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A European trial randomly assigned patients to receive either nightly vardenafil, on-demand vardenafil, or placebo for nine months following nerve-sparing surgery. It will take time to sort out the relative merits of these alternatives, but in each case, the experience and skill of the surgeon and his team is the major determinant of success. A second study found that another of the ED pills can also help men achieve erections after prostate cancer surgery, but it also put the role of prophylactic treatment and rehabilitation into perspective as well. Since many prostate cancers grow slowly, the first decision is whether to begin treatment at once or to wait until there is clinical evidence that treatment is necessary. That was the price a man paid for "getting it all out" untilwhen Dr. Oxygen is delivered by blood; because an erection involves a six-fold increase in penile blood flow, it increases tissue oxygenation. Before you decide that penile rehabilitation sounds like fun, remember that it's triggered by a diagnosis of prostate cancer.

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Even so, many people still don't understand that sexual fulfillment does not necessarily depend on a good erection.

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The penile rehabilitation hypothesis says that even the best nerve-sparing operation is bound to inflict some damage on the network of nerves and blood vessels that surround the prostate. They are somewhat less effective in diabetics and even less likely to work after prostate cancer surgery. The crucial chemical for both spontaneous and medication-assisted erections is nitric oxide, which transmits the impulses of arousal between nerves and also relaxes muscle cells in the penile arteries, causing them to widen and admit more blood. During the treatment period, on-demand vardenafil outscored both nightly vardenafil and placebo. Over time, this produces fibrosis scarring and the loss of elasticity and normal function in the corpora cavernosa, making erections progressively harder to come by. If this explanation is correct, improving penile blood flow should protect sensitive tissues and promote recovery of erectile function.

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