Editorial Comment from Dr Hinata to Impact of penile rehabilitation with phosphodiesterase‐5 inhibitors on recovery of erectile function in patients undergoing robot‐assisted radical prostatectomy: A propensity score‐matched analysis

Abstract

Despite efforts to preserve the neurovascular bundles with nerve sparing surgery, erectile dysfunction remains common following radical prostatectomy. Postoperative penile rehabilitation seeks to restore erectile function, but results have been conflicting. Efforts to evaluate the effects of penile rehabilitation strategies in restoring erectile function after radical prostatectomy for prostate cancer, therefore, have already been undertaken and conclusions have been reported. Compared with placebo or no treatment for men with postprostatectomy erectile dysfunction, scheduled phosphodiesterase-5 (PDE5) inhibitors appear to have little to no effect on shortterm (up to 11 months) self-reported potency and erectile function, but may result in fewer serious adverse events compared with placebo (23 vs 71 per 1000 men). As a result, for men with postprostatectomy erectile dysfunction, scheduled PDE5 inhibitors have been reported to have little to no effect on erectile function compared with no treatment in Cochrane Library. By contrast, the present study by Kimura et al. shows that penile rehabilitation with tadalafil after robotassisted radical prostatectomy improved erectile function and also improved erectile function after partial nerve sparing in Japanese patients. This study moves the efficacy of penile rehabilitation another step forward in terms of erectile function recovery in Asian patients. In addition to robust data on long-term follow-up, which are still needed, the study could be further improved if the authors adopt 1:1.5 or 1:2 matching in the future, as in a previous report. However, this study presents novel findings in postoperative erectile function recovery in Asian patients. The subject matter of this work is laudable and of interest to the Asian prostate cancer community.