Oral Therapies Improve Potency After Nerve-Sparing Prostatectomy

Compared with no treatment, early oral therapy with phosphodiesterase type 5 inhibitors (PDE5-Is) is more successful at recovering erectile function in patients who had nerve-sparing radical retropubic prostatectomy (NSRRP), according to a new retrospective study. Among the oral therapies, a regimented rehabilitation program appears to be no better than on-demand therapy.

For the study, investigators led by Alessandro Natali, MD, of the University of Florence in Italy, analyzed the medical records of 196 consecutive patients who had NSRRP at a single center between 2004 and 2006. After undergoing either bilateral  or unilateral NSRRP, patients chose whether to receive oral therapy on demand (100 mg sildenafil, 20 mg tadalafil, and vardenafil); regimented rehab (100 mg sildenafil or 20 mg vardenafil 3 times a week, or 20 mg tadalafil twice a week at bedtime); or no therapy. 

All patients had mild to normal preoperative erectile function. The average preoperative potency was 22, as measured by the International Index of Erectile Function-5 (IIEF-5). 

Potency was significantly associated with surgical technique and oral therapy (compared with no treatment), the researchers reported in the International Journal of Impotence Research (2015;27:1-5). The potency rate at 24 months among bilateral prostatectomy patients was 68.7% (61% with no therapy and 71% with PDE5-Is) and 44% among unilateral prostatectomy patients (29% with no therapy and 51% with PDE5-Is).

Oral therapy was started early in patients—2 weeks after surgery—as soon as the catheter was removed. Some patients who received PDE5-Is discontinued therapy because the effect of therapy was below their personal expectations. No patients discontinued due to side effects. 

“In our opinion, as atrophy and fibrosis in the penis occur in the first 3 months after RRP, it is likely that early postoperative intervention is crucial,” the researchers stated. They suggest clinicians discuss oral therapy with patients at the same time surgery is being considered.

The investigators looked at potency by oncologic outcome (no progression versus PSA relapse) and Gleason score and found no significant differences in results. They confirmed that increasing age was related to lower potency.

Large randomized and controlled trials are still needed to determine the optimal post-operative strategies for preserving erectile function, according to the researchers.

---