{"id":316015,"date":"2026-05-05T15:33:15","date_gmt":"2026-05-05T15:33:15","guid":{"rendered":"https:\/\/www.pierluigibove.com\/2026\/05\/05\/radical-prostatectomy-and-erectile-function-why-rehabilitation-is-not-always-enough-and-when-a-different-approach-may-be-appropriate\/"},"modified":"2026-05-06T15:29:33","modified_gmt":"2026-05-06T15:29:33","slug":"radical-prostatectomy-and-erectile-function-why-rehabilitation-is-not-always-enough-and-when-a-different-approach-may-be-appropriate","status":"publish","type":"post","link":"https:\/\/www.pierluigibove.com\/en\/2026\/05\/05\/radical-prostatectomy-and-erectile-function-why-rehabilitation-is-not-always-enough-and-when-a-different-approach-may-be-appropriate\/","title":{"rendered":"Radical prostatectomy and erectile function: why rehabilitation is not always enough and when a different approach may be appropriate"},"content":{"rendered":"\n<p class=\"has-vivid-cyan-blue-color has-text-color has-link-color has-medium-font-size wp-elements-df6ee080fa4a38bee592ea9766a2905d wp-block-paragraph\">Professor Pierluigi Bove addresses a point that is often overlooked: after prostatectomy, spontaneous recovery of erections concerns only a minority of patients, and rehabilitation pathways are not always the most effective answer.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">When pelvic oncologic surgery and quality of life are discussed, the focus is often placed on cystectomy. After bladder removal, the risk of losing erectile function is indeed high. But if we look at the overall numbers, there is another reality that affects many more men.  <\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">\u201cThe concept should be shifted from cystectomy to prostatectomy,\u201d Professor <strong>Pierluigi Bove<\/strong> notes. \u201cIn terms of incidence and prevalence there is no comparison: prostate cancer is the most common cancer in men and its impact is clearly larger.\u201d<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">This means functional recovery after surgery is not a niche topic. It is a central issue in everyday clinical practice, particularly when discussing radical prostatectomy. <\/p>\n\n\n\n<p class=\"has-vivid-cyan-blue-color has-text-color has-link-color has-medium-font-size wp-elements-27f2137c3937607aa7ca7ddf4496cb91 wp-block-paragraph\">The clinical point: not every patient is a true candidate for <em>nerve-sparing<\/em> surgery<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">In common conversations, erectile function is often assumed to \u201ccome back\u201d after surgery, with time and some form of therapy. The reality is more selective. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">\u201cThe chances of recovering erectile function after prostatectomy apply to only a small group of patients,\u201d Professor Bove explains. \u201cWe are talking about men who are truly eligible for a pure <em>nerve-sparing<\/em> or intrafascial procedure.\u201d <\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">In practice, this applies to a limited proportion of cases. Typically, these are low-risk\u2014or at most favorable intermediate-risk\u2014tumours with clearly localized disease. For many other patients, to achieve adequate oncologic control, part of the neurovascular structures has to be sacrificed.  <\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">The result is that, for a significant number of men, recovery is neither quick nor guaranteed.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">\u201cFor many patients, surgery inevitably means that a portion of the nerves has to be removed,\u201d Professor Bove stresses. \u201cAnd that changes the probability of recovery completely.\u201d <\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">There is also a human and time-related aspect that is often underestimated. Early on, the patient is understandably dominated by the cancer diagnosis: fear of dying, concern about suffering, and a strong focus on \u201cremoving the tumour.\u201d In that phase, functional complications\u2014urinary incontinence and erectile dysfunction\u2014inevitably move to the background.  <\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">But that balance changes over time.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">After surgery, when the patient moves beyond the most critical phase, when follow-up is reassuring and a future perspective returns, other questions emerge. That is when erectile function becomes central to the patient\u2019s perception of quality of life. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">\u201cThat is often when the real ordeal begins.\u201d<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">The patient may enter long pathways involving medications, injections, devices, repeated attempts, with expectations that are often high and results that are not always proportional. This gap between hope and reality can carry a significant psychological burden, leading to frustration, a sense of failure, and, in some cases, a depressive state. