title: Standard operating procedure for the preservation of erectile function outcomes after radical prostatectomy.
abstract: BACKGROUND
  Prostate cancer is common, and, thus, more men are being treated surgically. Long-term functional outcomes are of significant importance to the patient and their partners. Erectile function (EF) preservation (rehabilitation) has gained significant traction worldwide, despite the absence of definitive evidence supporting its use.
  
  
  OBJECTIVE
  To review the effectiveness of specific pharmacological therapies and other erectogenic aids in the treatment of post-radical prostatectomy (RP) erectile dysfunction.
  
  
  METHODS
  A systematic literature review of original peer-reviewed manuscripts and clinical trials reported in Medline.
  
  
  METHODS
  This review focused on the evaluation of interventions that aimed to improve EF recovery following RP.
  
  
  RESULTS
  Although well documented in animal models, studies supporting the rehabilitation with phosphodiesterase type 5 inhibitors in humans are scarce. Daily sildenafil has been used in trials (only one randomized placebo-controlled trial) with a significant improvement in erection recovery when compared to placebo or no rehabilitation but with a low return to baseline rates (27% vs. 4% placebo). Nightly vardenafil vs. on demand vs. placebo has been studied in the Recovery of Erections: INtervention with Vardenafil Early Nightly Therapy trial with no difference in erection recovery following RP. Intracavernosal injections, although widely used and attractive from a rehabilitation standpoint, does not yet have definitive supporting its role in rehabilitation. Vacuum erection devices use following RP has been reported, but there are no data to support its role as monotherapy. Intraurethral alprostadil was also studied vs. sildenafil in a multicenter, randomized, open-label trial, and no superiority was found.
  
  
  CONCLUSIONS
  At this time, we are unable to define what represents the optimal rehabilitation program in regard to strategies utilized, timing of intervention, or duration of treatment.
authors.affiliation: Sexual & Reproductive Medicine, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA. mulhalj1@mskcc.org
authors.forename: John P
authors.initials: JP
authors.lastname: Mulhall
authors.forename: Trinity J
authors.initials: TJ
authors.lastname: Bivalacqua
authors.forename: Edgardo F
authors.initials: EF
authors.lastname: Becher
mesh_terms: D002985:Clinical Protocols / Q000592:standards; D007172:Erectile Dysfunction / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D008297:Male; D010410:Penile Erection / Q000502:physiology; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic / Q000592:standards; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods
chemical_list: D058986:Phosphodiesterase 5 Inhibitors