Optimal strategy for penile rehabilitation after robot-assisted radical prostatectomy based on preoperative erectile function

Department of Urology, School of Medicine, Gulhane Military Medical Academy, Ankara, Turkey.
BJU International (Impact Factor: 3.53). 11/2012; 111(4). DOI: 10.1111/j.1464-410X.2012.11487.x
Source: PubMed


Objective To define the optimal penile rehabilitation programme (PRP) based on preoperative Sexual Health Inventory for Men (SHIM) scores after robot-assisted radical prostatectomy (RARP). Patients and Methods The medical records of 203 patients who underwent bilateral nerve-sparing RARP between 2007 and 2011 were reviewed for the present retrospective study. According to patients' preoperative erection status, group 1 (SHIM = 8-16), group 2 (SHIM = 17-21) and group 3 (SHIM = 22-25) were defined. After bilateral nerve-sparing RARP, phosphodiesterase-5 inhibitors (PDE5Is), a vacuum erection device (VED), the combination of PDE5Is and a VED, or none of them were utilized by all patients for penile rehabilitation. Treatment success was defined as a rigid erection suitable for successful sexual intercourse. Results The numbers of patients in groups 1, 2 and 3, respectively, were 9, 22 and 73, and the mean erectile function recovery periods (EFRPs) were 15.44 +/- 7.73, 12.31 +/- 8.12 and 8.73 +/- 5.67 months (P < 0.05). Group 3 offered the best results for EFRP. Only PDE5Is or the combination of PDE5Is and VED use had a beneficial effect on EFRP (P < 0.05). Using PDE5Is and VED together provided the best result, but there was no difference between PDE5Is and a VED (P > 0.05). Conclusions After bilateral nerve-sparing RARP, PRP with PDE5Is, including the combination of PDE5Is and VED, has a beneficial effect on erectile function recovery across all levels of baseline erectile function. Further large randomized control studies are needed to validate these findings.

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