Early versus late rehabilitation of erectile function after nerve-sparing radical cystoprostatectomy: a prospective randomized study

ABSTRACT

To assess the value of early rehabilitation in patients who underwent nerve-sparing radical cystoprostatectomy based on a prospective randomized trial. Between March 2003 and March 2005, Twenty one patients underwent nerve-sparing [NS] cystoprostatectomy. Preoperative sexual Junction of all patients was evaluated by International Index of Erectile function questionnaire [IIEF] and penile Duplex ultrasound [PDU]. Patients who did not recover spontaneous erection at the 2[nd] month postoperatively were randomly divided into 2 groups; Group [1] received the erectogenic therapy at the 2[nd] month postoperatively and group [2] started it at the 6[th]- month. The pharmacological therapy constitutes of sildenafil citrate 50mg twice weekly to be increased to 100mg if the patients did not obtained an adequate response. If this regimen failed we shifted to ICI of PGEI. The treatment continued for 6 months in both groups. The erectile function status was evaluated at the end of the treatment program by IIEF questionnaire and PDU. Three patients [14%] regained their spontaneous erection within 2 months postoperatively and the remaining 18 were divided randomly into two groups. Six out of nine [66.7%] patients recovered unassisted erection after treatment in the first group compared to 3 out of 9 [33.3%] patients in the second group. Two patients in the first group and 3 patients in the second group still needed sildenafil therapy on demand basis. The remaining 4 patients are still using ICI of PGEI on demand. 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 patients in the early rehabilitation group compared with those in late rehabilitation group. Regarding PDU findings, significant improvement in EDV was elicited in the early rehabilitation group compared with the pretreatment value [p=0.03]; however, this was not translated into a significant difference between both groups. Early rehabilitation provides good and rapid recovery of erectile function in patients managed by nerve-sparing radical cystoprostatectomy