PDE-5 inhibitors should be used post radical prostatectomy as erection function rehabilitation? Opinion: Yes

Despite significant improvement in surgical techniques of radical prostatectomy (RP) since the nerve-sparing approach was introduced in 1982 (1), erectile dysfunction (ED) post RP remains a challenge for patients and urologists (2). Although most patients experience some degree of ED post RP, erectile function recovery rates vary according to age, baseline erectile function, comorbidities, and extent of nerve-sparing techniques (3, 4). The concept of penile rehabilitation has been evolving over the last two decades, in parallel with a better understanding of the basic scientific basis for ED post RP. In a recent systematic review of 11 randomized, controlled clinical trials (RCTs) on erection rehabilitation post RP in general, there was no significant improvement in spontaneous erectile function (unassisted by erection aids) rate of 20-25%. This rate was obtained from data in the control arm of trials after nerve sparing radical prostatectomy (NSRP) over the last two decades (5). Phosphodiesterase phosphate-5 inhibitors (PDE5I) are the first line therapeutic option for organic ED, including ED post RP. In some studies, unassisted erectile function preoperatively was associated with preserved potency post RP in 94% of cases, but self-reported return to baseline erectile function status was shown in less than 40% and 23% of patients with and without the use of PDE5I, respectively (6). The plausible hypothesis for the use of PDE5I in erection rehabilitation after RP has been investigated in multiple randomized, controlled trials. Although there is no consensus on the definition or algorithm for erection rehabilitation, a multidisciplinary approach addressing general and psychological well-being of patients and their partners, in addition to medical therapeutic options, would facilitate sexual function recovery post RP, including erectile function. DIffERENCE Of OPINION