Recovery of spontaneous erectile function after nerve-sparing radical retropubic prostatectomy with and without early intracavernous injections of alprostadil: results of a prospective, randomized trial. Early versus late rehabilitation of erectile function after nerve-sparing radical cystoprostatectomy: a prospective randomized study. Factors determining functional outcomes after radical prostatectomy: robot-assisted versus retropubic. A prospective trial comparing consecutive series of open retropubic and robot-assisted laparoscopic radical prostatectomy in a centre with a limited caseload. Randomized comparison between laparoscopic and robot-assisted nerve-sparing radical prostatectomy. Penile rehabilitation therapy following radical prostatectomy Recovery of overall exercise ability, quality of life, and continence after 12-week combined exercise intervention in elderly patients who underwent radical prostatectomy: a randomized controlled study. Factors predicting recovery of erections after radical prostatectomy. Effects of nonlinear aerobic training on erectile dysfunction and cardiovascular function following radical prostatectomy for clinically localized prostate cancer. The use of an erectogenic pharmacotherapy regimen following radical prostatectomy improves recovery of spontaneous erectile function. Tadalafil rehabilitation therapy preserves penile size after bilateral nerve sparing radical retropubic prostatectomy. Head-to-head comparison of retropubic, perineal and laparoscopic radical prostatectomy. Bilateral nerve sparing robotic-assisted radical prostatectomy is associated with faster continence recovery but not with erectile function recovery compared with retropubic open prostatectomy: the need for accurate selection of patients. Sildenafil citrate after radical retropubic prostatectomy. Effects of three-times-per-week versus on-demand tadalafil treatment on erectile function and continence recovery following bilateral nerve sparing radical prostatectomy: results of a prospective, randomized, and single-center study. Penile weight and cell subtype specific changes in a post-radical prostatectomy model of erectile dysfunction. Effect of statin therapy on early return of potency after nerve sparing radical retropubic prostatectomy.
PURPOSE This study was aim ed at assessing prospect ively the effect of postoperative intracavernous injections of alprostadil on the recovery of spontaneous erectile function after nerve-sparing radical retropubic prostatectomy . MATERIAL S AND METHODS A total of 30 potent patients with clinical ly localized prostate cancer ( clinical stage B1 or B2 , Gleason sum 7 or greater , prostatic specific antigen less than 20 ng./ml . ) underwent nerve-sparing radical retropubic prostatectomy  and was subsequently r and omized to alprostadil injections 3 times per week for 12 weeks ( group 1 , 15 patients ) or  observation without any erectogenic treatment ( group 2 , 15 patients ) . Patients were assessed at the 6-month followup by sexual history , physical examination , color Doppler sonography of the cavernous arteries and polisomnographic recording of nocturnal erections . RESULTS In group 1 , 12 patients ( 80 % ) completed the entire treatment schedule and were evaluated at the long-term followup . Eight patients in this group ( 67 % ) reported the recovery of spontaneous erection sufficient for satisfactory sexual intercourse , compared with 3 patients ( 20 % ) in group 2 . The difference between the 2 groups was statistically significant ( p < 0.01 ) . In group 1 , all but 1 patient reporting normal postoperative erections also showed normal erections at nocturnal testing , whereas color Doppler sonography demonstrated normal penile hemodynamics in all of them . In these patients , failures were the result of cavernous veno-occlusive dysfunction ( 2 cases , 17 % ) and cavernous nerve injury ( 2 cases , 17 % ) . In group 2 , patients with normal erections showed both normal nocturnal testing and penile hemodynamics , whereas failures were the result of cavernous veno-occlusive dysfunction ( 8 cases , 53 % ) , cavernous arterial insufficiency ( 2 cases , 13 % ) or cavernous nerve injury ( 3 cases , 20 % ) . Complications in patients treated with alprostadil injections accounted for 2 cases ( 13 % ) of a penile nodule and 1 further case ( 6 % ) of prolonged penile erection . Complications were not seen in group 2 patients . CONCLUSIONS Early postoperative administration of alprostadil injections significantly increases the recovery rate of spontaneous erections after nerve-sparing radical retropubic prostatectomy . It is our belief that programmed vasoactive injections improve cavernous oxygenation , thereby limiting the development of