Recovery of functional outcomes after robot assisted radical prostatectomy (RaRP): impact of vacuum therapy compared to PDE5 inhibitors alone.

Objective: This study evaluated the primary efficacy of vacuum therapy combined with phosphodiesterase type 5 inhibitors (PDE5i) vs. PDE5i alone in improving erectile function recovery, assessed via the International Index of Erectile Function (IIEF) questionnaire, after robotic-assisted radical prostatectomy (RARP). A secondary objective was to assess the impact of the combined therapy on continence outcomes, including pad usage and continence scores. The study also explored predictors of rehabilitation success and the potential synergistic effects of the combined approach.

Materials and methods: A retrospective analysis of 101 patients who underwent RARP (2021-2023) was conducted. Patients were divided into Group 1 (PDE5i only, n=70) and Group 2 (PDE5i + vacuum therapy, n=31). Vacuum therapy was started within 20 days postoperatively and performed daily under specialist supervision. All data were completely anonymous. Primary outcomes included IIEF-5 scores for erectile function and continence recovery (pad usage, continence scores based on three levels: 0 - complete incontinence, 1 - stress incontinence and 2 - full continence). Predictive factors were analysed using repeated measures ANOVA and multivariate regression.

Results: Group 2 showed significantly higher mean IIEF-5 scores at 12 months (10.2 vs. 2.5, p<0.001) and earlier continence recovery, with better scores at 3 and 6 months (p < 0.05). Vacuum therapy and PDE5i accelerate continence recovery during the early postoperative period, with fewer pads required, compared with patients treated with PDE5i alone, at 6 months (1.32 vs. 1.62; p=0.358) and 9 months (0.54 vs. 1.08; p=0.034). Key predictors of recovery included age, BMI, nervesparing status, and preoperative continence levels.

Conclusions: This study demonstrates the benefits of combining vacuum therapy with PDE5i for improving erectile function and early continence recovery after RARP, highlighting the importance of early, individualized rehabilitation. Vacuum therapy enhances oxygenation, reduces fibrosis and complements PDE5i effects. Further research is needed to refine predictive factors for success and explore the impact of intraoperative blood loss on erectile recovery, enabling optimized, tailored strategies for post-RARP rehabilitation.