The Use of an Erectogenic Pharmacotherapy Regimen Following Radical Prostatectomy Improves Recovery of Spontaneous Erectile Function

Abstract

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.

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

“…Early penile rehabilitation can significantly improve the rate of postoperative spontaneous erections and sexual QoL, and administration of a PDEI-5 such as sildenafil can help to enhance rigidity. [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.…”

Prediction of sexual function after radical prostatectomy

“…43 Penile rehabilitation after nerve-sparing radical prostatectomy: Clinical evidence Despite all the evidence in favor of chronic treatment with PDE5-I, only a few trials have assessed the role of penile rehabilitation in men who underwent RP. [46][47][48][49][50][51][52] Montorsi et al 46 demonstrated that, by using intracorporeal injections of alprostadil early after bilateral NSRP (BNSRP), the rate of recovery of spontaneous erections was significantly higher than the rate with observation alone. Those data also recently were confirmed by Mulhall et al,47 who demonstrated that the prophylactic use of intracorporeal injections of alprostadil in patients who did not respond to oral sildenafil resulted in higher rates of spontaneous functional erections and erectogenic drug response 18 months after NSRP.…”

“…[46][47][48][49][50][51][52] Montorsi et al 46 demonstrated that, by using intracorporeal injections of alprostadil early after bilateral NSRP (BNSRP), the rate of recovery of spontaneous erections was significantly higher than the rate with observation alone. Those data also recently were confirmed by Mulhall et al,47 who demonstrated that the prophylactic use of intracorporeal injections of alprostadil in patients who did not respond to oral sildenafil resulted in higher rates of spontaneous functional erections and erectogenic drug response 18 months after NSRP. In this context, the prophylactic administration of a vacuum constriction device also has been proposed recently as an early penile rehabilitation approach aimed at promoting adequate cavernosal oxygenation and, thus, preventing penile fibrosis after surgery.…”

“…A continuous improvement in erectile function up to 2 years after surgery has been reported. 47 Despite these limitations, the trial is 1 of the few addressing the role of chronic PDE5-I administration in patients who underwent bilateral NSRP.…”

The role of vacuum erection devices in penile rehabilitation after radical prostatectomy

“…Treated men also had a much higher response to sildenafil after 18 months, as well as higher IIEF-EF domain scores. 38 It is noted that the use of needles dissuades men from strict ICI rehabilitation protocols, as the attrition rate is quite high several months into treatment. 39 Intraurethral prostaglandins as a rehabilitation agent has been tested in the form of the Medicated Urethral System for Erection (MUSE; Vivus Inc., Mountain View, CA, USA).…”