Systematic Review and Meta-Analysis of the Use of Phosphodiesterase Type 5 Inhibitors for Treatment of Erectile Dysfunction following Bilateral Nerve-Sparing Radical Prostatectomy

Radical prostatectomy remains the gold-standard treatment for localised prostate cancer. Despite the widespread introduction of nerve-sparing techniques, post-operative erectile dysfunction (ED) is still a significant source of morbidity. There are multiple approaches to prevent and treat ED. Recent refinements to surgical technique attempt to minimise disruption to the prostatic neural and arterial supply. A greater understanding of the factors affecting ED has also enabled the first multi-variate risk stratification model, thereby potentially improving awareness of pre-operative risk. Numerous on-demand treatments are available, including phosphodiesterase type 5 inhibitors, intracavernous/transurethral alprostadil, vacuum erection devices and combination therapy with multiple agents. As our understanding of the aetiology improves, attempts to manipulate the molecular mechanisms underpinning ED are also being investigated. In addition, early pharmacological rehabilitation is used to preserve cavernosal smooth muscle function until intra-operative neurapraxia resolves, although the optimum regimen is yet to be defined. Currently, much work is ongoing to improve our understanding and treatment of post-prostatectomy ED. We review the current status and recent advances in this field.

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Re: Comparative Effectiveness and Safety of Oral Phosphodiesterase Type 5 Inhibitors for Erectile Dysfunction: A Systematic Review and Network Meta-Analysis

The Journal of Urology ◽

10.1016/j.juro.2013.06.077 ◽

2013 ◽

Vol 190 (4) ◽

pp. 1340-1341 ◽

Cited By ~ 1

Author(s):

Allen Seftel

Keyword(s):

Systematic Review ◽

Erectile Dysfunction ◽

Comparative Effectiveness ◽

Meta Analysis ◽

Phosphodiesterase Type 5 Inhibitors ◽

Phosphodiesterase Type

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Penile Rehabilitation and Treatment Options for Erectile Dysfunction Following Radical Prostatectomy and Radiotherapy: A Systematic Review

Frontiers in Surgery ◽

10.3389/fsurg.2021.636974 ◽

2021 ◽

Vol 8 ◽

Author(s):

Melianthe Nicolai ◽

Ahmet Urkmez ◽

Selcuk Sarikaya ◽

Mikkel Fode ◽

Marco Falcone ◽

...

Keyword(s):

Systematic Review ◽

Erectile Dysfunction ◽

Radical Prostatectomy ◽

Animal Studies ◽

Structural Changes ◽

Treatment Options ◽

Nerve Sparing ◽

Phosphodiesterase Type 5 Inhibitors ◽

Pelvic Floor Training ◽

Penile Rehabilitation

After radical prostatectomy (RP) or radiotherapy (RT) for prostate cancer, erectile dysfunction (ED) is the main complication next to urinary incontinence, affecting quality of life. The pathophysiology of ED after these treatments is believed to include neuropraxia causing reduced oxygenation and structural changes of the tissue in the corpora cavernosa. Next to the option of sparing the nerves during RP, research has been focusing on methods for penile rehabilitation after RP and RT, since it occurs often, even after nerve-sparing techniques were used. In animal studies, the use of phosphodiesterase type 5 inhibitors (PDE5i) after cavernous nerve damage is supported, but results in human studies are contradictory. Non-medical treatment options such as vacuum device therapy, hyperbaric oxygen therapy, yoga, aerobic, or pelvic floor training may be helpful, but evidence is scarce. Clear guidelines for penile rehabilitation are not yet available. However, care and support for ED after RP and RT is highly demanded by a large group of patients, so measures have to be taken even though the evidence is not strong yet. In this systematic review, an overview of the literature for penile rehabilitation and treatment options for ED after RP and RT is provided, using only randomized controlled trials (RCT).

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