Sexual function recovery following open and robotic radical prostatectomy: results of an academic penile rehabilitation program.

Michele Di NAUTA; Ugo Giovanni FALAGARIO; Anna RICAPITO; Matteo RUBINO; Pasquale ANNESE; Gian Maria BUSETTO; Luigi CORMIO; Giuseppe CARRIERI; Carlo BETTOCCHI

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Sexual function recovery following open and robotic radical prostatectomy: results of an academic penile rehabilitation program.

Author: Michele Di NAUTA ¹ ; Ugo Giovanni FALAGARIO ¹ ; Anna RICAPITO ¹ ; Matteo RUBINO ¹ ; Pasquale ANNESE ¹ ; Gian Maria BUSETTO ¹ ; Luigi CORMIO ² ; Giuseppe CARRIERI ¹ ; Carlo BETTOCCHI ¹
Author Information

1. Andrology Unit, Department of Urology and Kidney Transplantation, University of Foggia, Foggia 71122, Italy.
2. Department of Urology, Bonomo Teaching Hospital, University of Foggia, Andria (BAT) 76123, Italy.
Publication Type:Journal Article
Keywords: radical prostatectomy; rehabilitation; sexual recovery
MeSH: Humans; Male; Prostatectomy/rehabilitation*; Middle Aged; Erectile Dysfunction/drug therapy*; Aged; Recovery of Function; Robotic Surgical Procedures/adverse effects*; Phosphodiesterase 5 Inhibitors/therapeutic use*; Penile Erection; Tadalafil/therapeutic use*; Prostatic Neoplasms/surgery*; Treatment Outcome
From: Asian Journal of Andrology 2025;27(6):680-685
CountryChina
Language:English
Abstract: Despite surgical advancements, erectile dysfunction (ED) is a common consequence of radical prostatectomy (RP). This study aimed to evaluate the impact of early penile rehabilitation within a dedicated penile rehabilitation program on assisted and unassisted erectile function (EF) recovery. All patients who underwent RP and at least 1 year follow-up at penile rehabilitation program in the Department of Urology, OORR Policlinico Riuniti (Foggia, Italy) were included. Treatment involved phosphodiesterase type 5 inhibitors (PDE5Is; tadalafil 20 mg, 1 tablet every other day), intracavernous injections (Caverject 5 µg, 1 vial per week), and daily use of vacuum erection devices (VEDs). Primary end point was EF recovery defined as International Index of Erectile Function-5 (IIEF-5) ≥21 with or without rehabilitation aids. IIEF-5 and prescribed treatments were prospectively collected at 3 months, 6 months, 9 months, 12 months, and 24 months. Among 570 eligible patients, 397 (69.6%) underwent rehabilitation. Patients who undergoing andro-rehabilitation were younger (65 months vs 70 months; P < 0.0001), had lower prostate-specific antigen (PSA) levels (5.9 ng ml -1 vs 6.2 ng ml -1 ; P = 0.04), and lower grade tumors ( P = 0.001) compared to the patients who did not undergo sexual rehabilitation after radical prostatectomy. Two-year EF recovery rates in patients undergoing andro-rehabilitation ranged from 75% (preoperative IIEF-5 >16) to 45% (preoperative IIEF-5 <16) with rehabilitation aids. Combination treatments (PDE5I+VEDs with or without intracavernous injections) showed the highest rates of EF recovery (up to 80% at 2 years). EF recovery without rehabilitation aids was significantly higher for patients with IIEF-5 >21 (IIEF-5 >21 [36%] vs IIEF-5 of 17-21 [18%]; P = 0.01). Subanalysis indicated a moderate benefit of rehabilitation in patients with preoperative IIEF-5 <16 who underwent bilateral nerve-sparing RP. Participation in intensive penile rehabilitation programs improves EF recovery in patients undergoing RP. Preserving the neurovascular bundles may be beneficial for patients with preoperative ED.