The effectiveness of medical penile rehabilitation after radical prostatectomy

Abstract

Background. Among the drug methods of penile rehabilitation in patients after nerve-sparing prostatectomy, the use of phosphodiesterase-5 (PDE-5) inhibitors is proposed as the first line of therapy, which have shown high efficiency, ease of use, good tolerability and safety, improving the quality of life of patients.Aim. To evaluate the effectiveness of drug-induced penile rehabilitation after nerve-sparing prostatectomy in the restoration of erectile function (EF) with an analysis of the factors influencing it.Materials and methods. The study included 108 patients with localized prostate cancer who underwent nerve-sparing prostatectomy. All patients were randomized into two groups. In Group 1 patients did not receive drug therapy for the prevention and treatment of erectile dysfunction. In Group 2 patients in the postoperative period received daily PDE-5 inhibitors (tadalafil) at a minimum dosage of 5 mg for 12 months as a drug therapy. Initially and at the annual stage of the study, the state of EF, erectile rigidity, night penile test, and quality of life were assessed. An analysis was also made of the factors affecting the preservation of EF one year after nerve-sparing radical prostatectomy.Results. The best reliable results in terms of maintaining EF at the annual stage of the study were obtained in the group whose patients received postoperative drug therapy with PDE-5 inhibitors. It was possible to identify the most significant factors influencing the state of EF in the postoperative period after radical prostatectomy: the type of operation – bilateral nerve sparing, taking PDE-5 inhibitors, the patient’s age, the presence/absence of diabetes mellitus, the state of EF (International Index of Erectile Function-5 value) before the operation.Conclusion. Daily intake of PDE-5 inhibitors at a low dose of 5 mg is indicated for patients after nerve-sparing prostatectomy as an effective means of penile rehabilitation in order to preserve EF, as it provides better results compared to no drug therapy. Patients who meet criteria such as young age, no diabetes, high preoperative International Index of Erectile Function-5 levels may benefit most from nerve-sparing surgical techniques and early postoperative participation in a penile rehabilitation program for erectile dysfunction.