Abstract
Over the past decade, only 35% of patients experienced good erectile function two years after a nerve-sparing radical prostatectomy (nsRP), likely due to damaged neurovascular bundles and cavernosal tissue fibrosis during neuronal recovery. Given the limited prospective data, the ideal multimodal rehabilitation for enhancing erectile function following nsRP remains unclear. This study examined the feasibility and effectiveness of a multimodal penile rehabilitation program, involving daily sildenafil (100mg) and vacuum pump (VED) therapy (5 days a week, generating 5 erections per day).
Between May 2021 and October 2022, the study enrolled patients who had a good preoperative erection, undergone nsRP, and no history of pelvic radiotherapy, contraindications for sildenafil, or systemic neurological disorders. During follow up the adjustment of sildenafil dosage to 75mg to manage any side effects, was allowed. Feasibility was assessed by monitoring dropout rates due to program-related side effects. Furthermore, the assessment of erection rigidity was done every three months up to 18 months postoperatively, using both clinical reports and patient-reported outcome measures.
55 patients were initially enrolled. They had a median start time of 7 weeks post-nsRP. To date, 13 discontinued and 8 adjusted sildenafil to 75mg due to side effects. Among the 32 who completed a year in the program, 13 patients regained spontaneous erections, resulting in the program being deintensified to on-demand use of PDE5i and/or VED. Among the 18 patients who have reached the 18-month follow-up mark, 88% and 50% reported a good assisted and unassisted erection, respectively.
So far, most patients tolerated the multimodal strategy well, with a 24% dropout rate. The majority of patients who completed the rehabilitation program reported having a good assisted erection and half of these patients already reported good unassisted erections after 1.5 year of follow up.
No conflicts of interest.
