Recovery of Baseline Erectile Function in Men Following Radical Prostatectomy for High-Risk Prostate Cancer: A Prospective Analysis Using Validated Measures

J Sex Med. 2016 Mar;13(3):435-43. doi: 10.1016/j.jsxm.2016.01.005.


Introduction: Recovery of baseline erectile function (EF) after robotic radical prostatectomy in men with high-risk prostate cancer is under-reported. Published studies have selectively reported on low-risk disease using non-validated and poorly defined thresholds for EF recovery.

Aim: To assess return to baseline EF in men after robotic radical prostatectomy for high-risk prostate cancer.

Materials: Five hundred thirty-one men underwent robotic radical prostatectomy for high-risk prostate cancer from February 2010 through July 2014. Pre- and postoperative EF was prospectively assessed using the International Index of Erectile Dysfunction (IIEF-5) questionnaire. Multivariate logistic regression analysis determined the effect of age, preoperative function, comorbidities, body mass index, prostate-specific antigen level, cancer stage or grade, nerve-sparing status, adjuvant therapy, and continence on EF return (defined as postoperative return to baseline EF with or without use of phosphodiesterase type 5 inhibitors). Kaplan-Meier analysis and log-rank test were used to analyze return over time. Mann-Whitney U-test was used to compare IIEF-5 scores.

Main outcome measures: Pre- and postoperative EF was assessed using the IIEF-5 Sexual Health Inventory for Men at 3 months, 6 months, 1 year, 2 years, 3 years, and 4 years postoperatively.

Results: Overall, return of EF was seen in 23.5% of patients at 18 months. This was significantly increased in men no older than 60 years (P = .024), with a preoperative IIEF-5 score of at least 22 (P = .042), and after undergoing neurovascular bundle preservation (34.9% of patients, P < .001). There was no significant change in IIEF-5 scores from 3 to 36 months in patients who were treated with phosphodiesterase type 5 inhibitors in the non-neurovascular bundle preservation group (P = .87), although there was significant improvement in those receiving second- or third-line therapies (P = .042). Other than preoperative hypertension (P = .03), none of the other comorbidities predicted return of EF.

Conclusion: In this study, 23.5% of men recovered to baseline EF. Of those who underwent bilateral neurovascular bundle preservation robotic radical prostatectomy, 70% recovered baseline EF; however, this accounted for only 9.6% of all patients. Only 4% of men who underwent non-neurovascular bundle preservation had baseline recovery with phosphodiesterase type 5 inhibitors up to 36 months. There was significant improvement after use of second- or third-line therapies, indicating the need for earlier institution of these treatment modalities.

Keywords: Counseling; Erectile Dysfunction; Prostatectomy; Prostatic Neoplasm; Recovery of Function; Robotic.

MeSH terms

  • Adult
  • Aged
  • Biomarkers, Tumor / blood
  • Erectile Dysfunction / etiology
  • Erectile Dysfunction / physiopathology*
  • Erectile Dysfunction / psychology
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Penile Erection / drug effects
  • Penile Erection / physiology*
  • Phosphodiesterase 5 Inhibitors / pharmacology
  • Postoperative Period
  • Preoperative Period
  • Prospective Studies
  • Prostate-Specific Antigen / blood
  • Prostatectomy* / adverse effects
  • Prostatic Neoplasms / blood
  • Prostatic Neoplasms / physiopathology*
  • Prostatic Neoplasms / surgery*
  • Recovery of Function
  • Robotic Surgical Procedures* / adverse effects
  • Surveys and Questionnaires
  • Time Factors


  • Biomarkers, Tumor
  • Phosphodiesterase 5 Inhibitors
  • Prostate-Specific Antigen