Abstract

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• INTRODUCTION:

  Treatment of erectile dysfunction (ED) subsequent to bilateral nerve sparing robotic prostatectomy (BNSRP) with tadalafil plus a vacuum erection device (VED) may improve return of sexual function.

  MATERIALS AND METHODS:

  Men with prostate cancer who had BNSRP were randomized to receive tadalafil, 20 mg three times weekly, or tadalafil plus a VED, 10 minutes unbanded per day for at least 5 days weekly. Treatments started 1 month after surgery; clinic visits were at 1, 3, 6, 9 and 12 months. Patients were requested to attempt intercourse at least twice before each visit. At every visit patients completed the International Index of Erectile Function (IIEF-5) questionnaire and a penile hardness scale (1-4) and were questioned as to their ability to have vaginal penetration and intercourse to orgasm.

  RESULTS:

  Thirteen men started the combination regimen, and there were no dropouts; 10 patients started the tadalafil treatment, and three men dropped out. The mean IIEF-5 at months 6, 9 and 12 were significantly higher for the combination group, while the penile hardness scores were significantly greater for the combination group at 6 and 9 months. After 12 months 92% of combination patients responded yes to the vaginal penetration question versus 57% of the tadalafil group; corresponding figures were 92% and 29%, respectively, for intercourse to orgasm. Compliance to the VED was superior to that of tadalafil.

  CONCLUSION:

  Men with ED subsequent to BNSRP had a more rapid and complete return of sexual function when treated with tadalafil plus VED versus tadalafil alone.