hypoxia-induced tissue damage . The potential complications related to the use of intracavernous injections must be clearly explained to patients INTRODUCTION Pharmacological rehabilitation of erectile function ( EF ) after nerve-sparing radical prostatectomy was repeatedly advocated . AIM To compare early vs. late penile rehabilitation in patients with nerve-sparing ( NS ) radical cystoprostatectomy  based on a prospect i ve r and omized trial . METHODS Eighteen patients without spontaneous erection 8 weeks after NS radical cystoprostatectomy  were r and omly divided into two groups ; group I and II who started the erectogenic therapy at the 2nd and 6th month postoperatively , respectively . The pharmacological therapy constitutes of sildenafil citrate twice weekly to be shifted to intracavernosal injection ( ICI ) of prostagl and in E1 ( PGE1 ) if not responding . The treatment continued for 6 months in both groups . MAIN OUTCOME MEASURES The EF status was evaluated before and at the end of the treatment by International Index of Erectile Function question naire and penile Doppler ultrasonography ( PDU ) . RESULTS Six out of nine patients recovered unassisted erection after treatment in group I compared to three out of nine patients in group II . Two patients in group I and three patients in group II were maintained on sildenafil therapy on dem and basis . The remaining four patients were dependent on ICI of PGE1 . At final evaluation , a significant improvement was found in the EF , the intercourse satisfaction and overall satisfaction domains ( P = 0.02 , 0.03 , and 0.02 , respectively ) in group I compared with group II . Regarding PDU findings , significant improvement in end-diastolic velocity was elicited in the early rehabilitation group compared with the pretreatment value ( P = 0.03 ) with no significant difference between both groups . CONCLUSION Early compared with delayed erectile rehabilitation brings forward the natural healing time of potency and maintains nerve-assisted erection BACKGROUND Early studies reported comparative results of functional outcomes between robot-assisted ( RARP ) and retropubic radical prostatectomy ( RRP ) . However , well-controlled single-surgeon prospect i ve studies comparing the outcomes are rare . OBJECTIVE To compare functional outcomes after RARP and RRP performed by a single surgeon , and to identify factors predictive of early return of continence and potency . DESIGN , SETTING , AND PARTICIPANTS A total of 763 consecutive patients undergoing RP between 2007 and 2010 were prospect ively included and serially followed postoperatively for comparative analysis . INTERVENTION RARP  was performed in 528 patients , and 235 underwent RRP .  MEASUREMENTS Continence was defined as being completely pad free . Potency was defined as having erection sufficient for intercourse with or without a phosphodiesterase type 5 inhibitor . Continence and potency recovery were checked serially by interview and question naire at 1 , 3 , 6 , 9 , 12 , 18 , and 24 mo postoperatively . Cox proportional hazards method analyses was performed to determine predictive factors for early recovery . RESULTS AND LIMITATIONS After the initial 132 cases , patients who underwent RARP demonstrated faster recovery of urinary continence compared to RRP patients . Potency recovery was more rapid in the RARP group at all evaluation time points , beginning from the initial cases . In multivariate analysis , younger age and longer preoperative membranous urethral length seen by prostate magnetic resonance imaging ( MRI ) demonstrated statistical significance as independent prognostic factors for continence recovery ; younger age , surgical method ( RARP vs RRP ) , and higher preoperative serum testosterone were independent prognostic factors for potency recovery . The limitations of the present study were that it was nonr and omized and used interview to evaluate potency recovery . CONCLUSIONS Patients after RARP demonstrated superior functional recovery . Moreover , membranous urethral length on preoperative MRI and patient age were factors independently predictive of continence recovery , while patient age and higher preoperative serum testosterone were independent prognostic factors for potency recovery BACKGROUND Robot-assisted radical prostatectomy ( RALP ) is performed worldwide , even in institutions with limited caseloads . However , although the results of large RALP series are available , oncologic and functional outcomes as well as complications from low-caseload centres are lacking . OBJECTIVE To compare perioperative , oncologic , and functional outcomes from two consecutive series of patients with localised prostate cancer treated by retropubic radical