PD49-07: Sexual function recovery following open and robotic Radical prostatectomy: results of an academic Penile Rehabilitation Program

Ugo Falagario*, Michele Di Nauta, Andrea Checchia, Marco Recchia, Anna Ricapito, Nicola D'Altilia, Pasquale Annese, Gian Maria Busetto, Luigi Cormio, Giuseppe Carrieri, Carlo Bettocchi, Foggia, Italy

Introduction: Radical prostatectomy (RP) is the gold standard treatment for clinically localized prostate cancer (PCa) in patients with a life expectancy 10 yr. Notwithstanding improvements in surgical techniques, erectile dysfunction (ED) is a common sequela of RP.

The aim of the present study was to evaluate the effect of early penile rehabilitation in a dedicated Penile Rehabilitation Program on both assisted and unassisted erectile function (EF) in men who developed ED after open and robotic RP.

Methods: All patients undergoing open or robotic RP and early penile rehabilitation were included in the present study. All patients were treated and followed up at a single academic institution in a dedicated Penile Rehabilitation Program. Treatment included phosphodiesterase type 5 inhibitors (PDE5Is), intracavernous injections and vacuum erection devices (VEDs). EF recovery was defined as IIEF>20. Both assisted and unassisted EF was evaluated. Data were prospectively collected and retrospectively reviewed. Kaplan Mayer curves were used to evaluate EF recovery. Ethical Committee approval has been obtained.

Results: a total of 397 patients were eligible. 168 (42.3%) underwent robotic RP. Unilateral and bilateral nerve sparing was performed in 38 (9.6%) and 116 (29.2%) patients respectively.

A combination of PDE5I and intracavernous injections was the most frequently used first line treatment (233, 59%). VEDs were used in 52 patients in addition to PDE5I and intracavernous injections (39, 10%) or intracavernous injections (23, 6%). In patients with a preoperative IIEF>21, assisted and unassisted EF recovery rates were 78% and 36% respectively.

In patients with a preoperative IIEF <16, assisted and unassisted EF recovery rates were 46% and 18% respectively. Sub analysis showed a moderate benefit of penile rehabilitation also in patients with a preoperative IIEF <16 undergoing bilateral nerve sparing RP.

Intensive penile rehabilitation with PDE5I, intracavernous injections and VEDs led to the best patient perceived results.

Conclusions: Intensive penile rehabilitation programs improves EF recovery in patients undergoing radical prostatectomy. Preservation of Neurovascular bundles should be attempted also in patients with preoperative ED.

Source of Funding: none