Sexual function recovery following open and robotic radical prostatectomy: results of an academic penile rehabilitation program

Abstract

Despite surgical advancements, erectile dysfunction (ED) is a common consequence of radical prostatectomy (RP). This study aimedto evaluate the impact of early penile rehabilitation within a dedicated penile rehabilitation program on assisted and unassistederectile function (EF) recovery. All patients who underwent RP and at least 1 year follow-up at penile rehabilitation program inthe Department of Urology, OORR Policlinico Riuniti (Foggia, Italy) were included. Treatment involved phosphodiesterase type 5inhibitors (PDE5Is; tadalafil 20 mg, 1 tablet every other day), intracavernous injections (Caverject 5 μg, 1 vial per week), and dailyuse of vacuum erection devices (VEDs). Primary end point was EF recovery defined as International Index of Erectile Function-5(IIEF-5) ≥21 with or without rehabilitation aids. IIEF-5 and prescribed treatments were prospectively collected at 3 months,6 months, 9 months, 12 months, and 24 months. Among 570 eligible patients, 397 (69.6%) underwent rehabilitation. Patientswho undergoing andro-rehabilitation were younger (65 monthsvs 70 months;P < 0.0001), had lower prostate-specific antigen(PSA) levels (5.9 ng ml−1vs 6.2 ng ml−1;P = 0.04), and lower grade tumors (P = 0.001) compared to the patients who did notundergo sexual rehabilitation after radical prostatectomy. Two-year EF recovery rates in patients undergoing andro-rehabilitationranged from 75% (preoperative IIEF-5 >16) to 45% (preoperative IIEF-5 <16) with rehabilitation aids. Combination treatments(PDE5I+VEDs with or without intracavernous injections) showed the highest rates of EF recovery (up to 80% at 2 years). EF recoverywithout rehabilitation aids was significantly higher for patients with IIEF-5 >21 (IIEF-5 >21 [36%]vs IIEF-5 of 17–21 [18%];P = 0.01). Subanalysis indicated a moderate benefit of rehabilitation in patients with preoperative IIEF-5 <16 who underwentbilateral nerve-sparing RP. Participation in intensive penile rehabilitation programs improves EF recovery in patients undergoingRP. Preserving the neurovascular bundles may be beneficial for patients with preoperative ED