prostatectomy ( RRP ) or recently established RALP in our hospital , which has a limited caseload . DESIGN , SETTING , AND PARTICIPANTS One hundred fifty consecutive patients were enrolled . Their data and outcomes were collected and extensively evaluated . INTERVENTION Seventy-five consecutive patients underwent RRP , and 75 consecutive patients underwent RALP , including all patients of the learning curve . MEASUREMENTS Patient baseline characteristics , perioperative and postoperative outcomes , and complications were evaluated . End points were oncologic data ( positive margins , prostate-specific antigen [ PSA ] ) , perioperative complications , urinary continence , and erectile function at 3- and 12-mo follow-up . RESULTS AND LIMITATIONS The preoperative parameters from the two groups were comparable . The positive surgical margin ( PSM ) rates were 32 % for RRP and 16 % for RALP ( p=0.002 ) . For RRP and RALP , the PSA value was < 0.2 ng/ml in 91 % and 88 % of patients 3 mo postoperatively ( p=0.708 ) and in 87 % and 89 % of patients 12 mo postoperatively ( p=0.36 ) , respectively . Continence rates for RRP and RALP were 83 % and 95 % at 3-mo follow-up ( p=0.003 ) and 80 % and 89 % after 12-mo follow-up ( p=0.092 ) , respectively . Among patients who were potent without phosphodiesterase type 5 inhibitors ( PDE5-I ) before RRP and RALP , recovery of erectile function with and without PDE5-Is was achieved in 25 % ( 12 of 49 patients ) and 68 % ( 25 of 37 patients ) 3 mo postoperatively ( p=0.009 ) and in 26 % ( 12 of 47 patients ) and 55 % ( 12 of 22 patients ) 12 mo postoperatively ( p=0.009 ) , respectively . Minimal follow-up for RRP was 12 mo ; median follow-up for the RALP group was 12 mo ( range : 3 - 12 ) . According to the modified Clavien system , major complication rates for RRP and RALP were 28 % and 7 % ( p=0.025 ) , respectively ; minor complication rates were 24 % and 35 % ( p=0.744 ) , respectively . CONCLUSIONS Despite a limited caseload and including the learning curve , RALP offers slightly better results than RRP in terms of PSM , major complications , urinary continence , and erectile function INTRODUCTION Lack of r and omized controlled trials ( RCTs ) that compare pure laparoscopic radical prostatectomy ( LRP ) with robot-assisted laparoscopic radical prostatectomy ( RALRP ) is an important gap of the literature related to the surgical treatment of the clinical ly localized prostate cancer ( PCa ) . AIM To provide the first prospect i ve r and omized comparison on the functional and oncological outcomes of LRP and RALRP for the treatment of the clinical ly localized PCa . METHODS Between 2007 and 2008 , 128 consecutive male patients were r and omized in two groups and treated by a single experienced surgeon with traditional LRP ( Group I-64 patients ) or RALRP ( Group II-64 patients ) in all cases with intent of bilateral intrafascial nerve sparing . MAIN OUTCOME MEASURES Primary end point was to compare the 12 months erectile function ( EF ) outcomes . Complication rates , continence outcomes , and oncological results were also compared . The sample size of our study was able , with an adequate power ( 1-beta > 0.90 ) , to recognize as significant large differences ( above 0.30 ) between incidence proportions of considered outcomes . RESULTS No statistically significant differences were observed for operating time , estimated blood loss , transfusion rate , complications , rates of positive surgical margins , rates of biochemical recurrence , continence , and time to continence . However , the 12-month evaluation of capability for intercourse ( with or without phosphodiesterase type 5 inhibitors ) showed a clear and significant advantage of RALRP ( 32 % vs. 77 % , P < 0.0001 ) . Time to capability for intercourse was significantly shorter for RALRP . Rates of return to baseline International Index of Erectile Function ( IIEF-6 ) EF domain score question naires ( questions 1 - 5 and 15 ) ( 25 % vs. 58 % ) and to IIEF-6 > 17 ( 38 % vs. 63 % ) were also significantly higher for RALRP ( P = 0.0002 and P = 0.008 , respectively ) . CONCLUSIONS Our study offers the first high-level evidence that RALRP provides significantly better EF recovery than LRP without hindering the oncologic radicality of the procedure . Larger RCTs are needed to confirm if a new gold-st and ard treatment in the field of RP has risen Purpose . To compare erectile function ( EF ) recovery of patients treated by early penile rehabilitation therapy ( PRT ) with sildenafil and with control group . Method . Forty men treated by bilateral nerve sparing radical prostatectomy ( NSRP ) and with a normal pre-operative EF were enrolled . Fourteen days after surgery , they were r and omised to