Standard Operating Procedure for the Preservation of Erectile Function Outcomes After Radical Prostatectomy

Abstract

Introduction Prostate cancer is common, and, thus, more men are being treated surgically. Long-term functional outcomes are of significant importance to the patient and their partners. Erectile function (EF) preservation (rehabilitation) has gained significant traction worldwide, despite the absence of definitive evidence supporting its use. Aim To review the effectiveness of specific pharmacological therapies and other erectogenic aids in the treatment of post-radical prostatectomy (RP) erectile dysfunction. Methods A systematic literature review of original peer-reviewed manuscripts and clinical trials reported in Medline. Main Outcome Measure This review focused on the evaluation of interventions that aimed to improve EF recovery following RP. Results Although well documented in animal models, studies supporting the rehabilitation with phosphodiesterase type 5 inhibitors in humans are scarce. Daily sildenafil has been used in trials (only one randomized placebo-controlled trial) with a significant improvement in erection recovery when compared to placebo or no rehabilitation but with a low return to baseline rates (27% vs. 4% placebo). Nightly vardenafil vs. on demand vs. placebo has been studied in the Recovery of Erections: INtervention with Vardenafil Early Nightly Therapy trial with no difference in erection recovery following RP. Intracavernosal injections, although widely used and attractive from a rehabilitation standpoint, does not yet have definitive supporting its role in rehabilitation. Vacuum erection devices use following RP has been reported, but there are no data to support its role as monotherapy. Intraurethral alprostadil was also studied vs. sildenafil in a multicenter, randomized, open-label trial, and no superiority was found. Conclusions At this time, we are unable to define what represents the optimal rehabilitation program in regard to strategies utilized, timing of intervention, or duration of treatment.

Unexpected Long-term Improvements in Urinary and Erectile Function in a Large Cohort of Men with Self-reported Outcomes Following Radical Prostatectomy

“…Good EF recovery was determined with a score ≥22 points on the validated International Index of Erectile Function (IIEF-6) scale ranging from 1 to 30 [13,14]. Three questions pertain to sexual intercourse and therefore depend on men having a sexual partner.…”

Priapism Impact Profile Questionnaire: Development and Initial Validation

“…ED was defined as erection loss inclusive of mild to moderate, moderate or severe descriptors using specified ranges of the International Index of Erectile Function (IIEF) questionnaire-Erectile Function (EF) Domain (scores <22) or its short form comprising 5 questions (IIEF-5) (scores <17). 8,10,16,17 …”

Editorial Comment

“…A number of factors influence postprostatectomy erectile dysfunction, including but not limited to nerve sparing, age, systemic comorbidities, the surgeon's experience, and use of androgen-deprivation therapy. 4 The results of that study are thought-provoking, but their data come from a retrospective single-surgeon series and have yet to be borne out by other studies. Certainly, these are not common complications that have received much attention in the existing lymphadenectomy literature.…”