It has not been clearly proven in real practice whether early rehabilitation with phosphodiesterase type 5 inhibitors starting immediately after radical prostatectomy improves erectile function recovery more effectively compared with delayed treatment with the same regimen. We performed a prospective randomised trial to identify this.
Patients with prostate cancer and pre-operative International Index of Erectile Function (IIEF)-5 score ≥17 were randomly assigned to regularly receive sildenafil 100mg twice a week for 3 months immediately after urethral catheter removal (early group) or only at 3 months after nerve-sparing robot-assisted laparoscopic radical prostatectomy (delayed group). The primary endpoint was full erectile function recovery rates (defined as IIEF-5 ≥17) over the 12 months.
In the 120 randomised patients, the proportion of patients achieving full recovery was significantly higher over the 12 months in the early group than in the delayed group (β: 0.356, p < 0.001, generalized estimating equation). After 9 months following surgery, the proportion of patients achieving full recovery had steadily increased, resulting in 41.4% at 12 months in the early group, while patients in the delayed group had not shown further improvement, thus achieving full recovery only in 17.7% of patients at 12 months. Only early sildenafil treatment (hazard ratio 2.943, p = 0.034) independently improved full recovery at 12 months.
Our trial provides clinical data to suggest that the earlier rehabilitation with phosphodiesterase type 5 inhibitors can contribute more to the recovery of erectile function after radical prostatectomy in the clinical setting.
The Journal of urology. 2018 Jan 04 [Epub ahead of print]
Jung Ki Jo, Seong Jin Jeong, Jong Jin Oh, Sang Wook Lee, Sangchul Lee, Sung Kyu Hong, Seok-Soo Byun, Sang Eun Lee
Department of urology, Hanyang University Hospital, Seoul., Seoul National University Bundang Hospital, Seongnam. Electronic address: ., Seoul National University Bundang Hospital, Seongnam., Kangwon National University Hospital, Chuncheon, Korea.