Immediate post-operative PDE5i therapy improves early erectile function outcomes after robot assisted radical prostatectomy (RARP)

Published on Feb 8, 2021in Journal of Robotic Surgery
· DOI :10.1007/S11701-021-01198-4
Arjun Nathan (University of Cambridge), Shivani Shukla (University of Cambridge)+ 7 AuthorsBenjamin W Lamb1
Estimated H-index: 1
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Abstract
To assess whether the timing of post-operative Phosphodiesterase Inhibitor (PDE5i) therapy after Robot-Assisted Radical Prostatectomy (RARP) is associated with a change in early erectile function (EF) outcomes, continence or safety outcomes. Data were prospectively collected from a single surgeon in one tertiary centre. 158 patients were treated with PDE5i therapy post RARP over a 2-year period. PDE5i therapy was started: immediately (day 1-2) post-op in 29%, early (day 3-14) post-op in 37% and late (after day 14) post-op in 34%. EPIC-26 EF scores were collected pre-op and post-op. There were no significant differences in pre-operative characteristics between the therapy groups. Drop in EF scores and percentage return to baseline for unilateral nerve sparing was, respectively, 9 and 11.1% of immediate therapy, 7 and 14.8% of early therapy and 9.7 and 9.5% of late therapy (p = 0.9 and p = 0.6). For bilateral nerve sparing, this was, respectively, 3.5 and 42.9% immediate therapy, 5.5 and 35.5% early therapy and 7.3 and 25% late therapy (p = 0.017 and p = 0.045). Pad free and social continence were achieved in 54% and 37% of those receiving immediate therapy, 60% and 33% for early therapy and 26% and 54% for late therapy. There were no differences in compliance, complication or readmission outcomes. In patients with bilateral nerve sparing RARP, immediate post-operative PDE5i therapy can protect EF and improve early continence outcomes. Therefore, immediate PDE5i therapy should be considered in patients following nerve sparing RARP to maximise functional outcomes.
References30
Newest
#1A. Nathan (UCL: University College London)H-Index: 1
#2G. Mazzon (UCL: University College London)H-Index: 1
Last. Senthil Nathan (UCL: University College London)H-Index: 12
view all 6 authors...
The incidence of vesicourethral anastomotic stenosis (VUAS) post radical prostatectomy varies from 1 to 26%. Current treatment can be challenging and includes a variety of different procedures. These range from endoscopic dilations to bladder neck reconstruction to urinary diversion. We investigated a 2-stage endoscopic treatment, using the thermo-expandable Memokath®045 bladder neck stent to manage patients with VUAS post radical prostatectomy. We retrospectively reviewed 30 patients, between 2...
5 CitationsSource
#1R. De Groote (UCLH: University College Hospital)H-Index: 1
#2A. Nathan (UCLH: University College Hospital)H-Index: 1
Last. Senthil Nathan (UCLH: University College Hospital)H-Index: 12
view all 9 authors...
Abstract Background Salvage Robot-Assisted Radical Prostatectomy (sRARP) has been described as feasible treatment for the management of localised prostate cancer (PCa) recurrence after primary treatment. However, no large reports have published cancer and quality outcomes. Objective To report perioperative, functional and oncologic outcomes of sRARP in patients with localised PCa recurrence. Design, Setting, and Participants We retrospectively evaluated 106 patients with local recurrence eligibl...
3 CitationsSource
#1Jung Ki Jo (Hanyang University)H-Index: 10
#2Seong Jin Jeong (Seoul National University Bundang Hospital)H-Index: 21
Last. Sang Eun Lee (Seoul National University Bundang Hospital)H-Index: 31
view all 8 authors...
Purpose: It has not been clearly proved in real practice whether early rehabilitation with phosphodiesterase type 5 inhibitors starting immediately after radical prostatectomy improves erectile function recovery more effectively than delayed treatment with the same regimen. We performed a prospective randomized trial to identify this.Materials and Methods: Patients with prostate cancer and an IIEF-5 (International Index of Erectile Function-5) preoperative score of 17 or greater were randomly as...
24 CitationsSource
#1Cesare CozzariniH-Index: 43
#2Tiziana RancatiH-Index: 27
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Abstract Background and purpose Urinary incontinence following radiotherapy (RT) for prostate cancer (PCa) has a relevant impact on patient’s quality of life. The aim of the study was to assess the unknown dose–effect relationship for late patient-reported urinary incontinence (LPRUI). Methods and materials Patients were enrolled within the multi-centric study DUE01. Clinical and dosimetry data including the prescribed 2 Gy equivalent dose (EQD2) were prospectively collected. LPRUI was evaluated...
