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2008 Annual Meeting Abstracts
A Prospective Concurrent Longitudinal Study Of The Return Of Erectile Function After Robotic And Open Prostatectomy From A Penile Rehabilitation Study Of Nightly Intraurethral Alprostadil Vs. Sildenafil
Jason D. Engel1, Elias S. Hyams2, Artrit Bytyci2, Brianne Goodwin*2, Kristofer R. Wagner3, Herbert Lepor2, Samir Taneja2, Andrew McCullough2
1George Washington University, Washington, DC;2New York University, New York, NY;3Scott & White Health Care System, Texas A&M Health Sciences Center, Temple, TX
Introduction: We present the preliminary results of the first prospective, bi-institutional, concurrent, comparative study of erectile function recovery after robot assisted prostatectomy (RAP) vs. radical retropubic prostatectomy (RRP) as part of a penile rehabilitation protocol.
Methods:
An ongoing multi-center randomized prospective comparative study of nightly intraurethral alprostadil (IUA) vs. oral sildenafil (SC) on patients undergoing RRP and RAP was reviewed. Patients were randomized 2:1 to IUA:SC. IIEF-30 scores were assessed at 1 week, 3, 6, 9 and 11 months.
Results:
Overall, 207 patients were enrolled and 51 pts withdrew (25%). Bilateral cavernous nerve sparing was performed in 100% of RAP patients (GWU) and 90% of RRP patients (NYU). Mean age and baseline IIEF did not differ significantly between sites. No significant differences were observed in IIEF scores after 1 week postoperatively, percentage of patients returning to baseline IIEF at 9 month (11 vs. 17%), or in IIEF scores for unilateral and bilateral nerve dissection between the two groups. Intercourse success rates were almost 40% greater in the first 6 months in the IUA group.
Conclusion:There are comparable acute declines in erectile function post-operatively between RAP and RRP patients, and no significant differences in the normalization of function between either RAP or RRP through nine month follow-up. IUA allowed higher intercourse success in the first 6 months.
Differences in IIEF scores between RRP and RAP. | RRP | RAP | p value | | Preoperative Baseline | 29.0 | 29.1 | >0.5 | | 1 week postop | 1.87 | 3.42 | <0.0001 | | 3 months postop | 10.6 | 9.2 | >0.5 | | 6 months postop | 11.2 | 11.1 | >0.5 | | 9 months postop | 13.4 | 13.6 | >0.5 |
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