Comparison of efficacy and satisfaction profile, between penile prosthesis implantation and oral PDE5 inhibitor Tadalafil therapy, in men with nerve‐sparing radical prostatectomy erectile dysfunction

Abstract

What's known on the subject? and What does the study add?• Erectile dysfunction after nerve-sparing radical retropubic prostatectomy constitutes a challenge to the urologist.The mainstay of medical treatment after radical prostatectomy to restore spontaneous erectile function remains phosphodiesterase (PDE5) inhibitors, despite the fact that data from animal studies suggesting that PDE5 inhibitors can prevent smooth muscle apoptosis and fibrosis have not yet been extrapolated to humans because of a lack of standardized protocols. If the above treatment fails, second-line therapies such as intraurethral prostaglandins, penile injection therapy and vacuum devices are offered. When less invasive therapies are ineffective, interventions that preserve sexual function such as penile prosthesis implantation become the treatment of choice.• Our study reveals the alternative of penile prosthesis implantation as first-line treatment in erectile dysfunction after nerve-sparing radical prostatectomy. It also highlights its superiority to the oral PDE5 inhibitor treatment, regarding the erection, frequency, firmness, maintenance and penetration ability. This suggests that a concept of an early penile intervention in the future would be promising for those patients who wish to remain sexually active without depending on oral formulations with doubtful and delayed results.

Satisfaction rate at 1‐year follow‐up in patients treated with penile implants: data from the multicentre prospective registry INSIST‐ED

“…Conversely, other authors adopted validated questionnaires developed to assess the outcome of treatments other than PPI [8,12,13]; in a recently published series, for instance, 94% of 98 men who underwent PPI after radical prostatectomy reported being satisfied after treatment according to the validated EDITS score [8]. Similar results were also reported in previous series using the IIEF [13,23]. The use of either a non-validated questionnaire or a tool developed in a non-PPI population could lead to an improper estimation of patient satisfaction.…”

The Efficacy and Safety of Tadalafil 5 mg Once Daily in the Treatment of Erectile Dysfunction After Robot-Assisted Laparoscopic Radical Prostatectomy: 1-Year Follow-up

“…Recent literature shows that PDE5-Is are safe and effective in treating ED patients after RP. Once daily administration of PDE5-Is has been experimentally proven to have a protective role in ED, and early administration of PDE5-Is helps to prevent cavernosal hypoxia, which leads to smooth muscle apoptosis and penile fibrosis [8-11]. Although PDE5-Is are one of the standard treatments for ED after RP, consensus has not been reached on their use, such as when to start, which drug is best, which dosage to use, how long to use, and when to stop [9,10].…”

Preventing Erectile Dysfunction after Radical Prostatectomy: Nerve-Sparing Techniques, Penile Rehabilitation, and Novel Regenerative Therapies

“…They reported good sexual function (EPID score > 60) in 77% of men and treatment satisfaction in 94% (EDITS score > 50). Other studies have actually reported improved satisfaction for men undergoing early penile prosthesis insertion compared to those receiving sildenafil or intracavernosal injection therapy 6 months after radical prostatectomy [169,170].…”