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

Michele Di Nauta, Ugo Giovanni Falagario, Anna Ricapito, Matteo Rubino, Pasquale Annese, Gian Maria Busetto, Luigi Cormio, Giuseppe Carrieri, Carlo Bettocchi
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Abstract

Despite surgical advancements, erectile dysfunction (ED) is a common consequence of radical prostatectomy (RP). This study aimed to evaluate the impact of early penile rehabilitation within a dedicated penile rehabilitation program on assisted and unassisted erectile function (EF) recovery. All patients who underwent RP and at least 1 year follow-up at penile rehabilitation program in the Department of Urology, OORR Policlinico Riuniti (Foggia, Italy) were included. Treatment involved phosphodiesterase type 5 inhibitors (PDE5Is; tadalafil 20 mg, 1 tablet every other day), intracavernous injections (Caverject 5 µg, 1 vial per week), and daily use 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. Patients who undergoing andro-rehabilitation were younger (65 months v s 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 not undergo sexual rehabilitation after radical prostatectomy. Two-year EF recovery rates in patients undergoing andro-rehabilitation ranged 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 recovery without 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 underwent bilateral nerve-sparing RP. Participation in intensive penile rehabilitation programs improves EF recovery in patients undergoing RP. Preserving the neurovascular bundles may be beneficial for patients with preoperative ED.

开放性和机器人根治性前列腺切除术后的性功能恢复:学术阴茎康复计划的结果。
尽管手术进步,勃起功能障碍(ED)是根治性前列腺切除术(RP)的常见后果。本研究旨在评估在专门的阴茎康复计划中早期阴茎康复对辅助和非辅助勃起功能(EF)恢复的影响。所有接受RP并在orr polilinico Riuniti (Foggia, Italy)泌尿外科阴茎康复计划至少随访1年的患者均被纳入研究。治疗包括磷酸二酯酶5型抑制剂(PDE5Is;他达拉非20mg,每隔一天1片),海绵内注射(Caverject 5µg,每周1瓶),每日使用真空勃起装置(VEDs)。主要终点是EF恢复,定义为有无康复辅助的国际勃起功能指数-5 (IIEF-5)≥21。在3个月、6个月、9个月、12个月和24个月时前瞻性收集ief -5和处方治疗。在570例符合条件的患者中,397例(69.6%)接受了康复治疗。接受雄激素康复治疗的患者年龄较小(65个月vs 70个月;P < 0.0001),前列腺特异性抗原(PSA)水平较低(5.9 ng ml -1vs 6.2 ng ml -1;P = 0.04),与根治性前列腺切除术后未行性康复的患者相比,肿瘤级别较低(P = 0.001)。接受雄激素康复的患者两年EF恢复率从75%(术前IIEF-5 > - 16)到45%(术前IIEF-5 > -21 [36%] vs IIEF-5 17-21 [18%];P = 0.01)。亚分析显示术前IIEF-5患者的康复获益中等
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