Results from a study published in BJU International indicate that penile rehabilitation programs (PRPs) can help restore erectile function following nerve-sparing robot-assisted radical prostatectomy (RARP).
These findings are consistent with previous results showing that PRPs can significantly benefit early recovery of erectile function, one of the many challenges associated with the use of such procedures for treating patients with prostate cancer.
Commenting on the study, lead investigator Ketan Badani (Columbia University Medical Center, New York, USA) says: "The present study is clinically important because it reflects the real-life outcomes in one center with one surgeon and is relevant to current practice."
However, the investigators caution that the study's small numbers, selection bias, and lack of a control group are all limitations, and therefore "further large, randomized controlled studies are needed to validate these findings."
Radical prostatectomy is a standard treatment for patients with organ-confined prostate cancer, but is often associated with varying levels of erectile function loss. Even when nerves are spared, full restoration of function can take as long as 2 years.
PRPs involving vasoactive agents and/or vacuum erection devices (VERDs) can help to preserve erectile tissue integrity.
To determine the optimal PRP based on improvement in preoperative Sexual Health Inventory for Men (SHIM ) scores, Badani and colleagues retrospectively analyzed records from 203 patients who underwent RARP. Patient records were divided into three groups based on SHIM scores, representing moderate (Group 1), mild (Group 2), or no erectile dysfunction (Group 3).
The PRP success rates for Groups 1, 2, and 3 were 19%, 46%, and 68%, respectively, with the longest erectile function recovery period (EFRP) occurring in Group 1. For all groups, the use of oral phosphodiesterase-5 inhibitors alone or in combination with VERDs produced the greatest improvements in erectile function and the shortest EFRPs. However, the best results were seen with the combination therapy.
In general, recovery periods from RARPs range from 6 to 24 months. Penile rehabilitation can be started anywhere from 2 to 6 months following surgery, although patient compliance appears to be greatest with earlier PRP initiation.
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