Effect of penile rehabilitation on erectile function after bilateral nerve-sparing robotic-assisted radical prostatectomy

Introduction. Penile rehabilitation has been regards as a standard after radical prostatectomy. However, the REINVENT study recently demonstrated that the use of nightly PDE-5 inhibitors failed to increase the potency recovery after. Methods. We collected prospectively the clinical records of all patients who underwent robot-assisted radical prostatectomy for clinically localized prostate cancer at the University of Padua. For the present study, we extracted all consecutive cases receiving a bilateral nerve-sparing technique with a minimum follow-up ≥ 12 months. Results. Penile rehabilitation was performed in 151 patients (66%) of 229 patients. Twelve months after bilateral nerve-sparing robot-assisted radical prostatectomy, 142 patients (62%) were potent. The median time to recovery of erectile function was 6 months (IQR: 2.5-11). Specifically, age (hazard ratio [HR]: 1.093; p < 0.001), Charlson score (HR: 0.863; p = 0.003), baseline IIEF-6 score (HR: 0.954; p < 0.001), and penile rehabilitation (HR: 0.800; p = 0.018) were predictors of erectile function recovery in univariable analysis. In multivariable analysis, penile rehabilitation did not retain an independent predictive role (HR: 1.663; p = 0.188), once adjusted for the effect of age (HR: 1.048; p = 0.005), and baseline IIEF-6 score (HR: 0.803; p < 0.001) Conclusions. About 60% of the patients were potent 12-mo after underwent robot-assisted radical prostatectomy series. Patients age and preoperative erectile function were the most powerful predictor of erectile function recovery. Adoption of postoperative rehabilitation was not significantly associated with improved postoperative erectile function, once adjusted for the effect of the other covariates.