Immediate penile rehabilitation with sildenafil may yield better results after prostatectomy than delaying the regimen, according to new research published in the Journal of Urology.
Radical prostatectomy is an effective way to treat prostate cancer, but many men experience urinary incontinence and erectile dysfunction (ED) afterward, even after nerve-sparing robot-assisted procedures (NS-RALP).
Penile rehabilitation with phosphodiesterase type 5 inhibitors (such as sildenafil) can be a useful strategy for minimizing these effects. However, the best time frame for such rehabilitation has not been determined.
For the study, 124 men undergoing NS-RALP were randomly assigned to one of two groups.
The early group started taking 100 mg of sildenafil twice weekly for three months immediately after their urethral catheter was removed following surgery. After three months, they were free to take sildenafil on demand as needed.
The delayed group took the same sildenafil regimen but started three months after surgery.
Outcomes were assessed with the 5-item International Index of Erectile Function (IIEF-5) and two questions from the Sexual Encounter Profile (SEP) questionnaire, which evaluated whether an erection was hard enough for penetration (SEP Q2) and maintained for the full duration of a sexual encounter (SEP Q3). These assessments were conducted three, six, and nine months into the study, with an overall efficacy assessment at twelve months, then the study concluded.
At twelve months, 41.4% of the early group and 17.7% of the delayed group showed full recovery of erectile function, defined as IIEF-5 scores of 17 or above. (Lower IIEF-5 scores indicate poorer function.) The delayed group had better function at each follow up point, and their scores increased consistently over time.
The researchers also predicted that men in the early group were three times more likely to see full recovery than those in the delayed group.
As for SEP responses, 56.9% of the early group and 46.8% of the delayed group said their erection was suitable for penetration (SEP Q2) after twelve months. For SEP Q3, 37.9% of the early group said they could maintain their erection, compared to 17.7% of the delayed group.
Mild facial flushing was the most commonly reported side effect. However, early sildenafil treatment did not increase side effect rates.
“Our trial provides data advocating that earlier rehabilitation can contribute more to the preservation of cavernous tissue competence,” the authors wrote, adding that further studies with longer follow-up are needed to fully understand the effects of this approach.
The Journal of Urology
Jo, Jung Ki, et al.
“Effect of Starting Penile Rehabilitation with Sildenafil Immediately after Robot-Assisted Laparoscopic Radical Prostatectomy on Erectile Function Recovery: A Prospective Randomized Trial”
(Full-text. Published online: January 4, 2018)
Trends in Urology and Men’s Health
“The use of questionnaires to assess sexual function”