Erectile dysfunction post radical cystectomy. The role of early rehabilitation with pharmacotherapy in nerve sparing and non-nerve sparing group: A randomized, clinical trial

Abstract

Objectives: No clinical studies testing erectile function (EF) post radical cystectomy (RC) were done. Our objective was to assess the effect of early pharmacologic therapy after RC using intracorporeal injection (ICI), phosphodiesterase inhibitor (PDE5i) and PDE5i+ICI. Materials and Methods: In our randomized, double-blinded study, we prospectively enrolled 160 potent male patients with invasive bladder cancer. Patients were operated by RC using the nerve-sparing (NS) or non-nerve sparing (NNS) technique. They were treated since 1 month postoperatively by different regimens (PDE5i vs. ICI vs. ICI+PDE5i). Patients were evaluated using the international index of erectile function questionnaire and were followed up regularly at 1, 3, 6, and 12 months using the same parameters. Results: One month after therapy, the mean of EF domain improved in both NS and NNS group. In the NNS group, in patients treated with ICI alone and ICI+PDE5i, the EF domain at 12 months moved to the moderate and to the mild category respectively. In patients treated by the NS approach, the mean value remained in the mild category with or without therapy. Conclusions: Early pharmacotherapy since one-month post RC using ICI and a combination of ICI+PDE5i can improve the erectile function of patients operated with a NNS approach.

Oncological and functional outcomes of organ‐preserving cystectomy versus standard radical cystectomy: A systematic review and meta‐analysis

“…Male sexual function was evaluated in 13 studies, as highlighted in Table 6 9,24–27,29,31,32,36,38,40–42 . To assess potency, the primary functional outcome, seven studies used the IIEF‐5 questionnaire.…”

“…In total, seven studies reported on the use of adjuvant treatments to aid sexual rehabilitation. The percentage of patients who required treatment to restore sexual function ranged from 1 to 100%, as defined by the trialists 24,26,29,31,36,38,40 . All these patients were considered to have maintained potency status.…”

“…Based upon our eligibility criteria, a further 22 articles were excluded, leaving a total of 19 studies included from the database searches. A further two articles were included from searching references of included articles, leaving 21 studies included in the present review 9 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 (Figure 3 ).…”

“…In total, 1886 male patients were included across 17 studies. Eight studies reported on nerve-sparing cystectomy, 24,[26][27][28][29]34,38,40 seven on prostate-sparing cystectomy, 9,25,32,36,38,42,43 four on capsule-sparing cystectomy 24,29,30,41 and two on seminal vesicle-sparing cystectomy. 29,31 There were a total of 305 female patients included across five studies [33][34][35]37,39 ; four of which were female-only studies.…”

“…Table 3 summarises the clinical and pathological characteristics of participants in 19 studies, with two studies not reporting any data pertaining to this. 33,40 Table 4 highlights the recurrence-free survival, progression-free survival, disease-specific survival and overall survival rates reported in 13 studies. One of the comparative prostate-sparing studies reported a 5-year overall survival rate of 47% compared to 30% in the radical technique (p > 0.05).…”