Time course of recovery of erectile function after radical retropubic prostatectomy: does anyone recover after 2 years?
BACKGROUND
Given the paucity of literature on the time course of recovery of erectile function (EF) after radical prostatectomy (RP), many publications have led patients and clinicians to believe that erections are unlikely to recover beyond 2 years after RP.


OBJECTIVE
We sought to determine the time course of recovery of EF beyond 2 years after bilateral nerve sparing (BNS) RP and to determine factors predictive of continued improved recovery beyond 2 years.


METHODS
EF was assessed prospectively on a 5-point scale: (i) full erections; (ii) diminished erections routinely sufficient for intercourse; (iii) partial erections occasionally satisfactory for intercourse; (iv) partial erections unsatisfactory for intercourse; and (v) no erections. From 01/1999 to 01/2007, 136 preoperatively potent (levels 1-2) men who underwent BNS RP without prior treatment and who had not recovered consistently functional erections (levels 1-2) at 24 months had further follow-up regarding EF. Median follow-up after the 2-year visit was 36.0 months.


METHODS
Recovery of improved erections at a later date: recovery of EF level 1-2 in those with level 3 EF at 2 years and recovery of EF level 1-3 in those with level 4-5 EF at 2 years.


RESULTS
The actuarial rates of further improved recovery of EF to level 1-2 in those with level 3 EF at 2 years and to level 1-3 in those with level 4-5 EF at 2 years were 8%, 20%, and 23% at 3, 4, and 5 years postoperatively, and 5%, 17%, and 21% at 3, 4, and 5 years postoperatively, respectively. Younger age was predictive of greater likelihood of recovery beyond 2 years.


CONCLUSIONS
There is continued improvement in EF beyond 2 years after BNS RP. Discussion of this prolonged time course of recovery may allow patients to have a more realistic expectation.
Rabbani
Farhang
F
Department of Urology, Montefiore Medical Center, Bronx, NY 10467, USA. frabbani@montefiore.org
Schiff
Jeffrey
J
Piecuch
Michael
M
Yunis
Luis Herran
LH
Eastham
James A
JA
Scardino
Peter T
PT
Mulhall
John P
JP
D000367:Age Factors; D007172:Erectile Dysfunction / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010410:Penile Erection; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects*; D020127:Recovery of Function; D013997:Time Factors