a flexible-dose sildenafil group and to a control group . The International Index of Erectile Function ( IIEF ) question naire was completed before surgery and at 3 , 6 , 12 and 24 weeks after NSRP . Results . In the group treated , the mean IIEF score before surgery was 26.2 and 14.1 , 16.2 , 22.5 and 25.2 at 3 , 6 , 12 and 24 weeks after NSRP , respectively . In the control group , the respective scores were 26.5 and 12.4 , 15.8 , 15.3 and 17.4 . There was a significant difference in IIEF mean score ( 25 ± 6 vs. 17 ± 9 , p < 0.05 ) and in the potency rate ( 87 % vs. 56 % ) between the groups at 24 weeks after NSRP . The percentage of patients who were capable of having medication-unassisted intercourse was 54 % vs. 21 % ; 34 % vs. 18 % of patients had a normal EF with 72 % vs. 32 % of responders to sildenafil . Conclusions . PRT with PDE-5 inhibitors should be offered early after RP to allow the recovery of EF OBJECTIVE To examine the changes from a combined exercise intervention after radical prostatectomy ( RP ) in elderly patients with prostate cancer , because r and omized controlled trials addressing exercise intervention after RP have been lacking . METHODS From May 2009 to May 2010 , all patients who underwent laparoscopic RP were assessed for eligibility . A total of 66 patients were r and omized to an exercise or a control group . The exercise group received a combined exercise intervention ( resistance , flexibility , and Kegel exercises ) twice a week for 12 weeks , and the control group received only Kegel exercises . The primary outcome was physical function , and the secondary outcomes were continence status and quality of life after the exercise intervention . RESULTS A total of 49 patients completed follow-up to the end of study . After the 12-week exercise intervention , except for grip strength , all physical functions were better in the exercise group than in the control group . The 24-hour pad test results ( 12.2 g in the exercise group , 46.2 g in the control group ) and continence rate ( 73.1 % in exercise group , 43.5 % in the control group ) recovered more promptly in the exercise group . On a question naire study using the International Consultation on Incontinence question naire , Beck Depression Inventory , and Medical Outcomes Study 36-item short-form health survey , only the exercise group showed improvement at the last follow-up visit . CONCLUSION A 12-week combined exercise intervention after RP results in improvement of physical function , continence rate , and quality of life . These results could help with prompt recovery of daily activities PURPOSE Because preservation of functioning penile erections is a major concern for many patients considering treatment for localized prostate cancer , we analyzed various factors determined before and after radical retropubic prostatectomy to identify those significantly associated with recovery of erectile function . MATERIAL S AND METHODS Our prospect i ve data base of patients undergoing pelvic lymphadenectomy and radical retropubic prostatectomy  was used to determine factors predictive of erection recovery after radical prostatectomy . The study included 314 consecutive men with prostate cancer treated with radical retropubic prostatectomy between November 1993 and December 1996 . Preoperative potency satisfactory for intercourse and degree of neurovascular bundle preservation during the operation were documented . RESULTS Patient age , preoperative potency status and extent of neurovascular bundle preservation but not pathological stage were predictive of potency recovery after radical prostatectomy . At 3 years after the operation 76 % of men younger than age 60 years with full erections preoperatively who had bilateral neurovascular bundle preservation would be expected to regain erections sufficient for intercourse . Compared to the younger men , those 60 to 65 years old were only 56 % ( 95 % confidence interval [ CI ] 37 to 84 ) and those older than 65 years were 47 % ( 95 % CI 30 to 73 ) as likely to recover potency . Patients with recently diminished erections were only 63 % ( 95 % CI 38 to 100 ) as likely to recover potency as men with full erections preoperatively , and those with partial erections were only 47 % ( 95 % CI 23 to 96 ) as likely to recover potency . Resection of 1 neurovascular bundle reduced the chance of recovery to 25 % ( 95 % CI 10 to 61 ) compared to preserving both nerves . CONCLUSIONS Knowledge of preoperative erectile function and patient age before the operation and the degree of neurovascular bundle preservation afterward may aid in patient counseling regarding potency recovery after radical prostatectomy UNLABELLED Erectile dysfunction ( ED ) is a major adverse