RESPONSE TO ERECTILE DYSFUNCTION TREATMENT AFTER NON-NERVE-SPARING ROBOT-ASSISTED RADICAL PROSTATECTOMY

Erectile function recovery is known to be significantly lower following non-nerve-sparing (NNS) robot assisted radical prostatectomy (RARP) compared to nerve-sparing RARP. Despite this, there is a notable lack of contemporary research evaluating the efficacy of post-operative treatment options—such as phosphodiesterase type 5 inhibitors (PDE5i), vacuum erection devices (VED), and intracavernosal injections (ICI)—in patients who have undergone NNS RARP.

This is a retrospective review of patients who underwent NNS RARP at a high volume referral centre over a 7-year period (2018–2024). The inclusion criteria were: NNS RARP and follow-up in andrology clinic at least twice. Prior prostate cancer treatments (such as radiotherapy or focal therapy) patients were excluded. Efficacy was defined as erections sufficient for penetrative intercourse, as reported by the patients.

A total of 404 patients met the inclusion criteria, with a mean age of 63.3 years, an mean BMI of 28, and a mean follow-up period of 29.2 months. The mean preoperative International Index of Erectile Function-5 (IIEF5) score was 14, while the mean postoperative IIEF5 score was 6.5. Patient comorbidities were also noted.

Of the patients, 301 received PDE5i (on-demand Sildenafil 100 mg and/or Tadalafil 20 mg), with only 1.6% (n = 5) responding to treatment. A total of 319 patients used VED, and 24.5% (n = 78) were able to resume sexual activity with its use. ICI with alprostadil were administered and self-injection taught to 159 patients, of whom 29 experienced pain and 4 reported prolonged, painful erections. Sexual activity was successfully resumed in 35% (n = 56) of these patients. A second-line ICI treatment, aviptadil/phentolamine, was used in 42 patients, with 50% (n = 21) achieving resumption of sexual activity. Ultimately, 6.9% (n = 28) of the cohort went on to receive a penile implant.

In this study, we assessed the response of post-operative erectile dysfunction treatments for patients undergoing NNS RARP. PDE5i response in NNS RARP patients is notably low, indicating that medications alone should not be offered. The use of VED proved successful in up to a quarter of patients. Starting with second-line treatments, ICI may lead to quicker resumption of sexual activity.

None.