13 CitationsSource
#1Ashwin Sridhar (UCLH: University College Hospital)H-Index: 14
#2Mohammed Abozaid (UCLH: University College Hospital)H-Index: 1
Last. Tim Briggs (UCLH: University College Hospital)H-Index: 13
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Purpose of Review A variety of different surgical techniques are thought to impact on urinary continence (UC) recovery in patients undergoing robot assisted radical prostatectomy (RARP) for prostate cancer. Herein, we review current evidence and propose a composite evidence-based technique to optimize UC recovery after RARP.
35 CitationsSource
#1Yasuhiro Kaiho (Tohoku University)H-Index: 18
#2Shinichi Yamashita (Tohoku University)H-Index: 14
Last. Yoichi Arai (Tohoku University)H-Index: 62
view all 9 authors...
Purpose To evaluate the effects of phosphodiesterase type 5 inhibitor (PDE5i) on urinary continence recovery after bilateral nerve-sparing radical prostatectomy (BNSRP).
5 CitationsSource
#1Ashwin Sridhar (UCLH: University College Hospital)H-Index: 14
#2Paul Cathcart (St Thomas' Hospital)H-Index: 5
Last. Suks Minhas (UCLH: University College Hospital)H-Index: 29
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Abstract Introduction Recovery of baseline erectile function (EF) after robotic radical prostatectomy in men with high-risk prostate cancer is under-reported. Published studies have selectively reported on low-risk disease using non-validated and poorly defined thresholds for EF recovery. Aim To assess return to baseline EF in men after robotic radical prostatectomy for high-risk prostate cancer. Materials Five hundred thirty-one men underwent robotic radical prostatectomy for high-risk prostate...
22 CitationsSource
#1Gerald B. Brock (UWO: University of Western Ontario)H-Index: 42
#2Francesco Montorsi (UniSR: Vita-Salute San Raffaele University)H-Index: 138
Last. Hartwig BüttnerH-Index: 14
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Objective To report penile integrity measures, including stretched penile length (SPL), from a randomized, double-blind, double-dummy, placebo-controlled trial evaluating treatment with tadalafil initiated after nerve-sparing radical prostatectomy (nsRP). Methods Patients aged ≤68 years were randomized after nsRP 1:1:1 to 9-month double-blind treatment (DBT) with tadalafil 5 mg once daily (OaD), 20-mg tadalafil on-demand (“pro-re-nata”; PRN), or placebo, followed by 6-week drug-free washout and ...
22 CitationsSource
#1Inge Geraerts (Katholieke Universiteit Leuven)H-Index: 16
#2Hendrik Van Poppel (Katholieke Universiteit Leuven)H-Index: 82
Last. Marijke Van Kampen (Katholieke Universiteit Leuven)H-Index: 16
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Abstract Background The efficacy of preoperative pelvic floor muscle training (PFMT) for urinary incontinence (UI) after open radical prostatectomy (ORP) and robot-assisted laparoscopic radical prostatectomy (RARP) is still unclear. Objective To determine whether patients with additional preoperative PFMT regain urinary continence earlier than patients with only postoperative PFMT after ORP and RARP. Design, setting, and participants A randomized controlled trial enrolled 180 men who planned to ...
62 CitationsSource
#1John P. Mulhall (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 79
#2Arthur L. Burnett (Johns Hopkins University)H-Index: 87
Last. Wesley W. DayH-Index: 10
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Purpose: We evaluated the safety and efficacy of 100 and 200 mg avanafil for the treatment of adult males with erectile dysfunction after bilateral nerve sparing radical prostatectomy.Materials and Methods: This was a double-blind, placebo controlled, parallel group, phase 3 study in males age 18 to 70 years with a history of erectile dysfunction of 6 months or more after bilateral nerve sparing radical prostatectomy. Patients were randomized to 100 or 200 mg avanafil or placebo (taken 30 minute...
83 CitationsSource
Cited By1
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#1Sailantra Sivathasan (University of Cambridge)
#2Keval Patel (University of Cambridge)
Last. Benjamin W. Lamb (ARU: Anglia Ruskin University)H-Index: 21
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Surgeons should aim for continuous quality improvement. The aim of this study was to evaluate the impact of incremental changes to Robot Assisted Radical Prostatectomy (RARP) technique on intra-operative and early post-operative outcomes. All cases of RARP performed by a single surgeon in a tertiary institution over a 2-year period were included in this evaluation. Routine clinical data were collected. Cases were retrospectively allocated to four groups depending on key technical steps (1 = stan...
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