effect of radical prostatectomy ( RP ) . We conducted a r and omized controlled trial to examine the efficacy of aerobic training ( AT ) compared with usual care ( UC ) on ED prevalence in 50 men ( n=25 per group ) after RP . AT consisted of five walking sessions per week at 55 - 100 % of peak oxygen uptake ( VO2peak ) for 30 - 60 min per session following a nonlinear prescription . The primary outcome was change in the prevalence of ED , as measured by the International Index of Erectile Function ( IIEF ) , from baseline to 6 mo . Secondary outcomes were brachial artery flow-mediated dilation ( FMD ) , VO2peak , cardiovascular ( CV ) risk profile ( eg , lipid profile , body composition ) , and patient-reported outcomes ( PROs ) . The prevalence of ED ( IIEF score ≤ 21 ) decreased by 20 % in the AT group and by 24 % in the UC group ( difference : p=0.406 ) . There were no significant between-group differences in any erectile function subscale ( p>0.05 ) . Significant between-group differences were observed for changes in FMD and VO2peak , favoring AT . There were no group differences in other markers of CV risk profile or PROs . In summary , nonlinear AT does not improve ED in men with localized prostate cancer in the acute period following RP . TRIAL REGISTRATION Clinical trials.gov identifier NCT00620932 PURPOSE It has been suggested that postradical prostatectomy ( RP ) erectile function outcomes are improved by early use of erectogenic medications . This analysis was design ed to assess the ability of a post-RP vasoactive drug program to improve long-term spontaneous erectile function . METHODS Men with functional preoperative erections who underwent RP were challenged early postoperatively with oral sildenafil . Nonresponders were switched to intracavernosal injection therapy ( ICI ) . Patients were instructed to inject three times a week . Only patients who presented within 6 months post RP , who completed the International Index of Erectile Function ( IIEF ) question naire on at least three separate occasions after surgery , and who had been followed for at least 18 months were included . Data from men who were committed to rehabilitation were compared with those of men who did not follow the protocol but continued to be followed serially following RP . RESULTS There were 58 patients in the rehabilitation ( R ) group and 74 in the nonrehabilitation ( NR ) group . No differences existed in mean patient age , comorbidity profile , intraoperative nerve sparing status , or postoperative erectile hemodynamics between the two groups . At 18 months post RP , there were statistically significant differences between the two groups in the percentage of patients who were capable of having medication-unassisted intercourse ( R=52 % vs. NR=19 % , P<0.001 ) ; mean erectile rigidity ( R=53+/-21 % vs. NR=26+/-43 % , P<0.01 ) ; mean IIEF erectile function ( EF ) domain scores ( R=22+/-6 vs. NR=12+/-14 , P<0.01 ) ; the percentage of patients with normal EF domain scores ( R=22 % vs. NR=6 % , P<0.01 ) ; the percentage of patients responding to sildenafil ( R=64 % vs. NR=24 % , P<0.001 ) ; the time to become a sildenafil responder ( R=9+/-4 vs. NR=13+/-3 months , P=0.02 ) ; and the percentage of patients responding to ICI ( R=95 % vs. NR=76 % , P<0.01 ) . CONCLUSIONS The data generated from this nonr and omized study indicate that a pharmacologic penile rehabilitation protocol results in higher rates of spontaneous functional erections and erectogenic drug response after RP OBJECTIVE To evaluate the change in penile size r bilateral nerve sparing retropubic radical prostatectomy ( BNSRRP ) and possible effect of Tadalafil . MATERIAL S AND METHODS A total of 65 patients underwent BNSRRP and they were evaluated prospect ively for a whole year of follow-up . The patients were r and omized to control without rehabilitation ( Group 1 ) or Tadalafil rehabilitation group ( Group 2 ) . The patients were evaluated at months 3 , 6 and 12 postoperatively for erectile function , penile measurements ( flaccid penile length , penile length at maximum erection , penile circumference at flaccid status , and penile circumference at maximum erection ) , penile abnormalities and general health status . Statistical analysis was performed by Chi-Square test and significance was defined as p value < 0.05 . RESULTS In Group 1 there was significant decrease in penile measurements at month 3 compared to preoperative measurements . There was decrease in all parameters at month 6 compared to month 3 but only the decrease in penile length at maximum erection was significant . There were no significant differences between postoperative months 6 and 12 for all measurements . In Group 2 there was a tendency to decrease