Current state of penile rehabilitation after radical prostatectomy

Garcı́a, Francisco; Brock, Gerald

doi:10.1097/mou.0b013e3283383b02

Cited by 17 publications

(15 citation statements)

References 41 publications

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“…IIEF data however suggests continued improvements up through the completion of this trial at 13 months. Prior studies reported that recovery can occur up to 24–40 months following surgery and several authors suggest a treatment course of up to 24 months (Mulhall, ; Garcia & Brock, ). Longer follow‐up would be needed to assess long‐term recovery on RigiScan ™ with PDE5i therapy in this study.…”

Section: Discussionmentioning

confidence: 99%

A prospective, randomized, placebo‐controlled trial of on‐Demand vs. nightly sildenafil citrate as assessed by Rigiscan and the international index of erectile function

Kim

Hawksworth

Hurwitz³

et al. 2015

Andrology

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SUMMARYMultiple studies have evaluated the use of PDE5 inhibitors in penile rehabilitation following nerve-sparing prostatectomy. These studies have evaluated the use of various pharmacologic agents as well as various approaches to treatment (on-demand vs. rehabilitative). Most of these studies relied on self-reported outcomes to determine efficacy of the therapy which could allow response bias to affect their results. The aim of this study was to evaluate the effects of nightly sildenafil citrate therapy during penile rehabilitation, using nocturnal penile rigidity (RigiScan TM , Gotop Medical, Inc., St. Paul, MN, USA) in addition to the IIEF-EF. Patients with localized prostate cancer and normal erectile function prior to nsRP were randomized to take either nightly 50 mg sildenafil citrate or placebo starting the night following surgery. Both groups were allowed on-demand sildenafil citrate. Erectile function was evaluated at 2 weeks, 3, 6, 9 and 12 months post-operatively, with a final assessment made at 13 months, following a 1 month drug washout. At all time points, self-reported (IIEF-EF) and objective (RigiScan TM ) measures were obtained and evaluated. About 74 of 97 randomized patients completed the study. On completion, 40% of patients in each group had normal erectile function based on RigiScan TM (p = 1.0). Additionally, no statistical differences were seen using the IIEF-EF domain (32.4% of placebo, 29% of treatment; p = 0.79). Multivariable analysis showed no significant differences in erectile function based on treatment intervention. Results did show that African-American men in this cohort were at higher risk for lower RigiScan TM scores over time (OR: 0.48, p = 0.0399). This study demonstrates that nightly sildenafil citrate does not provide a therapeutic benefit for recovery of erectile function post-prostatectomy when compared to on-demand dosing using both self-reported as well as objective measures. Differences in objective recovery parameters based on patients' race/ethnicity warrant further investigation.

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Section: Discussionmentioning

confidence: 99%

A prospective, randomized, placebo‐controlled trial of on‐Demand vs. nightly sildenafil citrate as assessed by Rigiscan and the international index of erectile function

Kim

Hawksworth

Hurwitz³

et al. 2015

Andrology

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“…Results from this trial did not support nightly PDE5 inhibitors over on‐demand dosing, and in fact found no improvement in EF after washout for either protocol compared with placebo. This impressive REINVENT trial was also subject to some limitations . The overall design was complicated, with three arms and participant‐controlled titration of dosing, which muddied the analysis .…”

Section: Discussionmentioning

confidence: 99%

“…This impressive REINVENT trial was also subject to some limitations . The overall design was complicated, with three arms and participant‐controlled titration of dosing, which muddied the analysis . Drop‐out rates were high, ranging between 31 and 35% in the study arms.…”

Section: Discussionmentioning

confidence: 99%

Nightly vs on‐demand sildenafil for penile rehabilitation after minimally invasive nerve‐sparing radical prostatectomy: results of a randomized double‐blind trial with placebo

