Phosphodiesterase-5 Inhibitors and Vacuum Erection Device for Penile Rehabilitation After Laparoscopic Nerve-Preserving Radical Proctectomy for Rectal Cancer: A Prospective Controlled Trial

Abstract

The current study sought to clarify the role of phosphodiesterase type 5 inhibitors (PDE-5i) and a vacuum erection device (VED) in penile rehabilitation after laparoscopic nerve-preserving radical proctectomy (LNRP) for rectal cancer. Participants were assigned to one of the following arms-no-intervention, nightly use of sildenafil 25 mg for 3 months after surgery, or concurrent use of nightly sildenafil 25 mg/day for 3 months and a vacuum erection device (VED) 10 to 15 minutes/day for 3 months-in a nonrandomized fashion. All participants had a follow-up of over 12 months prospectively, and patients had baseline, 3-, 6-, and 12-month assessment based on the International Index of Erectile Function-5 (IIEF-5). Seventy-one cases were included in final analyses. In the no-intervention group, the mean baseline IIEF-5 score of 21.9 decreased rapidly to 5.0 at 3 months (p < .001), 9.2 at 6 months (p < .001), and stayed at 10.9 at 12 months (p < .001). In the single therapy group, the mean baseline IIEF-5 score of 22.4 decreased dramatically to 9.0 at 3 months (p < .001), 14.9 at 6 months (p = .005), and stayed at 15.1 at 12 months (p = .005). In the combined therapy group, the mean baseline IIEF-5 score of 23.0 decreased slightly to 15.0 at 3 months (p = .005), 18.0 at 6 months (p = .038), and maintained at 18.7 at 12 months (p = .163). Findings suggested an over 50% decline in the quality of erection function of the patients after LNRP. The early use of PDE-5i alone or combined use of PDE-5i and VED after LNRP maintained erectile function at 12 months.

Urogenital function 3 years after abdominoperineal excision for rectal cancer

“…Pelvic surgery (both prostatectomy and APE) was associated with troubling sexual dysfunction particularly common in men. Even though far from all patients suffer from sexual or urinary dysfunction after pelvic surgery, we suggest that all patients should be advised about the risk for sexual and urinary dysfunction before pelvic surgery and that these aspects should be included in all follow‐ups after surgery in order to identify those in need of further assistance .…”

Penile Rehabilitation: the “Up”-date

“…The benefit of combination VED/PDE-5 inhibitor therapy was demonstrated in a study of men undergoing penile rehabilitation following total mesorectal excision for rectal cancer (which tends to be a younger age group than prostate cancer) [16•]. As seen in previous studies without a washout period, nightly low dose sildenafil was associated with significant improvement in IIEF-5 scores at 3, 6, and 12 months post-surgery compared to no intervention.…”

PDE-5i Management of Erectile Dysfunction After Rectal Surgery: A Systematic Review Focusing on Treatment Efficacy

“…Among the included studies, there were two RCTs (Lindsey et al, 2002;Park et al, 2015), one NRCT (Deng et al, 2017), one prospective (Nishizawa et al, 2011), and one retrospective before-after (noncomparative) study (Lindsey et al, 2003). Two studies were conducted by the same author group in the United Kingdom (Lindsey et al, 2002(Lindsey et al, , 2003; the other studies were conducted in Korea (Park et al, 2015), China (Deng et al, 2017), and Japan (Nishizawa et al, 2011).…”

“…The first version of the IIEF score (based on 15 questions, score ranging from 0 to 75; Rosen et al, 1997) was adopted in one study published in 2002 (Lindsey et al, 2002). The fifth version of the IIEF (based on five questions, score ranging from 0 to 25) was used in the more recent studies (Deng et al, 2017;Lindsey et al, 2003;Nishizawa et al, 2011;Park et al, 2015). A total of 253 (82.7%) rectal cancer patients and 53 (17.3%) IBD patients were included.…”