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Volume 24, Issue 5 (September 2022) 24, 473–477; 10.4103/aja202189

A prospective randomized controlled study on scheduled PDE5i and vacuum erectile devices in the treatment of erectile dysfunction after nerve sparing prostatectomy

Ming Zhang1, Ji-Zhong Che2, Yi-Dong Liu1, Hong-Xiang Wang1, Yan-Ping Huang1, Xiang-Guo Lv1, Wei Liu1, Mu-Jun Lu1

1 Department of Urology and Andrology, Shanghai Institute of Andrology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China
2 Department of Urology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai 264100, China

Correspondence: Dr. MJ Lu (lumujun@163.com) or Dr. W Liu (nickliu2k@163.com)

Date of Submission 29-May-2021 Date of Acceptance 25-Oct-2021 Date of Web Publication 28-Dec-2021


Cavernous nerve injury is an important cause of erectile dysfunction (ED). Although protective nerve technology has been widely used in nerve-sparing radical prostatectomy (nsRP), the incidence of ED is still very high after surgery. The purpose of our study was to evaluate erectile function (EF) and penile length in the non-erectile state (PLNES) following scheduled phosphodiesterase 5 inhibitor (PDE5i), vacuum erectile device (VED) treatment, and combination therapy after nsRP. One hundred patients with localized prostate cancer and normal EF were randomized to scheduled PDE5i group, VED treatment group, a combined treatment group, and the control group without any intervention. The International Index of Erectile Function-5 (IIEF-5) scores and PLNES were evaluated after 6 months and 12 months of treatment. Sexual Encounter Profile (SEP-Question 2 and SEP-Question 3) were evaluated after 12 months of treatment. Ninety-one of the 100 randomized patients completed the study. We found that the 5 mg tadalafil once a day (OaD) combined with VED can help improve IIEF-5 scores in nsRP patients after both 6 months and 12 months. VED alone or combined with tadalafil OaD can help patients maintain PLNES. VED combined with tadalafil OaD can improve the rate of successful penetration (SEP-Question 2) after 12 months. There were no significant differences in the return to target EF after 12 months among the groups. No significant correlation was noted between the variables and return to target EF (IIEF ≥ 17), and between the variables and effective shortening of the patient's penis (shortening ≥ 1 cm) after 12 months of intervention.

Keywords: erectile dysfunction; nerve-sparing radical prostatectomy; penile length; tadalafil; vacuum erectile devices

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