Comparative evaluation of treatments for erectile dysfunction in patients with prostate cancer after radical retropubic prostatectomy

Abstract

Objective To assess the effectiveness of a progressive local treatment protocol for erectile dysfunction (ED) in patients after undergoing radical retropubic prostatectomy (RRP) for prostate cancer. Patients and Methods The study included 85 patients (mean age 59.5 years, range 50±75) with ED after RRP. Treatment was offered in four progressive phases, with patients passing to the next phase only if they failed the previous one: in phase I patients used a vacuum erection device; in phase II, sildena®l; in phase III, intracorporal injection; and in phase IV, intracorporal injection plus the vacuum erection device. The patients were followed for 1 year. Results Of the 85 patients, 78 (92%) responded to the vacuum erection device (with an erection suf®cient for vaginal penetration), but only 11 (14%) agreed to continue with it at home. Of the remaining 74 patients, 69 with no contraindications were given sildena®l and 14 (20%) had a positive response. Sixty patients were then treated with intracorporal injection and 51 (85%) had a positive response; four of the nine failures in phase III responded to intracorporal injection plus vacuum therapy. Five patients failed all four protocols. After 1 year of follow-up, 76 of the 80 patients were successfully continuing treatment at home; seven (9%) used the vacuum erection device, 11 (14%) sildena®l, 54 (71%) intracorporal injection and four (5%) intracorporal injection plus the vacuum erection device. Conclusion Overall, this progressive treatment method gave a positive response in 80 of the 85 patients (94%). After 1 year of follow-up, 76 of the 80 patients (95%) continued to respond well. Of all the methods used, intracorporal injection was the most effective for ED after RRP.

Erectile dysfunction and sexual health after radical prostatectomy: impact of sexual motivation

“…[7][8][9] According to a literature review, the efficacy of sildenafil ranges from 14 to 53%, but this range can be extended to 14-85% on switching to ICI. 10,11 Penile rehabilitation should be discussed with all patients, regardless of their sexual motivation, and initiated promptly after RP. 9,12,13 Among our 63 RP patients, 74.6% were regularly using ED treatment and 81% had erections adequate for intercourse with or without pharmacological assistance.…”

Penile rehabilitation following treatment for prostate cancer: an analysis of the current state of the art

“…On the other hand, Bechara and coauthors 49 performed a prospective study which showed that the 3-drug mixture is more effective than high-dose PGE1 alone in achieving erections suitable for penetration. In addition, Baniel and colleagues 50 found that ICSI of papaverine, phentolamine and PGE1 combination was effective in 51 (85%) of 60 patients following RP using structured interviews with patients and their partners.…”

Management of Erectile Dysfunction Secondary to Treatment for Localized Prostate Cancer

“…This is relatively simple to use, but the erection produced is unlike a physiologic erection. Some patients consider it unappealing; in a report by Baniel et al, 31 only 11 (14%) of 78 patients who responded to the vacuum erection device agreed to continue with it. For patients who failed either sildenafil or MUSE therapy and do not want to use ICI or penile prostheses, a combination of MUSE and sildenafil may allow erections sufficient for penetration.…”

“…After 1 year of followup, ICI was described as the most effective alternative for ED after radical retropubic prostatectomy. 31 Kim and colleagues 42 have described some recovery of erectile function in men who underwent bilateral sural nerve graft placement during radical retropubic prostatectomy where both cavernous nerves were deliberately resected. Other authors remain skeptical about the value of nerve grafts in restoring sexual function in men undergoing radical surgery.…”