Time Course of Recovery of Erectile Function After Radical Retropubic Prostatectomy: Does Anyone Recover After 2 Years?

Abstract

Introduction Given the paucity of literature on the time course of recovery of erectile function (EF) after radical prostatectomy (RP), many publications have led patients and clinicians to believe that erections are unlikely to recover beyond 2 years after RP. Aims We sought to determine the time course of recovery of EF beyond 2 years after bilateral nerve sparing (BNS) RP and to determine factors predictive of continued improved recovery beyond 2 years. Methods EF was assessed prospectively on a 5-point scale: (i) full erections; (ii) diminished erections routinely sufficient for intercourse; (iii) partial erections occasionally satisfactory for intercourse; (iv) partial erections unsatisfactory for intercourse; and (v) no erections. From 01/1999 to 01/2007, 136 preoperatively potent (levels 1–2) men who underwent BNS RP without prior treatment and who had not recovered consistently functional erections (levels 1–2) at 24 months had further follow-up regarding EF. Median follow-up after the 2-year visit was 36.0 months. Main Outcome Measures Recovery of improved erections at a later date: recovery of EF level 1–2 in those with level 3 EF at 2 years and recovery of EF level 1–3 in those with level 4–5 EF at 2 years. Results The actuarial rates of further improved recovery of EF to level 1–2 in those with level 3 EF at 2 years and to level 1–3 in those with level 4–5 EF at 2 years were 8%, 20%, and 23% at 3, 4, and 5 years postoperatively, and 5%, 17%, and 21% at 3, 4, and 5 years postoperatively, respectively. Younger age was predictive of greater likelihood of recovery beyond 2 years. Conclusion There is continued improvement in EF beyond 2 years after BNS RP. Discussion of this prolonged time course of recovery may allow patients to have a more realistic expectation.

Randomized Comparison Between Laparoscopic and Robot-Assisted Nerve-Sparing Radical Prostatectomy

“…Lastly, in few cases, EFR could necessitate up to 40 months [5,41]. Thus, the patient population that scored less in the IIEF‐6 questionnaire will need to be reevaluated later in time.…”

Psychosocial perspectives on sexual recovery after prostate cancer treatment

“…48 Waiting for natural recovery of erections is difficult for patients and their partners, as recovery times are highly individual. 5 For example, for patients who undergo radical prostatectomy, even partial recovery of erectile function can take up to 4 years, owing to nerve recovery, 49 though the majority of function returns within the first 24 months. 39 Salonia et al 50 stipulate that patients should be told that recovery typically takes 6-36 months, but that the level of recovery at 6 months is predictive of long-term, overall recovery, as discussed by Vickers et al 39 To maintain sexual intimacy during that recovery period, patients and their partners should be encouraged to explore not just erectile assistance but also alternative sexual practices that are not erection-dependent.…”

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

“…Despite numerous surgical modifications including the anatomic nerve‐sparing (NS) RP, ED rates in contemporary RP series range between 30% and 87% [4–6]. Although anatomic NS radical prostatectomy (RP) promises a high likelihood of postoperative recovery of erectile function (EF), many men will require as much as 2 years or longer to recover satisfactory EF [7]. Recent evidence strongly supports the notion that sexual function is the health‐related quality‐of‐life domain most commonly impaired after prostate cancer treatment [4].…”