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Efficacy of a preprostatectomy multi-modal penile rehabilitation regimen on recovery of postoperative erectile function

International Journal of Impotence Research volume 32, pages 323–328 (2020)Cite this article

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Abstract

To evaluate the efficacy of a novel, multi-modal, preoperative approach to postprostatectomy penile rehabilitation (PR), we performed a retrospective review of patients who underwent nerve-sparing robotic-assisted laparoscopic prostatectomy (NS-RALP). All patients were evaluated at a comprehensive, academic sexual medicine clinic between 2016 and 2017. The “prehabilitation” PR group (n = 106) consisted of men who were seen in the pre-op period and began tadalafil and l-citrulline 2 weeks prior to surgery. Vacuum erectile device (VED) therapy was started at 1-month post-op. These interventions were continued throughout the 12-month follow-up period. Individuals refractory to these therapies could start treatment with intracavernosal injections. The postprostatectomy PR group (n = 25) consisted of men who were not seen in the pre-op period and started the above therapies immediately following their first visit. A higher percentage of men in the prehabilitation group reported return of erectile function within 12 months (56% vs. 24%, P = 0.007). The prehabilitation group also showed better compliance with PR (PDE5i [96% vs. 64%, P < 0.001], l-citrulline [93% vs. 49%, P < 0.001], and VED [55% vs. 20%, P < 0.001]). Seventy-eight percent of men who attended 4–5 follow-up visits reported return of erectile function. Our results suggest that men undergoing a preoperative protocol show superior recovery of erectile function following NS-RALP. Further studies with prospective designs are warranted.

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Authors and Affiliations

  1. Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Vadim Osadchiy, Sriram V. Eleswarapu, Steven A. Mills, Matthew E. Pollard, Robert E. Reiter & Jesse N. Mills

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  1. Vadim Osadchiy
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  2. Sriram V. Eleswarapu
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  3. Steven A. Mills
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Correspondence to Jesse N. Mills.

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Osadchiy, V., Eleswarapu, S.V., Mills, S.A. et al. Efficacy of a preprostatectomy multi-modal penile rehabilitation regimen on recovery of postoperative erectile function. Int J Impot Res 32, 323–328 (2020). https://doi.org/10.1038/s41443-019-0187-y

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