(268) EARLY EXPERIENCE IN PENILE REHABILIATION AFTER RADICAL PROSTATECTOMY

Abstract Objectives The incidence rate of erectile dysfunction (ED) is reportedly as high as 30-90% after radical prostatectomy which seriously affects the patients' quality of life. Penile rehabilitation is defined as the use of any drug or device at or after radical prostatectomy to maximize erectile function recovery. Methods Prospective study in men who underwent open radical prostatectomy and who received penile rehabilitation after surgery. Highly motivated (group I) patient started treatment with 5 mg tadalafil on the fifth postoperative day and continued to receive every day, regardless of erectile function. Intracavernous injection of prostaglandin E1 was initiated at 1 month. Minimally motivated patients (group II) started PDE5i on demand only. Follow up evaluations were done at 3, 6, 12, 18 and 24 months. Patients filled in International Index of Erectile Function-5 (IIEF-5) questionnaires. Results Of 165 men who underwent open radical prostatectomy 48 patients met inclusion criteria, complied with the study medication, and had complete data for 24 months. A total of 12 patients (25%) underwent (undefined include also unilateral) nerve-sparing surgery (NSS), while 36 patients (75%) had bilateral nerve-sparing surgery. At 24 months, 30% of patients who underwent undefined nerve-sparing surgery and 60% of patients who underwent bilateral nerve-sparing surgery reported having sufficient erectile function for intercourse without using intracavernous injection or PDE5i on demand. At 24 months after surgery, the median IIEF-5 score was 13 (1-25) for the whole cohort, 7 (1-25) for patients who had undergone undefined nerve-sparing surgery and 16 (1-25) for patients who had undergone bilateral nerve-sparing surgery. Patients received ICI treatment had success early in the study period compared to patients taking PDE5i alone. Conclusions Proper selection of patients, NSS and postoperative counseling as well as patient’s motivations and expectations might explain inferior erectile function results following this surgery. Conflicts of Interest No conflicts.