The use of an erectogenic pharmacotheraphy regimen following radical prostatectomy improves recovery of spontaneous erectile function

Purpose. It has been suggested that postradical prostatectomy (RP) erectile function outcomes are improved by early use of erectogenic medications. This analysis was designed 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) questionnaire 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 nonrandomized study indicate that a pharmacologic penile rehabilitation protocol results in higher rates of spontaneous functional erections and erectogenic drug response after RP.