Chronology of erectile function in patients with early functional erections following radical prostatectomy.
BACKGROUND
The association between erectile dysfunction (ED) and radical prostatectomy (RP) is well established. It is our clinical experience that some men who have functional erections in the days to weeks after RP go on to lose erectile function (EF) after the first 3 months postsurgery.


OBJECTIVE
To assess EF over a 12-month period in patients with functional erections at 3 months following RP.


METHODS
As part of a large prospective quality-of-life (QOL) study of men undergoing RP at our institution, EF is measured postoperatively at regular time intervals using serial administration of the International Index of Erectile Function (IIEF) questionnaire. For study inclusion, patients had to have functional erections (a score 4 or 5 on IIEF question 3) at the third postoperative month, and have at least 12 months of follow-up.


METHODS
Assessment of EF and phosphodiesterase type 5 inhibitor (PDE5i) use at 3, 6, and 12 months after RP.


RESULTS
At 3 months, 76 of 482 patients (16%) had functional erections. Between 3 to 6 months postoperatively, 20% of men deteriorated in their functional status. Of these men, 91% had functional erections at 1 year. Comparing patients who did not require PDE5i to obtain a functional erection at 3 months with those who did, the EF outcomes were superior at 6 months (80% vs. 72%, P = 0.74) and 12 months (100% vs. 88%, P = 0.33).


CONCLUSIONS
The recovery of functional erections in the early postoperative phase, especially without the need for PDE5i, is a good prognostic indicator for EF at 12 months. However, a distinct cohort of men lose functional erections within 6 months after surgery. It is important to inform patients of this possibility, as it has an impact on their QOL and, potentially, on their compliance with post-RP therapy for ED.
Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Darren
D
Katz
Nelson E
NE
Bennett
Jason
J
Stasi
James A
JA
Eastham
Bertrand D
BD
Guillonneau
Peter T
PT
Scardino
John P
JP
Mulhall
D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data; D007172:Erectile Dysfunction / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000187:drug effects / Q000523:psychology; D058986:Phosphodiesterase 5 Inhibitors; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D011379:Prognosis; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects* / Q000523:psychology / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000601:surgery*; D011788:Quality of Life / Q000523:psychology; D011795:Surveys and Questionnaires; D014665:Vasodilator Agents / Q000627:therapeutic use
D058986:Phosphodiesterase 5 Inhibitors; D010726:Phosphodiesterase Inhibitors; D014665:Vasodilator Agents