Rehabilitative therapy for erectile function after nerve-sparing radical prostatectomy

Abstract

Background To date, the time course for recovery of erectile function and the effect of rehabilitative treatment after nerve-sparing radical prostatectomy (RP) is still under debate. The aim of this study was to evaluate the effect of low-dose sildenafil for rehabilitation of erectile function after nerve-sparing RP. Methods In a prospective, randomised study, 43 sexually active patients underwent a nerve-sparing retropubic RP. Erectometer measurement of nocturnal penile tumescence and rigidity (NPTR) was carried out 7–14 days after surgery. Some patients (23) with preserved nocturnal erections received sildenafil 25 mg/day at night to support recovery of erectile function. A control of 18 patients underwent follow up without phosphodiesterase type 5 (PDE-5) inhibitors. The International Index of Erectile Function (IIEF-5) questionnaire was given 6, 12, 24, 36, 52 and 78 weeks after operation. Results A total of 41 out of 43 patients (95%) showed 1–5 erections during the first night after catheter removal. In the daily sildenafil group, the IIEF-5 score decreased from a preoperative mean score of 20.8 to mean scores of 3.6 at 6 weeks, 3.8 at 12 weeks, 5.9 at 24 weeks, 9.6 at 36 weeks, 14.1 at 52 weeks and 19.4 at 78 weeks after prostatectomy. In the control group, the preoperative IIEF-5 mean score of 21.2 decreased to 2.4 at 6 weeks, 3.8 at 12 weeks, 5.3 at 24 weeks, 6.4 at 36 weeks, 9.3 at 52 weeks and 13.4 at 78 weeks. Statistical evaluation showed a significant difference in IIEF-5 score and time to recovery of erectile function between the groups ( p<0.001) with potency rates of 92% vs. 68%. Conclusions In this study of men, the measurement of NPTR after nerve-sparing RP showed erectile function even during the “first” night after catheter removal. Sildenafil was efficacious when used in a “daily low dose” treatment and led to a significant improvement in recovery of erectile function.