A comparison of different oral therapies versus no treatment for erectile dysfunction in 196 radical nerve-sparing radical prostatectomy patients

Abstract

We retrospectively analyzed the effects on the erectile function (EF) of no treatment (NT), and an oral therapy (OT; on-demand therapy (OD) or a regimented rehabilitation (RR) program with phosphodiesterase type 5 inhibitors (PDE5-Is)), in a cohort of 196 consecutive patients following nerve-sparing radical retropubic prostatectomy (NSRRP). Patients undergoing bilateral NSRRP (BP; n = 147) and unilateral NSRRP (UP; n = 49), chose between OT (PDE5-Is OD or RR program) and NT. Patients who chose OD therapy received PDE5-Is (100 mg sildenafil, 20 mg tadalafil and vardenafil), whereas patients who chose the RR program received 100 mg sildenafil or 20 mg vardenafil three times a week, or 20 mg tadalafil twice a week at bedtime. The t-test for unpaired data and Fisher test were used for univariate analyses, logistic regression multivariate analysis was used to test the accuracy of available variables to predict EF recovery after radical prostatectomy. Potency rates were significantly correlated with the surgical technique and with OT when compared to NT (P < 0.02), respectively 68.7% for BP (61% with no therapy and 71% with PDE5-Is) and 44% for UP (29% with no therapy and 51% with PDE5-Is), while no statistically significative differences were found between OD and rehabilitation protocols (72% with rehabilitation and 70% with OD therapy in BP, 52% with rehabilitation and 50% with OD therapy in UP; P = NS). Early OT with PDE5-Is (OD or RR program) was superior to NT in recovery of EF in NSRRP. Furthermore, an RR program with PDE5-Is did not appear to be superior to OD therapy.

Comparisons of regular and on-demand regimen of PED5-Is in the treatment of ED after nerve-sparing radical prostatectomy for Prostate Cancer

“…( Figure 8 ) A retrospective research from Natali et al . 28 also witness no statistically profound differences between on-demand and regular protocols (72% with regular and 70% with on-demand therapy). Meta-regression models based on year of publication, treatment duration, age at the trial level.…”

Exploratory Decision-Tree Modeling of Data from the Randomized REACTT Trial of Tadalafil Versus Placebo to Predict Recovery of Erectile Function After Bilateral Nerve-Sparing Radical Prostatectomy

“…Also, presurgery EF assessment was performed at screening (ie, after cancer diagnosis and biopsy). Although patients had to report no history of erectile dysfunction as the entry criterion [6], the reliability of a baseline EF assessment using the IIEF-EF questionnaire in patients after PCa diagnosis is questionable because it may be affected by psychological stress and anxiety [29]. …”

An update on the current status and future prospects of erectile dysfunction following radical prostatectomy

“…CNI during RP is the major cause of ED, which is observed frequently despite advanced surgical methods, particularly nerve‐sparing techniques 15–18 . The widely adopted use of nerve‐sparing surgical procedures and robot‐assisted laparoscopic techniques in RP can not completely prevent post‐RP‐ED.…”