title: Recovery of Baseline Erectile Function in Men Following Radical Prostatectomy for High-Risk Prostate Cancer: A Prospective Analysis Using Validated Measures.
abstract: BACKGROUND
  Recovery of baseline erectile function (EF) after robotic radical prostatectomy in men with high-risk prostate cancer is under-reported. Published studies have selectively reported on low-risk disease using non-validated and poorly defined thresholds for EF recovery.
  
  
  OBJECTIVE
  To assess return to baseline EF in men after robotic radical prostatectomy for high-risk prostate cancer.
  
  
  METHODS
  Five hundred thirty-one men underwent robotic radical prostatectomy for high-risk prostate cancer from February 2010 through July 2014. Pre- and postoperative EF was prospectively assessed using the International Index of Erectile Dysfunction (IIEF-5) questionnaire. Multivariate logistic regression analysis determined the effect of age, preoperative function, comorbidities, body mass index, prostate-specific antigen level, cancer stage or grade, nerve-sparing status, adjuvant therapy, and continence on EF return (defined as postoperative return to baseline EF with or without use of phosphodiesterase type 5 inhibitors). Kaplan-Meier analysis and log-rank test were used to analyze return over time. Mann-Whitney U-test was used to compare IIEF-5 scores.
  
  
  METHODS
  Pre- and postoperative EF was assessed using the IIEF-5 Sexual Health Inventory for Men at 3 months, 6 months, 1 year, 2 years, 3 years, and 4 years postoperatively.
  
  
  RESULTS
  Overall, return of EF was seen in 23.5% of patients at 18 months. This was significantly increased in men no older than 60 years (P = .024), with a preoperative IIEF-5 score of at least 22 (P = .042), and after undergoing neurovascular bundle preservation (34.9% of patients, P < .001). There was no significant change in IIEF-5 scores from 3 to 36 months in patients who were treated with phosphodiesterase type 5 inhibitors in the non-neurovascular bundle preservation group (P = .87), although there was significant improvement in those receiving second- or third-line therapies (P = .042). Other than preoperative hypertension (P = .03), none of the other comorbidities predicted return of EF.
  
  
  CONCLUSIONS
  In this study, 23.5% of men recovered to baseline EF. Of those who underwent bilateral neurovascular bundle preservation robotic radical prostatectomy, 70% recovered baseline EF; however, this accounted for only 9.6% of all patients. Only 4% of men who underwent non-neurovascular bundle preservation had baseline recovery with phosphodiesterase type 5 inhibitors up to 36 months. There was significant improvement after use of second- or third-line therapies, indicating the need for earlier institution of these treatment modalities.
authors.affiliation: Department of Urology, University College London Hospital, London, UK. Electronic address: ashwinsridhar@doctors.org.uk.
authors.forename: Ashwin N
authors.initials: AN
authors.lastname: Sridhar
authors.affiliation: Department of Urology, Guy's and St. Thomas hospital, London, UK.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Cathcart
authors.affiliation: Department of Urology, University College London Hospital, London, UK.
authors.forename: Tet
authors.initials: T
authors.lastname: Yap
authors.affiliation: Department of Urology, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Hines
authors.affiliation: Department of Urology, University College London Hospital, London, UK.
authors.forename: Senthil
authors.initials: S
authors.lastname: Nathan
authors.affiliation: Department of Urology, University College London Hospital, London, UK.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Briggs
authors.affiliation: Department of Urology, University College London Hospital, London, UK; Division of Surgery and Interventional Science, University College London, London, UK.
authors.forename: John D
authors.initials: JD
authors.lastname: Kelly
authors.affiliation: Department of Urology, University College London Hospital, London, UK.
authors.forename: Suks
authors.initials: S
authors.lastname: Minhas
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D007172:Erectile Dysfunction / Q000209:etiology / Q000503:physiopathology* / Q000523:psychology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000187:drug effects / Q000502:physiology*; D058986:Phosphodiesterase 5 Inhibitors / Q000494:pharmacology; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000009:adverse effects; D011471:Prostatic Neoplasms / Q000097:blood / Q000503:physiopathology* / Q000601:surgery*; D020127:Recovery of Function; D065287:Robotic Surgical Procedures / Q000009:adverse effects; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D014408:Biomarkers, Tumor; D058986:Phosphodiesterase 5 Inhibitors; D017430:Prostate-Specific Antigen
keywords: Counseling; Erectile Dysfunction; Prostatectomy; Prostatic Neoplasm; Recovery of Function; Robotic