to cite: Nasseri R. “Preserving Post-Prostatectomy Sexual Function: Pills, Pumps, or Injections.” Grand Rounds in Urology. November 13, 2025. Accessed Apr 2026. https://grandroundsinurology.com/preserving-post-prostatectomy-sexual-function-pills-pumps-or-injections/
Summary
Ryan Nasseri, MD, Assistant Professor of Urology, University of California, San Diego, San Diego, California, reviews the physiologic impact of radical prostatectomy on erectile function, emphasizing that both nerve-sparing and non-nerve-sparing procedures carry substantial risk. He outlines the physiologic changes that occur following prostatectomy, including corporal fibrosis, penile shortening, and the development of Peyronie’s disease, explaining why early intervention is considered important.
Dr. Nasseri outlines the rationale for penile rehabilitation as a strategy to preserve tissue oxygenation, reduce fibrosis, and maintain penile length. He emphasizes the importance of early counseling and realistic expectations when initiating rehabilitation strategies.
Oral phosphodiesterase type 5 inhibitors, particularly daily tadalafil, are discussed in the context of non-randomized studies and the REACTT trial, which demonstrate improved recovery of erectile function during active treatment. Vacuum erection devices are reviewed as a method to preserve tissue oxygenation and penile length, with early use associated with higher rates of intercourse success, especially when combined with oral therapy. Intracavernosal injection therapy is presented as an option for patients unresponsive to oral medications, despite challenges related to tolerability and adherence.
Dr. Nasseri shares when to initiate rehabilitation, how long recovery may take, and when to consider penile implant placement. He emphasizes patient motivation, realistic expectations, and individualized treatment planning in post-prostatectomy sexual rehabilitation.
About the 32nd Annual Perspectives in Urology: Point Counterpoint conference: Presented by Program Chair and Grand Rounds in Urology Editor-in-Chief E. David Crawford, MD, this conference brought together leading experts in urology, medical oncology, and radiation oncology to discuss and debate the latest topics in genitourinary cancers, primarily prostate cancer and bladder cancer. This interactive conference offered topical lectures, pro/con debates, interesting-case presentations, interactive panel discussions, and interactive audience and faculty networking.
ABOUT THE AUTHOR
Ryan Nasseri, MD, is an Assistant Professor of Urology at the University of California, San Diego. Dr. Nasseri specializes in men's urologic health, including male infertility, low testosterone, erectile dysfunction, Peyronie's disease, and prosthetic urology. He has clinical interests in conditions encompassing general urology, including stone disease, enlarged prostate, recurrent infections, and scrotal conditions such as hydroceles.