in all measurements at month 3 compared to baseline . There was no significant difference for penile measurements between postoperative 3rd and 6th months and between 6th month and the first year . CONCLUSION Although further large sample d trials are needed to describe the possible positive effect of tadalafil or other PDE5-I 's on penile size after BNSRRP , tadalafil rehabilitation is effective in preserving penile size especially in the early postoperative period after BNSRRP OBJECTIVE As more patients are diagnosed with prostate cancer at an early stage , it is becoming increasingly important to refine the technique of surgical excision . For this purpose we have generated objective data comparing three different surgical approaches used by three experienced surgeons . METHODS We prospect ively compared three contemporary personal series of 50 consecutive radical prostatectomy ( RP ) patients . The health-related quality of life was evaluated preoperatively and in months 1 , 3 , 6 , 12 and 24 . RESULTS Considering in turn the patients undergoing retropubic , perineal and laparoscopic RP , the median procedure time was 2 h and 27 min , 1 h and 50 min and 4 h , with a transfusion rate of 2 , 0 and 8 % , respectively . In the perineal group there were more wound infections . Median catheter drainage was 7 , 10 and 7 days and zero , 13 and one patients needed reinsertion of a catheter . Early continence varied considerably , with 57.4 , 11.4 and 6.3 % of patients pad-free after 1 month , but there were no differences in social continence ( zero or one pad ) with 97.8 , 97.8 and 91.9 % after 2 years . The Litwin score for incontinence ( preoperative minus postoperative ) was -24 , -41 and -63 % after 1 month and -13 , + 3 and -29 % after 2 years . Twenty-nine , five and 15 patients had a preoperative five-item version of International Index of Erectile Function ( IIEF-5 ) score of > or = 17 points and a nerve-sparing procedure . After 2 years , 48.1 , 0 and 0 % had an IIEF-5 score of > or = 17 points without the use of phosphodiesterase type 5 ( PDE-5 ) inhibitors , but when including patients using inhibitors there were no significant differences . CONCLUSIONS A comparison of morbidity , short-term convalescence and long-term side-effects of different surgical techniques is strongly biased by both the preoperative status of patients and the skill of the surgeons . Overall , we found some differences in the short-term results ( e.g. early continence ) and comparable long-term results Robotic-assisted radical prostatectomy ( RARP ) shows measurable advantages , compared to conventional open surgery , even if some aspects are , still , under debate . The aim of this study was to compare the potency recovery rate of patients with clinical ly localised prostate cancer treated by bilateral nerve-sparing ( BNS ) RARP or retropubic radical prostatectomy ( RRP )  , and secondarily , the urinary continence recovery evaluation and the oncological efficacy . All patients treated with BNS-RARP or BNS-RRP for clinical ly localised prostate cancer , performed by a single dedicated surgeon , between January 2004 and December 2008 , were enrolled in this non-r and omised prospect i ve comparative study . The International Index of Erectile Function ( IIEF ) and erection hardness score ( EHS ) , in the form of a question naire , were self-administered to each patient pre-operatively and after 12 months . The presence of surgical margins was considered as oncological outcome measure . Eighty-two patients underwent BNS-RARP while 48 underwent BNS-RRP . For BNS-RARP and BNS-RRP the median operative time was 221 and 103 min , respectively ( P<0.001 ; df=128 ; t=721.43 ) , and intra-operative blood loss was 280 and 565 ml , respectively ( P<0.001 ; df=128 ; t=1742.44 ) . At a mean follow-up period of 12.4±2.3 months , 12 patients ( 25 % ) in the BNS-RRP group and 22 ( 26.8 % ) in the BNS-RARP group were considered potent with or without drugs ( P=0.81 ) . Moreover , we did not find any statistically significant difference between the 2 groups in terms of IEFF and EHS scores after treatment ( 17.21 vs. 16.98 ; P=0.16 and 2.1 vs. 2.0 ; P=0.54 ) . On the other h and , statistically significant differences between the 2 groups were found in terms of faster urinary continence recovery and the presence of positive surgical margins ( P<0.001 , P=0.009 ) . Shorter catheterization duration ( 7 vs. 3 days ) and post-operative hospital stays ( 8 vs. 4 days ; P<0.001 ) were found in the BNS-RARP group compared to the BNS-RRP group . In conclusion , our results demonstrate that BNS-RARP does not improve erectile function recovery compared to open radical prostatectomy ; however , it significantly improves urinary