Recovery of erectile function after bilateral nervesparing retropubic radical prostatectomy: an italian multicenter study

Objective: To assess erectile function in patients subjected to bilateral nerve-sparing retropubic radical prostatectomy (NSRRP). Materials and methods: We assessed 620 patients subjected to bilateral nerve-sparing retropubic radical prostatectomy in six participating centres from 2003 to 2008. The average period of follow-up was twelve months (range 6-18). Erectile function was assessed by means of the IIEF (International Index Erectile Function) before and subsequently 3, 6, 12 and 18 months after the radical prostatectomy. All patients were prescribed Tadalafil at a dose of 20 mg every 3 days for six months at a distance of one month from the operation. In the event of no erectile response, administration of PGE1 at least once a week was advised. Patients were defined potent if the post-operative IIEF was > 17 and if they were capable of achieving penetration during intercourse with their partner. Results: In the follow-up phase 238 patients out of 620 (38.3%) recuperated their erectile function. 81 out of 238 (34%) presented spontaneous erections; 112 out of 238 (47%) presented drug-assisted (Tadalafil) erections; 45 (18.9)% used intracavernous PGE1s. Erectile function recovery was observed in 73 out of the 238 (30.6%) three months after the operation, in 121 (50.8%) after six months and in 215 (90.3%) after one year. 382 subjects out of the total 620 complained of erectile dysfunction. 273 out of 382 (71.4%) were over 65 years old and 175 out of 382 (45.8%) presented an important comorbidity. 73.5% of the patients took Tadalafil at doses of 20 mg twice/week, 25.1% once/week and 1.6% three times/week. 20% of subjects dropped out within three months after the operation, and 40% within six months. Costs and inefficacy of the rehabilitation protocol were the main causes for drop-out from the study. Conclusions: Bilateral nerve-sparing retropubic radical prostatectomy has had in all a success rate of 38% of the cases. Age younger than 60 years and absence of comorbidity constitute the main predictive factors of erectile recovery. Only 30% of potent patients do not require drug assistance after the nerve-sparing radical prostatectomy. More than 40% of patients drop out of the rehabilitation regime due to elevated costs and inefficacy of the therapy.