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Immediate post-operative PDE5i therapy improves early erectile function outcomes after robot assisted radical

Arjun Nathan1,2,3, Shivani Shukla4, Amil Sinha4

  • 1Urology Department, Addenbrooke's Hospital, Cambridge, UK. arjun.nathan.11@ucl.ac.uk.

Journal of Robotic Surgery
|February 8, 2021
PubMed
Summary

Starting Phosphodiesterase Inhibitor (PDE5i) therapy immediately after robot-assisted radical prostatectomy (RARP) can improve erectile function (EF) and continence in patients with bilateral nerve sparing. This approach maximizes functional outcomes post-surgery.

Keywords:
ContinenceErectile dysfunctionPhosphodiesterase inhibitors (PDE5i)Robot-assisted radical prostatectomy (RARP)

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Area of Science:

  • Urology
  • Andrology
  • Surgical Oncology

Background:

  • Robot-assisted radical prostatectomy (RARP) is a common treatment for prostate cancer.
  • Post-operative erectile dysfunction (ED) and incontinence are significant concerns for patients undergoing RARP.
  • Phosphodiesterase Inhibitor (PDE5i) therapy is often used to manage post-operative ED.

Purpose of the Study:

  • To evaluate the impact of initiating PDE5i therapy timing on early erectile function (EF), continence, and safety outcomes after RARP.
  • To determine if immediate post-operative PDE5i therapy offers superior functional recovery compared to delayed initiation.

Main Methods:

  • A prospective study involving 158 patients treated with PDE5i post-RARP.
  • Patients were categorized into three groups based on PDE5i initiation: immediate (day 1-2), early (day 3-14), and late (after day 14).
  • Erectile function was assessed using EPIC-26 scores; continence was evaluated by pad-free and social continence metrics.

Main Results:

  • No significant differences in EF recovery were observed for unilateral nerve sparing across therapy groups.
  • For bilateral nerve sparing, immediate PDE5i therapy showed a statistically significant improvement in EF recovery (p=0.017) and return to baseline (p=0.045).
  • Immediate and early PDE5i initiation demonstrated trends towards better continence outcomes, though late therapy showed higher social continence rates in one instance.

Conclusions:

  • Immediate post-operative PDE5i therapy is associated with improved early erectile function and continence in patients undergoing bilateral nerve-sparing RARP.
  • Initiating PDE5i therapy promptly after RARP, particularly in nerve-sparing cases, should be considered to optimize functional recovery.
  • No significant differences in compliance, complications, or readmissions were noted between the different PDE5i timing groups.