Effect of Starting Penile Rehabilitation with Sildenafil Immediately after Robot-Assisted Laparoscopic Radical Prostatectomy on Erectile Function Recovery: A Prospective Randomized Trial

J Urol. 2018 Jun;199(6):1600-1606. doi: 10.1016/j.juro.2017.12.060. Epub 2018 Jan 4.


Purpose: It has not been clearly proved in real practice whether early rehabilitation with phosphodiesterase type 5 inhibitors starting immediately after radical prostatectomy improves erectile function recovery more effectively than delayed treatment with the same regimen. We performed a prospective randomized trial to identify this.

Materials and methods: Patients with prostate cancer and an IIEF-5 (International Index of Erectile Function-5) preoperative score of 17 or greater were randomly assigned to receive sildenafil 100 mg regularly twice per week for 3 months immediately after urethral catheter removal as the early group or only 3 months after nerve sparing robot-assisted laparoscopic radical prostatectomy as the delayed group. The study primary end point was the full erectile function recovery rate, defined as an IIEF-5 score of 17 or greater, during the 12 months.

Results: Of the 120 randomized patients the proportion who achieved full recovery was significantly higher during the 12 months in the early group than in the delayed group (β = 0.356, p <0.001, generalized estimating equation). After 9 months postoperatively the proportion of patients who achieved full recovery steadily increased to 41.4% at 12 months in the early group while patients in the delayed group showed no further improvement. Thus, full recovery was achieved in only 17.7% of patients at 12 months. Only early sildenafil treatment independently improved full recovery at 12 months (HR 2.943, p = 0.034).

Conclusions: Our trial provides clinical data to suggest that earlier rehabilitation with phosphodiesterase type 5 inhibitors can contribute to the recovery of erectile function after radical prostatectomy in the clinical setting.

Keywords: erectile dysfunction; penis; phosphodiesterase 5 inhibitors; prostatectomy; robotic surgical procedures.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Erectile Dysfunction / etiology
  • Erectile Dysfunction / rehabilitation*
  • Follow-Up Studies
  • Humans
  • Laparoscopy / adverse effects*
  • Laparoscopy / methods
  • Male
  • Middle Aged
  • Penile Erection / drug effects
  • Penile Erection / physiology
  • Phosphodiesterase 5 Inhibitors / pharmacology
  • Phosphodiesterase 5 Inhibitors / therapeutic use*
  • Postoperative Complications / etiology
  • Postoperative Complications / rehabilitation*
  • Prospective Studies
  • Prostate / pathology
  • Prostate / surgery
  • Prostatectomy / adverse effects*
  • Prostatectomy / methods
  • Prostatic Neoplasms / surgery
  • Recovery of Function / drug effects
  • Robotic Surgical Procedures / adverse effects*
  • Robotic Surgical Procedures / methods
  • Sildenafil Citrate / pharmacology
  • Sildenafil Citrate / therapeutic use*
  • Time Factors
  • Treatment Outcome


  • Phosphodiesterase 5 Inhibitors
  • Sildenafil Citrate