EVALUATION OF COMBINED PHARMACOLOGIC TREATMENT INVOLVING TADALAFIL AND ALPROSTADIL INTRAURETHRAL GEL FOR PENILE REHABILITATION AFTER RADICAL PROSTATECTOMY

Abstract

Radical prostatectomy is considered the safest oncological treatment for localized prostate cancer. But although the surgical technique has been improved in the last four decades the main postoperative complications for patients who undergo this operation are erectile dysfunction and urinary incontinence. The objective of the study was to compare the effect of tadalafil 5 mg once a day as monotherapy to tadalafil 5 mg once a day associated with alprostadil gel on-demand as postoperative penile rehabilitation in patients that underwent open or laparoscopic radical prostatectomy. It was conducted an open-label prospective nonrandomized interventional study in which we have enrolled a total number of 111 patients diagnosed with prostate cancer that underwent radical prostatectomy. Nerve sparring technique was performed selectively according to oncological indication. For the assessment of the sexual status of prostate cancer patients, we used the SHIM questionnaire both before and after surgery: immediately after urethral catheter removal, at 3 and 6 months postoperative. Based on the postoperative results of SHIM score and the treatment option for erectile dysfunction we have classified our patients in two groups: tadalafil 5 mg group (n = 56) and tadalafil 5 mg associated with alprostadil gel (n = 55). The study demonstrated the efficacy and safety of PDE5i and PGE1 combined therapy effects compared to PDE5i monotherapy for the treatment of postoperative erectile disfunction. In this regard, we can affirm that the association of Tadalafil 5 mg once a day and Alprostadil gel on-demand can increase by 10 folds the chance of erectile function recovery after prostatectomy. Also, the combined effect of PDE5i and PGE1 could be enhanced if the laparoscopic approach is preferred over the open approach and nerve bundle preservation is performed at least unilateral.