Penile rehabilitation protocol after robot-assisted radical prostatectomy: Assessment of compliance with phosphodiesterase type 5 inhibitor therapy and effect on early potency

Daniel J. Lee, Philippa Cheetham, Ketan K. Badani

Research output: Contribution to journalArticlepeer-review

28 Scopus citations

Abstract

Objective: To evaluate factors that affect compliance in men who enrol in a phosphodiesterase type 5 inhibitor (PDE5I) protocol after nerve-sparing robot-assisted prostatectomy (RAP), and report on short-term outcomes, as PDE5Is may help restore erectile function after RAP and patient adherence to the regimen is a factor that potentially can affect outcome. PATIENT AND METHODS We prospectively followed 77 men who had nerve-sparing RAP and enrolled in a postoperative penile rehabilitation protocol. The men received either sildenafil citrate or tadalafil three times weekly. The minimum follow-up was 8 weeks. Potency was defined as erection adequate for penetration and complete intercourse. Compliance was defined as men adhering to the regimen for ≥2 months. Results: The mean age of the cohort was 57.8 years and the median follow-up was 8 months. In all, 32% of the men discontinued the therapy <2 months after RAP and were deemed noncompliant with an additional 39% discontinuing therapy by 6 months, with the high cost of medication being the primary reason (65%). Long-term compliance and preoperative erectile dysfunction were independent predictors of potency return after adjusting for age and nerve sparing. Conclusion:s: The high cost of medication remains a significant barrier to maintaining therapy. Noncompliance to PDE5I therapy in a tertiary care centre was much higher than reported in clinical trial settings. With longer-term follow-up, we need to further define the factors that improve overall recovery of sexual function after RAP.

Original languageEnglish
Pages (from-to)382-388
Number of pages7
JournalBJU International
Volume105
Issue number3
DOIs
StatePublished - Feb 2010
Externally publishedYes

Keywords

  • Phosphodiesterase 5 inhibitor compliance
  • Prostate cancer
  • Robot-assisted prostatectomy

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