What is the best strategy for erectile function recovery after radical prostatectomy?

Treatment with 100-mg sildenafil appears to be the best strategy to improve erectile function recovery rates after radical prostatectomy, suggests a study. However, the on-demand dose of phosphodiesterase-5 (PDE5) inhibitors does not appear to be any better than placebo and must therefore not be considered as a penile rehabilitation strategy.

The investigators systematically searched the databases of PubMed and Web of Science according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) extension statement for network meta-analysis. They identified studies comparing the erectile function recovery rate and adverse events between penile rehabilitation treatment groups (eg, medications, devices, and actions) and control group. The Bayesian approach was used in the network meta-analysis.

Twenty-two studies encompassing 2,711 patients were eligible for analysis. Out of 16 different penile rehabilitation strategies and schedules compared with placebo, only pelvic floor muscle training (odds ratio [OR], 5.21, 95 percent credible interval [CrI], 1.24–29.8) and sildenafil 100 mg regular dose (ie, once daily or nightly; OR, 4.00, 95 percent CrI, 1.40–13.4) correlated with a significantly higher likelihood of erectile function recovery.

The certainty of results was moderate for 100-mg sildenafil regular dose was moderate and low for pelvic floor muscle training. In sensitivity analysis, the regular high dose of PDE5 inhibitors regardless of type vs placebo (OR, 2.09, 95 percent CrI, 1.06–4.17) correlated with a significantly higher likelihood of erectile function recovery with a moderate certainty. The on-demand doses of PDE5 inhibitors, however, were not more beneficial than placebo.

Secondary outcomes such as adverse events (AEs) were not analysed due to incomplete data in the literature, but no serious AEs were reported in any of the studies.

“Although pelvic floor muscle training has been shown to be effective in increasing the erectile function recovery rate, well designed randomized controlled trials with larger sample sizes are needed to confirm the presented early results,” the investigators said.