Purpose It has been suggested that postradical prostatectomy (RP) erectile function outcomes are improved by early use of erectogenic medications. This analysis was designed to assess the ability of a post-RP vasoactive drug program to improve long-term spontaneous erectile function. Methods Men with functional preoperative erections who underwent RP were challenged early postoperatively with oral sildenafil. Nonresponders were switched to intracavernosal injection therapy (ICI). Patients were instructed to inject three times a week. Only patients who presented within 6 months post RP, who completed the International Index of Erectile Function (IIEF) questionnaire on at least three separate occasions after surgery, and who had been followed for at least 18 months were included. Data from men who were committed to rehabilitation were compared with those of men who did not follow the protocol but continued to be followed serially following RP. Results There were 58 patients in the rehabilitation (R) group and 74 in the nonrehabilitation (NR) group. No differences existed in mean patient age, comorbidity profile, intraoperative nerve sparing status, or postoperative erectile hemodynamics between the two groups. At 18 months post RP, there were statistically significant differences between the two groups in the percentage of patients who were capable of having medication-unassisted intercourse (R = 52% vs. NR = 19%, P < 0.001); mean erectile rigidity (R = 53 ± 21% vs. NR = 26 ± 43%, P < 0.01); mean IIEF erectile function (EF) domain scores (R = 22 ± 6 vs. NR = 12 ± 14, P < 0.01); the percentage of patients with normal EF domain scores (R = 22% vs. NR = 6%, P < 0.01); the percentage of patients responding to sildenafil (R = 64% vs. NR = 24%, P < 0.001); the time to become a sildenafil responder (R = 9 ± 4 vs. NR = 13 ± 3 months, P = 0.02); and the percentage of patients responding to ICI (R = 95% vs. NR = 76%, P < 0.01). Conclusions The data generated from this nonrandomized study indicate that a pharmacologic penile rehabilitation protocol results in higher rates of spontaneous functional erections and erectogenic drug response after RP.

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assessed males aged ≤ 19 years presenting with ED. The review of these databases focused on demographic characteristics, risk factors for ED, erectile function, results of vascular evaluation, and the causes of ED. RESULTSIn all, 40 males aged 14-19 years were identified. The mean (range) duration of ED at presentation was 22.6 (4-84) months. The major risk factors for ED were antecedent perineal trauma (37%) and penile trauma or surgery (15%). The mean ( SD ) International Index of Erectile Function 'erectile function' domain score was 15 (4). Information obtained by history taking was not predictive of the cause of ED. Vascular studies were performed in 62% of the patients and 48% of these patients were found to have an underlying vascular pathology; 42% of the latter group were found to be possible candidates for surgical intervention and another 16% needed further angiographic evaluation. CONCLUSIONED in teenagers should not be routinely categorized as psychogenic without an adequate vascular evaluation, as a significant percentage have abnormal erectile haemodynamics consistent with vasculogenic ED.