Optimization of sexual function outcome after radical prostatectomy using phosphodiesterase type 5 inhibitors

  Erectile dysfunction after radical prostatectomy is a major complication affecting postoperative quality of life. For early recovery from postoperative erectile dysfunction, attention has focused on penile rehabilitation using vacuum devices, prostaglandin E 1 injection into the corpus cavernosum of the penis or transurethral administration, and oral drugs such as phosphodiesterase type 5 inhibitors. Phosphodiesterase type 5 inhibitors have been used clinically based on the results of animal experiments that showed a preventive effect on fibrosis and loss of intracorporeal smooth muscle. Small randomized studies had reported a benefit from penile rehabilitation using phosphodiesterase type 5 inhibitors after radical prostatectomy. However, the largest trial to date, carried out in 2008, failed to show that daily phosphodiesterase type 5 inhibitor treatment was superior to on‐demand phosphodiesterase type 5 inhibitor treatment for erectile function recovery after radical prostatectomy. Thus, debate continues as to its efficacy in humans. Reports on penile rehabilitation using phosphodiesterase type 5 inhibitors have appeared after these negative results, and phosphodiesterase type 5 inhibitors are still widely used as first‐line treatment in penile rehabilitation.