Preoperative erectile function is the only predictor of the use of a high number of phosphodiesterase type-5 inhibitors after bilateral nerve-sparing radical prostatectomy

Abstract

It is well known that the administration of phosphodiesterase type-5 inhibitors (PDE5-Is) may improve erectile function (EF) recovery after bilateral nerve-sparing radical prostatectomy (BNSRP). The aim of our study was to identify predictors of the use of a high number of PDE5-Is (one or more per week) after surgery among 184 patients taking proerectile medications on demand. At a mean follow-up of 22.7 months, 116 patients (63%) recovered EF. Overall, EF recovery rates at 1- and 2- year follow-up were 47.3% and 65.4%, respectively. Overall, 43 (23.4%) patients used one or more PDE5-Is per week. Preoperative EF was the only predictor of the use of one or more PDE5-Is per week after BNSRP. This held true even after adjusting our analyses for age at surgery, body mass index and EF at 1 month after surgery. Particularly, patients fully potent before surgery had roughly 2.1-fold higher probability of using one or more pills per week compared with their counterparts with some degree of preoperative erectile dysfunction (ED; odds ratio: 2.16; 95% confidence interval: 1.03-4.37). In conclusion, preoperative EF represents the only determinant of the use of a higher number of PDE5-Is after surgery. Patients with better preoperative EF might represent individuals more motivated to achieve satisfactory sexual function after surgery. These observations should provide physicians with better preoperative patient counseling and management of postoperative ED.

Improvement in sexual function after robot-assisted radical prostatectomy: A rehabilitation program with involvement of a clinical sexologist

“…Patients with ULNS or NonNS are doing far worse; only 10-30% have an acceptable EF [ 4 , 7 , 23 , 24 ]. The (early) penile rehabilitation is more or less exclusively studied in patients with BLNS surgery [ 25 – 28 ] and its additional value is still under debate and yet to be proven [ 29 ].…”

Management of functional outcomes after radical prostatectomy in the Nordic countries: A survey of uro-oncological centers

“…This choice is not surprising, as PDE5Is are the most straightforward treatment option for ED. However, previous high-quality studies have suggested limited clinical effect in a large proportion of post-RP patients and a lack of effectiveness in terms of rehabilitation [22][23][24]. Therefore, it is concerning that only a few centers offered more lines of rehabilitation with VED, urethral suppositories, and injections.…”

Preoperative Evaluation of Sexual Function in Patients Undergoing Bilateral Nerve-Sparing Radical Retropubic Prostatectomy

“…The likelihood of satisfactory erections after surgery is extremely low in patients with severe ED as measured by IIEF [20,21]. Patients with a higher preoperative IIEF are generally more motivated to achieve satisfactory erectile and sexual function after surgery [22]. Surgical technique and surgeons' experience also have a signi cant impact on the likelihood of ED after surgery [23][24][25][26][27][28][29][30].…”