Effect of Starting Penile Rehabilitation with Sildenafil Immediately after Robot-Assisted Laparoscopic Radical Prostatectomy on Erectile Function Recovery: A Prospective Randomized Trial
- Authors
- Jo, Jung Ki; Jeong, Seong Jin; Oh, Jong Jin; Lee, Sang Wook; Lee, Sangchul; Hong, Sung Kyu; Byun, Seok-Soo; Lee, Sang Eun
- Issue Date
- Jun-2018
- Publisher
- ELSEVIER SCIENCE INC
- Keywords
- penis; prostatectomy; robotic surgical procedures; erectile dysfunction; phosphodiesterase 5 inhibitors
- Citation
- JOURNAL OF UROLOGY, v.199, no.6, pp.1601 - 1607
- Indexed
- SCIE
SCOPUS
- Journal Title
- JOURNAL OF UROLOGY
- Volume
- 199
- Number
- 6
- Start Page
- 1601
- End Page
- 1607
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/149954
- DOI
- 10.1016/j.juro.2017.12.060
- ISSN
- 0022-5347
- Abstract
- Purpose: It has not been clearly proved in real practice whether early rehabilitation with phosphodiesterase type 5 inhibitors starting immediately after radical prostatectomy improves erectile function recovery more effectively than delayed treatment with the same regimen. We performed a prospective randomized trial to identify this. Materials and Methods: Patients with prostate cancer and an IIEF-5 (International Index of Erectile Function-5) preoperative score of 17 or greater were randomly assigned to receive sildenafil 100 mg regularly twice per week for 3 months immediately after urethral catheter removal as the early group or only 3 months after nerve sparing robot-assisted laparoscopic radical prostatectomy as the delayed group. The study primary end point was the full erectile function recovery rate, defined as an IIEF-5 score of 17 or greater, during the 12 months. Results: Of the 120 randomized patients the proportion who achieved full recovery was significantly higher during the 12 months in the early group than in the delayed group (beta = 0.356, p <0.001, generalized estimating equation). After 9 months postoperatively the proportion of patients who achieved full recovery steadily increased to 41.4% at 12 months in the early group while patients in the delayed group showed no further improvement. Thus, full recovery was achieved in only 17.7% of patients at 12 months. Only early sildenafil treatment independently improved full recovery at 12 months (HR 2.943, p = 0.034). Conclusions: Our trial provides clinical data to suggest that earlier rehabilitation with phosphodiesterase type 5 inhibitors can contribute to the recovery of erectile function after radical prostatectomy in the clinical setting.
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