Erectile rehabilitation by slidenafil post radical prostatectomy and radical cystectomy. a prospective randomized study

Objective: The rehabilitative impact of PDE-5 inhibitors following nerve-sparing Radical Prostatectomy (RP) and Radical Cystectomy (RC) on penile function remains unclear. Active or passive rehabilitation and time of introducing these drugs are subject of controversial results. This unicentric, randomized study was realized to compare active and passive erectile rehabilitation by Sildenafil. Methods: Patients that had RP (T1c, T2a, T2b N0 M0 R0) or RC (T2 N0 M0) with normal preoperative erectile function were randomized 1:1 to either Sildenafil 50 mg once daily (group I) or Sildenafil 100 mg twice weekly (group II). Treatment was introduced 2 weeks after surgery and an International Index of Erectile Function Domain score (IIEF-5, EF) was noted 1, 3 and 6 months later. Were excluded from the study patients that had no-nerve-sparing surgery and those who needed adjuvant treatment after surgery. Results: A total of 36 patients were randomized to passive treatment in groupe I (N = 16) and active treatment in groupe II (N = 20). Mean age was 60 years (33-72). RP and RC were realized in 12 and 24 patients, respectively. Improvement in IIEF-5 EF was noted in 19 patients (53%) after one month of treatment and in 22 patients (61%) after 3 and 6 months. Active rehabilitation group had significantly better response (75%, 44%, p = 0.04) and improvement in IIEF-5 score (7.93; 4.20; p = 0.028). Univariate analysis showed that age less than 60 years was an independent success factor. We found no statistical difference between RP and RC patients (67%, 58%, p = 0.08). Treatments were well-tolerated in both groups. Conclusion: Erectile Function improved during 6-month Sildenafil rehabilitation in 61% of the cases. Active rehabilitation was significantly higher than passive rehabilitation. No difference between RP and RC were found in selected cases. However, larger series are needed to confirm our results.