continence and decreases the presence of positive surgical margins PURPOSE Erectile dysfunction continues to be a significant problem for men after radical retropubic prostatectomy  despite nerve sparing techniques . Sildenafil citrate ( Viagra ) has proved effective for erectile dysfunction in many men . We determine the efficacy of sildenafil in men with erectile dysfunction after radical retropubic prostatectomy  and examine variables that may impact the response to treatment . MATERIAL S AND METHODS A total of 84 men were prescribed sildenafil after radical retropubic prostatectomy  and asked to complete a series of question naires , including the International Index of Erectile Function ( IIEF ) , on erectile function before and after sildenafil administration . The importance of factors , such as patient age , time since surgery , degree of cavernous nerve sparing , preoperative prostate specific antigen , Gleason score , clinical and pathological stage , and baseline postoperative erectile function , was examined . RESULTS Of the 84 patients 45 ( 53 % ) had improved erections and 34 ( 40 % ) had improved ability for intercourse while taking sildenafil .  Mean IIEF score for the erectile function domain increased from 9 to 14 ( p < 0.001 ) . Orgasmic function ( p = 0.004 ) and intercourse satisfaction ( p = 0.009 ) also significantly improved . The degree of nerve sparing and baseline postoperative erectile dysfunction had a significant impact on the ability of sildenafil to improve erectile function ( p = 0.010 and p < 0.001 , respectively ) and total IIEF question naire responses ( p = 0.031 and p < 0.001 , respectively ) . Age and pathological stage also appeared to have a significant effect . CONCLUSIONS Sildenafil improved erectile function and the ability to have intercourse in more than half of men after radical retropubic prostatectomy . Baseline postoperative erectile function , which is dependent on the degree of nerve sparing technique , significantly impacts the likelihood that patients will respond to sildenafil Erectile dysfunction ( ED ) and urinary incontinence after bilateral nerve-sparing radical prostatectomy ( BNSRP ) still remain major causes of morbidity . Phosphodiesterase type 5 inhibitors ( PDE5-Is ) have a role in the treatment of ED after BNSRP . Several studies in patients with ED and lower urinary tract symptoms demonstrated that PDE5-Is could improve both erectile function and urinary symptoms . The aim of this study was to compare the efficacies of two dosing regimens of 20 mg tadalafil ( on-dem and and 3 times per week ) and to assess the role of tadalafil in recovery of erectile function and continence after BNSRP . We conducted a single-center , prospect i ve , r and omized controlled trial of three times per week versus on-dem and tadalafil 20 mg and a control group after BNSRP . A total of 129 preoperatively potent and continent patients were included in the study . The patients were evaluated at 6 weeks and 12 months postoperatively for erectile function and continence status . There was no significant difference between all three groups with respect to erectile function at 6 weeks after the surgery . Twelve months after the surgery , the International Index of Erectile Function score was significantly higher in the group using tadalafil 20 mg three times per week . However , there was no significant difference between the treated groups and the control group with respect to the continence status at 12 months after the surgery . There was no correlation between incontinence and ED after the surgery in all groups . Tadalafil 20 mg three times per week is an efficacious and well-tolerated treatment option for ED after BNSRP . Treatment with 20 mg tadalafil either three times per week or on dem and can not improve continence recovery after BNSRP compared with the control group PURPOSE We evaluated neurogenic erectile dysfunction , focusing on the post-radical prostatectomy model . We investigated changes in DNA , protein and apoptotic cells of the rat penis after  denervation . Gross morphometry was measured to eluci date the impact of chemical changes . MATERIAL S AND METHODS Postpubertal male Sprague-Dawley rats were r and omized to bilateral or unilateral cavernous nerve transection , or sham operation .  