REVIEW   Free access

Minerva Urologica e Nefrologica 2020 October;72(5):543-54

DOI: 10.23736/S0393-2249.20.03780-7

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Management of erectile dysfunction following robot-assisted radical prostatectomy: a systematic review

Michele MARCHIONI ^{1, 2, 3} ✉, Piergustavo DE FRANCESCO ², Roberto CASTELLUCCI ², Rocco PAPALIA ⁴, Selçuk SARIKAYA ^{3, 5}, Juan GOMEZ RIVAS ^{3, 6}, Luigi SCHIPS ^{1, 2}, Roberto M. SCARPA ⁴, Francesco ESPERTO ^{3, 4}

¹ Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, G. d’Annunzio University, Chieti, Italy; ² Department of Urology, ASL Abruzzo 2, Chieti, Italy; ³ European Associations of Urology-European Society of Residents in Urology (EAU-ESRU); ⁴ Department of Urology, Campus Bio-Medico University, Rome, Italy; ⁵ Department of Urology, Gulhane Research and Training Hospital, Ankara, Turkey; ⁶ Department of Urology, La Paz University Hospital, Madrid, Spain

INTRODUCTION: We aimed to summarize evidences about the efficacy of available treatments for erectile disfunction after robotic assisted radical prostatectomy (RARP).
EVIDENCE ACQUISITION: A systematic literature review searching on PubMed (Medline), Scopus, and Web of Science databases was performed in December 2019. PRISMA guidelines were followed. Population consisted of patients with erectile disfunction after RARP (P), conservative and surgical intervention were considered of interest (I). No comparator was considered mandatory (C). Outcomes of interest were the recovery of erectile function after conservative treatments and sexual function after surgical treatments (O).
EVIDENCE SYNTHESIS: Eleven studies were included. Seven studies focused on the use of phosphodiesterase-5 inhibitors (PDE5i) alone (five studies) or associated with other treatments (two studies). All the studies confirmed the efficacy of PDE5i, while the most promising association is with vacuum pump erectile devices. Two studies investigated topical treatments, namely low intensity extracorporeal shock wave therapy and alprostadil. Low intensity extracorporeal shock wave therapy may be a promising option in patients in whom nerve-sparing surgery was performed. The use of alprostadil could be an effective alternative to intracorporeal injection in those who underwent non-nerve-sparing surgery. One study focused and confirmed the efficacy of penile implants. Furthermore, one study reported the efficacy of a multi-modal treatment with preoperative medication, showing the benefits of a multimodal approach.
CONCLUSIONS: Penile rehabilitation with PDE5i is effective after nerve sparing RARP. The association of PDE5i with vacuum devices could led to a faster recovery. A multimodal approach with preoperative specific care seems to be effective to fasten erectile function recovery.

KEY WORDS: Robotics; Prostatectomy; Prostatic neoplasms; Erectile dysfunction; Penile prosthesis