Pavlovich

Levinson

et al. 2013

BJU International

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Objectives• To clarify the role of phosphodiesterase type 5 (PDE5) inhibitors in post-prostatectomy penile rehabilitation (PPPR).• To compare nightly and on-demand use of PDE5 inhibitors after nerve-sparing minimally invasive radical prostatectomy (RP). Patients and Methods• We conducted a single-institution, double-blind, randomized controlled trial of nightly vs on-demand 50-mg sildenafil citrate after nerve-sparing minimally invasive RP. • A total of 100 preoperatively potent men, aged <65 years, with scores on the Erectile Function domain of the International Index of Erectile Function (IIEF-EF) ≥26, underwent nerve-sparing surgery.• The patients were randomized to either nightly sildenafil and on-demand placebo (nightly sildenafil group), or on-demand sildenafil and nightly placebo (on-demand sildenafil group; maximum on-demand dose six tablets/month) for 12 months. Patients then underwent a 1-month washout period. • Validated measures of erectile function (IIEF-EF score and the Expanded Prostate Cancer Index Composite [EPIC])were compared between treatment groups over the entire 13-month time course, using multivariable mixed linear regression models. Results• The treatment groups were well matched preoperatively (mean age 54.3 vs 54.6 years, baseline IIEF-EF score 29.4 vs 29.3, for the nightly vs the on-demand sildenafil groups, respectively).• No significant differences were found in erectile function between treatments (nightly vs on-demand sildenafil) at any single timepoint after RP, after adjusting for potential confounding factors.• When evaluated over all timepoints simultaneously, no significant effects of treatment group (nightly vs on-demand sildenafil) were found on recovery of potency, as assessed by absolute IIEF-EF scores (P = 0.765), on percentage of men returning to an IIEF-EF score >21 (P = 0.830), or on IIEF-EF score recovery to a percentage of baseline value (P = 0.778).• When evaluated over all timepoints simultaneously, no significant effects of treatment group were found on secondary endpoints such as assessment of potency (including EPIC item 59 response 'erections firm enough for intercourse'), attempted intercourse frequency or confidence. Conclusions• Erectile recovery up to 1 year after RP does not differ between previously potent men who use sildenafil nightly compared to on-demand. • This trial does not support chronic nightly sildenafil as being any better than on-demand sildenafil for use in penile rehabilitation after nerve-sparing minimally invasive RP.

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“…Recently there have been advances in our understanding of the pathophysiology of post‐RP ED. These include the introduction of management protocols in the postoperative period and the identification of factors that allow us to predict which patients will most likely have return of normal EF (Penson et al, 2003; Dubbelman et al, 2006; Garcia and Brock, 2010; Kim et al, 2011; Treiyer et al, 2011).…”

Section: Edmentioning

confidence: 99%

Sexual Dysfunction Following Radical Prostatectomy

Benson

Şerefoğlu

2012

Journal of Andrology

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Prostate cancer is the most common solid cancer in men and the second leading cause of cancer death in men. A favored treatment option for organ-confined prostate cancer in a middle-aged healthy man is radical prostatectomy (RP). Despite advances in techniques for RP, there remain concerns among physicians and patients alike on its adverse effects on sexual function. Although post-RP erectile dysfunction has been extensively studied, little attention has been focused on the other domains of sexual function, namely loss of libido, ejaculatory dysfunction, orgasmic dysfunction, penile shortening, and Peyronie disease. The aim of this review is to discuss the most recent literature regarding post-RP sexual dysfunctions.

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Current state of penile rehabilitation after radical prostatectomy

Cited by 17 publications

References 41 publications

A prospective, randomized, placebo‐controlled trial of on‐Demand vs. nightly sildenafil citrate as assessed by Rigiscan and the international index of erectile function

A prospective, randomized, placebo‐controlled trial of on‐Demand vs. nightly sildenafil citrate as assessed by Rigiscan and the international index of erectile function

Nightly vs on‐demand sildenafil for penile rehabilitation after minimally invasive nerve‐sparing radical prostatectomy: results of a randomized double‐blind trial with placebo

Sexual Dysfunction Following Radical Prostatectomy

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