Wet weight , DNA content and protein content were measured . Tissue sections were stained for apoptosis by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling and the apoptotic index was calculated . Dual staining was performed for endothelial and smooth muscle cells to identify apoptotic cells . RESULTS Penile wet weight was significantly decreased at all time points after bilateral neurotomy ( p < 0.0005 ) . Unilateral neurotomy allowed much greater preservation of penile weight . DNA content was significantly decreased in bilaterally denervated penes and unchanged in unilaterally operated penes . Protein content was not significantly altered in the bilateral or unilateral cohorts . Bilateral neurotomy induced significant apoptosis , while unilateral surgery caused significantly less apoptosis . Each population had apoptotic clustering just beneath the tunica albuginea , which was mostly smooth muscle cells . CONCLUSIONS These data suggest the importance of neural integrity to maintain penile homeostasis . The loss in penile weight was consistent with the anecdotal experience of many clinicians . Decreased DNA content may have been due to significant levels of apoptosis in smooth muscle cells . Preserved protein content may suggest an increase in extracellular protein , as postulated in corporeal fibrosis . The subtunical population of apoptotic smooth muscle cells revealed a mechanism for veno-occlusive dysfunction observed after radical prostatectomy . These effects were significantly moderated in the unilateral model , reinforcing the critical nature of neural integrity PURPOSE We prospect ively investigated whether postoperative statin use would contribute to earlier recovery of erectile function in men who underwent bilateral nerve sparing radical retropubic prostatectomy for clinical ly localized prostate cancer . MATERIAL S AND METHODS A total of 50 potent men without hypercholesterolemia undergoing bilateral nerve sparing radical retropubic prostatectomy for clinical ly localized prostate cancer were prospect ively r and omized into 2 equal groups . Group 1 patients were instructed to ingest only 50 mg sildenafil per day if needed following hospital discharge after radical retropubic prostatectomy . Group 2 patients were prescribed atorvastatin at a dose of 10 mg daily from postoperative days 1 to 90 and they were also instructed to ingest sildenafil , as in group 1 . Patient status regarding potency and adverse events were assessed 6 months after surgery . RESULTS The 2 groups demonstrated no significant differences regarding various baseline factors , including International Index of Erectile Function-5 scores . Group 2 had a significantly higher postoperative International Index of Erectile Function-5 score than group 1 at 6 months postoperatively ( p = 0.003 ) . Meanwhile , as judged by a preset definition , the incidence of potent patients 6 months after prostatectomy was 26.1 % in group 1 and 55 % in group 2 ( p = 0.068 ) . Also , 17.4 % and 40 % of the men reported achieving intercourse by vaginal penetration without a phosphodiesterase 5 inhibitor in groups 1 and 2 , respectively ( p = 0.172 ) . No serious adverse events associated with medication were reported . CONCLUSIONS Postoperative treatment with atorvastatin in men who report normal erectile function preoperatively may contribute to earlier recovery of erectile function after nerve sparing radical retropubic prostatectomy
Experimental data support the concept of cavernosal damage and suggest a protective role for daily dosage of a PDE5-I ; however , similar data have not yet been replicated in humans .
Penile rehabilitation programs are common in clinical practice , but there is no definitive evidence to support their use or the best treatment strategy .
PDE5-Is are efficacious and safe in young patients with normal preoperative erectile function who have undergone bilateral nerve-sparing radical prostatectomy .
On-dem and use of a PDE5-I may be at least as efficacious as daily use .
PDE5-I use in penile rehabilitation programs is not supported by rigorous level 1 evidence -based medicine .
PDE5-Is are an efficacious and safe treatment for post-RP ED in properly selected patients .
The experimental results on the protective role of daily dosages of PDE5-Is , while robust , have not been replicated in humans .
CONTEXT  Erectile dysfunction ( ED ) after radical prostatectomy ( RP ) has a significant negative impact on a patient 's health-related quality of life .
Phosphodiesterase type 5 inhibitors ( PDE5-Is ) have recently been utilized not only as a treatment of ED in this population but also as a preventive strategy in penile rehabilitation programs .
OBJECTIVE To eluci date the pathophysiologic mechanisms of post-RP ED , to assess the need for rehabilitation following surgery , and to analyze the basic scientific evidence and clinical applications of PDE5-Is for the prevention and treatment of ED .
EVIDENCE SYNTHESIS Post-RP ED has many factors .
Cavernosal nerve injury induces pro-apoptotic factors ( ie , loss of smooth muscle ) and pro-fibrotic factors ( ie , an increase in collagen ) within the corpora cavernosa .