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"631\" src=\"https:\/\/www.pierluigibove.com\/wp-content\/uploads\/2026\/05\/Pierluigi-Bove-Urologist-Blog-Post-Radical-prostatectomy-and-erectile-function-featured-1024x631.jpg\" alt=\"\" class=\"wp-image-316018\" srcset=\"https:\/\/www.pierluigibove.com\/wp-content\/uploads\/2026\/05\/Pierluigi-Bove-Urologist-Blog-Post-Radical-prostatectomy-and-erectile-function-featured-980x604.jpg 980w, https:\/\/www.pierluigibove.com\/wp-content\/uploads\/2026\/05\/Pierluigi-Bove-Urologist-Blog-Post-Radical-prostatectomy-and-erectile-function-featured-480x296.jpg 480w\" sizes=\"(min-width: 0px) and (max-width: 480px) 480px, (min-width: 481px) and (max-width: 980px) 980px, (min-width: 981px) 1024px, 100vw\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"has-vivid-cyan-blue-color has-text-color has-link-color has-medium-font-size wp-elements-6c1df29fe241b63a2f5d9ebc33522c32 wp-block-paragraph\">When recovery happens, it often follows years of attempts<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">Structured rehabilitation pathways exist, including oral pharmacotherapy, intracavernosal injection therapy, vacuum devices, and other strategies. In some cases they are helpful. But it should be stated clearly that they do not always lead to a satisfactory recovery, and when they do, the timeline may be long.  <\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">\u201cWhen these patients recover, they often do so after years of medical therapy, injections, vacuum devices, and more,\u201d Professor Bove says.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">This is not about denying the value of rehabilitation, but placing it in the right context: it is a tool, not a promise. And it should not be pursued by inertia, without a realistic assessment of probabilities and goals. <\/p>\n\n\n\n<p class=\"has-vivid-cyan-blue-color has-text-color has-link-color has-medium-font-size wp-elements-de462fb663e1b0cd6775b44410dbde16 wp-block-paragraph\">A different approach in selected cases<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">Clinical experience points to a simple idea: in some patients\u2014especially when the chances of spontaneous recovery are low\u2014it can make sense to discuss alternative options early, with a more concrete horizon.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">\u201cTranslating the concept of a one-step approach to prostatectomy in patients with minimal or moderate nerve preservation can help avoid many psychological and functional problems,\u201d Professor Bove explains.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">Put plainly: rather than leaving the patient in a long and often frustrating sequence of attempts, it may be reasonable, in selected cases and with clear indications, to consider a more direct pathway that reduces waiting time and uncertainty.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">One sentence Professor Bove repeats on this topic is very clear: \u201cEnough with extremely expensive rehabilitation pathways that achieve little and, in many cases, lead the patient into depression.\u201d<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">Without generalizing, the clinical message is that patients should be guided with realism. A topic this sensitive should not become an \u201cafterthought,\u201d managed with an open-ended sequence of trials without a strategy. <\/p>\n\n\n\n<p class=\"has-vivid-cyan-blue-color has-text-color has-link-color has-medium-font-size wp-elements-a688a9005e58f7305aff3e8d8359bee0 wp-block-paragraph\">Clear information and shared decisions remain the core<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">Talking about erectile function after prostatectomy does not mean shifting attention away from cancer treatment. It means integrating the cure with what matters to the patient in real life, and doing so transparently.<br><br>Decisions about the functional pathway cannot be standardized. They depend on tumour stage and characteristics, the type of surgery that is possible, the patient\u2019s baseline condition, and expectations. But one element should be constant: telling patients upfront what is too often discussed only later.  <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link has-background wp-element-button\" href=\"https:\/\/www.pierluigibove.com\/urgenze\/\" style=\"background-color:#10b899\" rel=\"nofollow\">BOOK AN APPOINTMENT<\/a><\/div>\n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\"><strong>References:<\/strong><br>prostate cancer, radical prostatectomy, erectile function after prostatectomy, post-prostatectomy erectile dysfunction, nerve-sparing surgery, intrafascial surgery, eligibility for nerve sparing, erectile recovery after prostatectomy, postoperative erectile rehabilitation, intracavernosal injection therapy, vacuum erection device, pharmacological therapy for erectile dysfunction, quality of life after prostatectomy, functional outcomes of prostate cancer surgery, doctor\u2013patient communication, shared decision-making, urologic oncology Rome, Prof. Pierluigi Bove, Policlinico Tor Vergata, URMI, UPMC<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Professor Pierluigi Bove addresses a point that is often overlooked: after prostatectomy, spontaneous recovery of erections concerns only a minority of patients, and rehabilitation pathways are not always the most effective answer. When pelvic oncologic surgery and quality of life are discussed, the focus is often placed on cystectomy. After bladder removal, the risk of [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":316017,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"off","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[1],"tags":[],"class_list":["post-316015","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v25.1 (Yoast SEO v27.6) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Radical prostatectomy and erectile function rehabilitation<\/title>\n<meta name=\"description\" content=\"Prof. Pierluigi Bove explains that after prostatectomy, spontaneous recovery of erections occurs in only a small proportion of patients\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, 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