Recovering Penile Length and Erectile Function Following Radical Prostatectomy

Huber, N; Wood C., Babian, R; Madsen, L; Shen, Y; Wen, s; Wang, R

The Journal of Sexual Medicine Volume 3, Supplement 1, 2006

Vacuum Therapy, in conjunction with other ED treatments, can help men rehabilitate penile function after Radical Prostatectomy. Ed is a common side effect of a radical prostatectomy but can be minimized with prescribed penile rehabilitation.

Objects
Erectile dysfunction and decreased penile length are commonly reported side effects of radical prostatectomy. The prospective study was designed to evaluate the efficacy of penile rehabilitation for restoration of penile length and sexual functioning following unilateral nerve-sparing prostatectomy.

Materials and Methods
A total of 65 men ranging in age from 42-65 (mean 56, median age 57) were enrolled in this randomized prospective study with unilateral nerve-sparing prostatectomy with or without unilateral sural nerve grafting performed at the time of surgery. Penile rehabilitation was initiated six weeks post-operatively consisting of daily use of the vacuum erection device (VED), biweekly intracavernosal injection (ICI), and patient-directed use of sildenafil. Penile length was measured preoperatively, six weeks post-operatively, and at four month intervals after surgery for up to two years. A recent interim analysis of the data was completed. 39 patients were evaluated for return of erectile dysfunction and penile length. Fisher's test was used to test the difference between potency rates in the two groups.

Results
Of the 39 patients included in this report, 25 received unilateral sural nerve grafting and unilateral nerve-sparing prostatectomy. 14 patients received a unilateral nerve-sparing prostatectomy alone. The potency rates were measured by positive response to SEP question #2 and #3. The measured potency rate was 72% for the patients receiving sural nerve graft and 71% for patients receiving nerve sparing alone. The potency function rates between the two arms was not significant (p=0.969), which did not exceed the protocol-defined stopping boundary. Thus, there is no early efficacy observed for sural nerve grafting up to this analysis. However, the potency rates for the patients receiving unilateral nerve sparing alone are significantly better than previously reported patient cohorts. 33 of the 39 patients had 12-month follow-up penile length measurements. Patients who demonstrated return of erectile function had a significant improvement in penile length compared to 6 weeks postoperative (P<0.5). The mean improvement in penile length for patients who were potent was 1.2 cm. Patients who had not regained erectile function showed an increase of 0.2cm.

Conclusions
This study shows the value of a prescribed, programmed penile rehabilitation for patients following nerve sparing radical prostatectomy. Men should be counseled regarding the need for early penile rehabilitation following radical prostatectomy in order to regain penile length and restore normal function.