Assessing vacuum erectile devices effect on post-radical prostatectomy erectile function

Introduction and Objective

Radical prostatectomy, as a treatment for prostate cancer, could lead to erectile dysfunction (ED) which affects the sexuality of patients and may have significant psychological impact and in quality of life. Vacuum erectile devices (VED) have emerged as a non-invasive solution to aid post-prostatectomy ED recovery. This study aims to assess the gains in erectile function (EF) with VED usage in patients submitted to Retzius-sparing robot assisted radical prostatectomy (RS-RARP) at 6- and 12-months post-surgery.

Materials and Methods

Between January 2022 and September 2022 our center performed 46 RS-RARP, these patients had pre- and post-operative evaluations every 3 months during the first-year post-surgery, led by urology nursing team. If ED was identified and/or patient reported intention to improve EF a penile rehabilitation programme (PRP) that included VED usage was recommended. We conducted a prospective observational single-center study where EF was assessed using the International Index of Erectile Function (IIEF-5) at 6- and 12-months post-surgery. We compared the results of patients that had IIEF-5 score <15 at 6-month mark and started using VED, with IIEF-5 score at 12-month mark. The inclusion criteria are: patients that did not have adjuvant or salvage treatments during the follow up; have post-operative evaluations with IIEF-5 at 6 and 12 months and started PRP. A total of 43 patients were included. We have considered ED rehabilitation if the patient had at least 5 points gain on IIEF-5 score at 12 months versus IIEF-5 at 6 months. Every patient provided written informed consent for study inclusion, approved by the Institutional Ethics Committee (Approval 07.07.2017).

Results

From the total of patients included, 22 had an IIEF-5 score <15 at 6-month mark. We recommended VED to 7 patients and 4 used a VED regularly. Regarding patients that used VED, 3 had better IIEF-5 score at 12-month mark comparing to 6-month mark, with an average gain of 7,75 in IIEF-5 score. Regarding the total of patients (n = 43), 16 still had IIEF-5 score <15 at 12-month mark.

Conclusion

This observational study underscores the potential benefits of VED in aiding EF recovery post RS-RARP. Regular use of VED demonstrated significant improvement in IIEF-5 score at 12-month mark. Our findings suggest that integrating VED into the post RS-RARP rehabilitation care plan could serve as an effective strategy for patients that do not respond effectively to phosphodiesterase type 5 inhibitors. Study limitations are small sample of patients that used VED and not having a stablished VED protocol. Further controlled trials are warranted to validate these findings and explore long-terms effects.