The timing of penile rehabilitation after bilateral nerve-sparing radical prostatectomy affects the recovery of erectile function.
OBJECTIVE
To define if erectile function (EF) outcomes were better in men with early institution of penile rehabilitation after radical prostatectomy (RP), as one of the mechanisms by which patients fail to recover EF after RP is collagenization of corporal smooth muscle with subsequent venous leak development, and rehabilitation is aimed at preventing these structural alterations.


METHODS
The study population comprised patients who: (i) had clinically organ-confined prostate cancer; (ii) had fully functional erections, corroborated by the partner; (iii) had bilateral nerve-sparing RP; and (iv) committed to pharmacological penile rehabilitation. Patients completed the International Index of Erectile Function (IIEF) serially after RP. Patients were instructed to obtain three erections/week using initially sildenafil, and if unsuccessful, then intracavernous injections. Patients were subdivided into those starting rehabilitation at < 6 months after RP (early) and those starting at > or = 6 months after RP (delayed).


RESULTS
There were 48 patients in the early group and 36 in the delayed group; patients in both groups were matched for age, comorbidity status and baseline EF. The mean duration after RP at the time of starting penile rehabilitation was 2 and 7 months in the early and delayed groups, respectively (P < 0.01). At 2 years after surgery there was a highly statistically significant difference in IIEF EF domain score between the early and delayed groups (22 vs 16, P < 0.001). There were also statistically significant differences between the groups in the percentage of men at 2 years after RP who had unassisted functional erections and sildenafil-assisted functional erections (58% vs 30%, P < 0.01; 86% vs 45%, P < 0.01, respectively).


CONCLUSIONS
These data suggest that delaying the start of penile rehabilitation after RP is associated with poorer outcomes for EF.
Mulhall
John P
JP
Urology, Memorial Sloane-Kettering Cancer Center, New York, NY, USA. mulhalj1@mskcc.org
Parker
Marilyn
M
Waters
Bedford W
BW
Flanigan
Robert
R
D006801:Humans; D018783:Impotence, Vasculogenic / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000187:drug effects / Q000502:physiology*; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D010879:Piperazines / Q000627:therapeutic use*; D011446:Prospective Studies; D011468:Prostatectomy / Q000534:rehabilitation*; D011471:Prostatic Neoplasms / Q000534:rehabilitation* / Q000601:surgery; D011687:Purines / Q000627:therapeutic use; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate