Penile rehabilitation programs (PRPs), particularly those that include phosphodiesterase-5 inhibitors (PDE5Is), are effective in helping men regain or maintain erectile function after bilateral nerve-sparing robot-assisted radical prostatectomy (RARP), according to a study published in BJU International in December.
PRPs using PDE5Is alone or in combination with a vacuum erection device (VED) were beneficial, the authors said.
It is common for men to have some degree of erectile dysfunction (ED) after prostatectomy because the procedure can damage nerves involved with erection. Penile rehabilitation programs aim to restore that function by protecting tissue and preventing atrophy. PRPs usually begin about two to six months after surgery and may last up to two years. The programs often include oral medications, such as PDE5Is, intraurethral and intracavernosal vasoactive agents, and VEDs.
Success of PRPs often depends on a man’s erectile function before surgery and his compliance with the program.
Researchers from Columbia University Medical Center in New York, USA and Gulhane Military Medical Academy in Ankara, Turkey conducted the study. Their goal was to determine the “optimal” PRP for men after RARP using preoperative scores on the Sexual Health Inventory for Men (SHIM).
The researchers examined records of 203 patients who had undergone RARP. Using preoperative SHIM scores, they divided the records into three groups based on the degree of ED.
The scores for men in Group 1 indicated moderate ED. Group 2’s scores put them in the mild category. The men in Group 3 had no erectile dysfunction.
The men participated in four types programs: PDE5Is only, vacuum erection device only, combined PDE5I and VED therapies, and no therapy.
Treatment was considered successful if the men were able to have an erection firm enough for sexual intercourse. The researchers also considered the erectile function recovery periods (EFRP) for each group.
The results were as follows:
| Degree of ED|
| Success Rate|
| Mean EFRP|
|Group 1||Moderate||19%||15.44 ± 7.73|
|Group 2||Mild||46%||12.31± 8.12|
|Group 3||None||68%||8.73 ± 5.67|
Only PDE5Is alone or combined with vacuum erection devices had a beneficial effect on EFRP. The combination therapy yielded the best results overall.
These findings need validation by further large randomized control studies, the authors wrote.
Basal, Seref, et al.
“Optimal strategy for penile rehabilitation after robot-assisted radical prostatectomy based on preoperative erectile function”
(Abstract. First published online: November 27, 2012)
“Rehabilitation helps restore erectile function post radical prostatectomy”
(December 10, 2012)