UroToday.com – Following radical prostatectomy (RP) for prostate cancer (CaP), penile rehabilitation using PDE5 inhibitors, intraurethral alprostadil or injection therapy is suggested to improve return of erectile function. In the British Journal of Urology International, Dr. Craig Zippe and associates evaluate the long-term potency status after RP and use of a vacuum erection device (VED).

The study included 141 sexually active patients who underwent RP at the Cleveland Clinic. The mean patient age was 65 years and the follow-up was 6.4 years. Potency was defined as the patient’s ability to have unaided sexual intercourse. Patients who were sexually active at one year were reevaluated after a follow-up of five or more years.

  • At one year, 113 (80%) were sexually active, including those who required drug or device assistance.
  • For the 28 patients (20%) who were sexually inactive, the reasons included:
    • incontinence in 53%
    • loss of sexual interest in 36%
    • loss of libido in 11%.
  • Among these 113 men
    • 4 had natural erections sufficient for intercourse (3.5%)
    • 55 were using a VED (48.7%)
    • 26 used intraurethral alprostadil (23%)
    • 19 used injection therapy (16.8%)
    • 9 used sildenafil citrate.

Men with a lack of response to oral agents had good erections with use from non-oral therapies for penile rehabilitation.

  • Of the 113 men sexually active at 1 year, 50 (44%) had a return of spontaneous erections.
  • All 50 men were using non-oral agents like VED, intraurethral alprostadil and injections for penile rehabilitation.
  • Thirty of these 50 men tried the VED early on and had better compliance and decreased costs.
  • Five years after RP, 70/113 men (62%) were still sexually active and of these 70 men, 50 (71%) had natural erections sufficient for intercourse without assistance.
  • Six patients still used sildenafil citrate, 7 switched to tadalafil alone, and 7 used a combination of an oral agent and VED.
  • At 5 years, 43/113 men (38%) were sexually inactive.
  • The natural rate of erectile function sufficient for sexual intercourse without erectile assistance was preserved and maintained in the early rehabilitation patients and almost 60% had used a VED as early prophylaxis.

Raina R, Pahlajani G, Agarwal A, Jones S, Zippe C
Reference: BJU Int. 2010 Apr 15. Epub ahead of print.
doi: 10.1111/j.1464-410X.2010.09360.x

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

UroToday – the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice. To access the latest urology news releases from UroToday, go to: www.urotoday.com

Copyright © 2010 – UroToday