Recovery of erection after pelvic urologic surgery: our experience

Abstract

The incidence of erectile dysfunction (ED) in patients undergoing pelvic urologic surgery, the efficacy and tolerability of vardenafil-based rehabilitative treatment as first option in these patients, the role of spontaneous erection (SE) as a possible positive predictive factor to erection recovery after such treatment, and the role of second-line therapies in those nonresponders are evaluated. All the patients undergoing pelvic urologic surgery at our Institution between November 2002 and December 2003 were considered. Preoperative erectile function (EF) was evaluated by using the abridged five-item version of the International Index of Erectile Function (IIEF5) questionnaire. Study population was divided into separate groups considering grade of preoperative EF, nerve sparing (NS) surgery and type of procedure (radical prostatectomy, radical cystectomy (RC) or nerve and seminal sparing cystectomy). In total, 86 patients were evaluated. After 6 months, an increase in mean IIEF5 score of 12.9 points was found in those who had undergone a bilateral NSRP after vardenafil therapy, of 8.0 points in those who had undergone unilateral NSRP, of 11.3 in those who had undergone NSRC and of 11.5 in nerve and seminal sparing cistectomies. A better vardenafil response was found in patients with SE þ (Po0.001). Among those vardenafil notresponders, 13 were treated by using intracavernous injections, one by vacuum device and three with penile prosthesis implant. In conclusion, in our experience, vardenafil showed to be well tolerated and effective for recovery of EF in patients undergoing pelvic urologic surgery. This drug was particularly effective for those with a normal preoperative EF undergoing an NS procedure. Of course, it should be recognized that the absence of a control group in the study represents an important limitation. However, based on the data from the literature, there is a strong belief that such an approach will lead to an earlier recovery of EF than without rehabilitative treatment.

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

“…Also, the role of early use of PDE5 inhibitors appears to give minimal to moderate benefit in early ED. This benefit appears to be a 20% increase at 1 year in erection function, defined by vaginal penetration [23][24][25]. Combination therapy using intracavernous injections and sildenafil facilitated early sexual intercourse, patient satisfaction, earlier return of spontaneous erections and potentially an earlier return of natural erections sufficient for vaginal potency.…”

Prophylaxis of Erectile Function After Radical Prostatectomy with Phosphodiesterase Type 5 Inhibitors

“…Postoperative nocturnal penile tumescence assessments were supportive. In 2005, Gallo and colleagues [72] evaluated the role of vardenafil in the recovery of erectile function following pelvic urologic surgeries (RRP and cystectomy). After 6 mo of daily therapy, vardenafil therapy increased the mean IIEF-5 score to 12.9 points in the BNS group, to 8.0 points in the UNS group, and to 11.3 points in the BNS radical cystectomy group.…”

Early penile rehabilitation following radical prostatectomy: Cleveland clinic experience

“…In a subset of 54 patients (35 sildenafil group, 19 control group) from the same study, longitudinal measurement of nocturnal penile tumescence and rigidity evaluation revealed that 29% (10/35) of the sildenafil group demonstrated return of spontaneous erectile function compared to 5% (1/19) in the control group. 22 They also reported that tip rigidity of 455% appears to be the most important parameter to discriminate between responders and non-responders.…”

“…Recently, Gallo et al 22 from Italy evaluated the role of vardenafil in the recovery of erectile function following pelvic urological surgeries (RP and cystectomy). 23 After 6 months, vardenafil therapy increased the mean International Index for Erectile Function-5 (IIEF-5) score of 12.9 points in bilateral nerve-sparing RP patients, of 8.0 points in unilateral nerve-sparing RP patients and of 11.3 points in nerve-sparing radical cystectomy patients.…”