Department of Urology, Vita-Salute San Raffaele University, Milan, Italy.
J Sex Med. 2012 Mar;9(3):903-8. doi: 10.1111/j.1743-6109.2011.02622.x. Epub 2012 Jan 12.
Several studies have shown that erectile function (EF) recovery in patients undergoing bilateral nerve sparing radical prostatectomy (BNSRP) improves significantly when phosphodiesterase type 5 inhibitors (PDE5) are administered following surgery.
The aim of this article was to identify patients who may recover EF after retropubic BNSRP (BNSRRP) without PDE5.
We included 293 patients treated with BNSRRP at a single center. Postoperative EF recovery was defined as an EF domain score of the International Index of Erectile Function (IIEF) ≥22. No patient received any treatment for postoperative erectile dysfunction (ED). Kaplan-Meier curves assessed time to EF recovery according to patient age, preoperative EF, and Charlson comorbidity index (CCI). Univariable and multivariable Cox regression models tested the association between predictors and EF recovery. Finally, the rate of EF recovery of untreated patients after BNSRP was compared with a subset of patients with similar preoperative characteristics but receiving PDE5.
The main outcome measure of this article was the IIEF-EF domain score.
Overall, 105/293 (35.8%) reached an IIEF-EF ≥22 after a mean follow-up of 26.8 months. At multivariable analyses, age, preoperative IIEF-EF, and CCI achieved independent predictor status (all P≤0.04). Patients <55 years had a 72.4% EF recovery rate compared with 30% of patients >70 years (P<0.001). Similarly, preoperatively fully potent patients (IIEF-EF ≥26) had a 56.6% chance of recovering EF after surgery compared with 18% of patients with severe ED before surgery (P<0.001). The rate of EF recovery in untreated patients <55 years and with a pre-op IIEF-EF ≥22 was higher but did not differ significantly from comparable patients receiving PDE5 (P=0.11).
Overall, the rate of EF postoperative recovery in patients left untreated after surgery is modest (35.8%). Although younger patients with a good preoperative EF may experience good EF recovery rates even without any treatment, use of PDE5 after surgery further improved their functional outcomes. Therefore, a therapy for ED should be offered to all patients treated with BNSRP.
多项研究表明，接受双侧神经保留根治性前列腺切除术（BNSRP）的患者在手术后使用磷酸二酯酶 5 抑制剂（PDE5）可显著改善勃起功能（EF）恢复。
本文旨在确定接受耻骨后 BNSRRP（BNSRRP）后可能不使用 PDE5 恢复 EF 的患者。
我们纳入了在一家中心接受 BNSRRP 治疗的 293 例患者。术后 EF 恢复定义为国际勃起功能指数（IIEF）EF 域评分≥22。没有患者接受任何治疗术后勃起功能障碍（ED）。Kaplan-Meier 曲线根据患者年龄、术前 EF 和 Charlson 合并症指数（CCI）评估 EF 恢复时间。单变量和多变量 Cox 回归模型测试了预测因素与 EF 恢复之间的关系。最后，比较了未接受治疗的 BNSRP 患者的 EF 恢复率与具有相似术前特征但接受 PDE5 的患者子集。
本文的主要观察指标是 IIEF-EF 域评分。
总体而言，在平均随访 26.8 个月后，293 例患者中有 105 例（35.8%）达到 IIEF-EF≥22。在多变量分析中，年龄、术前 IIEF-EF 和 CCI 达到独立预测因素状态（均 P≤0.04）。<55 岁的患者 EF 恢复率为 72.4%，而>70 岁的患者为 30%（P<0.001）。同样，术前完全有效的患者（IIEF-EF≥26）术后 EF 恢复的可能性为 56.6%，而术前严重 ED 的患者为 18%（P<0.001）。未接受治疗的<55 岁且术前 IIEF-EF≥22 的患者 EF 恢复率较高，但与接受 PDE5 的可比患者无显著差异（P=0.11）。
总体而言，手术后未接受治疗的患者的 EF 术后恢复率适中（35.8%）。尽管术前 EF 良好的年轻患者即使不接受任何治疗也可能获得良好的 EF 恢复率，但手术后使用 PDE5 可进一步改善他们的功能结局。因此，应向所有接受 BNSRRP 治疗的患者提供 ED 治疗。
