Prostate news article, February 2006
| REHABILITATION
OF ERECTILE FUNCTION AFTER RADICAL PROSTATECTOMY
Ian Eardley Article in: Nature Clinical Practice Urology 2006; 3(2): 72-73. Reviewed by: Mr Tom Swallow BSc MBBS MRCS (Ed) |
Erectile dysfunction is a recognised, possible side effect after a radical prostatectomy. Recent studies have indicated that erectile function can be restored if an early rehabilitation program is implemented. This article investigates 132 men who participated in a non-randomised, prospective study. The study aimed to determine whether a pharmacologic penile rehabilitation program improves long-term erectile function after prostatectomy.
All the participants underwent nerve-sparing radical prostatectomy for localised prostate cancer and then chose to enter a rehabilitation treatment group or a non-rehabilitation group. Those on the rehabilitation program were instructed to obtain erections three times a week using sildenafil (100mg) for 12 or more months. In addition they were given sildenafil on 4 occasions soon after surgery. If they were unable to obtain erections with sildenafil, then penile injection therapy (30mg/ml papverine, 1mg/ml phentolamine and 10mg/ml prostaglandin E1; or 30 mg/ml papaverine and 1mg/ml phentolamine) was to be used. Postoperative erectile function was assessed every 4 months using the International Index of Erectile Function (IIEF) and a rigidity visual analog scale.
At 18 months after surgery, 52% of men in the rehabilitation group were able to achieve functional erections without medical assistance, compared to with 19% of men in the non-rehabilitation group. The men in the non-rehabilitation group who later used medical therapy to achieve erections were found to have less of a response to sildenafil and intracavernosal injections than compared to those men on the rehabilitation program. Furthermore the men in the rehabilitation group were responsive to sildenafil at an earlier point than compared with the non-rehabilitation group. The rehabilitation group also had a greater number of erections per week, as well as a significant improvement in IIEF and visual rigidity scores at 18 months.
Although a relatively small study, the results corroborate with other studies. The important factor appears to be the early implementation of the rehabilitation. However, the optimal penile rehabilitation strategy is still open for debate and large-scale placebo-controlled studies are indicated. It remains important that the possibility of a rehabilitation program is discussed with patients who are about to undergo a radical prostatectomy.
"Can an Erectogenic Pharmacotherapy Regimen After Radical Prostatectomy Improve Postoperative Erectlie Function?" Article in: Nature Clinical Practice Urology 2006; 3(2): 72-73.