TY - JOUR
T1 - Standard Operating Procedure for the Preservation of Erectile Function Outcomes after Radical Prostatectomy
AU - Mulhall, John P.
AU - Bivalacqua, Trinity J.
AU - Becher, Edgardo F.
PY - 2013/1
Y1 - 2013/1
N2 - Introduction. 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. Aim. 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. Main Outcome Measure. 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.
AB - Introduction. 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. Aim. 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. Main Outcome Measure. 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.
KW - Erectile Dysfunction
KW - Prostate Cancer
KW - Radical Prostatectomy
UR - http://www.scopus.com/inward/record.url?scp=84872836276&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84872836276&partnerID=8YFLogxK
U2 - 10.1111/j.1743-6109.2012.02885.x
DO - 10.1111/j.1743-6109.2012.02885.x
M3 - Article
C2 - 22970890
AN - SCOPUS:84872836276
SN - 1743-6095
VL - 10
SP - 195
EP - 203
JO - Journal of Sexual Medicine
JF - Journal of Sexual Medicine
IS - 1
ER -