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Penile rehabilitation protocol after robot‐assisted radical prostatectomy: assessment of compliance with phosphodiesterase type 5 inhibitor therapy and effect on early potency
Author(s) -
Lee Daniel J.,
Cheetham Philippa,
Badani Ketan K.
Publication year - 2010
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2009.08820.x
Subject(s) - medicine , erectile dysfunction , regimen , tadalafil , prostatectomy , rehabilitation , surgery , cohort , physical therapy , sildenafil , urology , prostate , cancer
Study Type – Therapy (case series)
Level of Evidence 4 OBJECTIVE To evaluate factors that affect compliance in men who enrol in a phosphodiesterase type 5 inhibitor (PDE5I) protocol after nerve‐sparing robot‐assisted prostatectomy (RAP), and report on short‐term outcomes, as PDE5Is may help restore erectile function after RAP and patient adherence to the regimen is a factor that potentially can affect outcome. PATIENT AND METHODS We prospectively followed 77 men who had nerve‐sparing RAP and enrolled in a postoperative penile rehabilitation protocol. The men received either sildenafil citrate or tadalafil three times weekly. The minimum follow‐up was 8 weeks. Potency was defined as erection adequate for penetration and complete intercourse. Compliance was defined as men adhering to the regimen for ≥2 months. RESULTS The mean age of the cohort was 57.8 years and the median follow‐up was 8 months. In all, 32% of the men discontinued the therapy <2 months after RAP and were deemed noncompliant with an additional 39% discontinuing therapy by 6 months, with the high cost of medication being the primary reason (65%). Long‐term compliance and preoperative erectile dysfunction were independent predictors of potency return after adjusting for age and nerve sparing. CONCLUSIONS The high cost of medication remains a significant barrier to maintaining therapy. Noncompliance to PDE5I therapy in a tertiary care centre was much higher than reported in clinical trial settings. With longer‐term follow‐up, we need to further define the factors that improve overall recovery of sexual function after RAP.