Table 1.
Study and patient characteristics of articles selected for literature review
| Study | Level of evidence | No. of patients | Study design | Regimen | Start of treatment (after RP) | Duration/follow up |
|---|---|---|---|---|---|---|
| Conservative management | ||||||
| Campbell et al. (Cochrane review) 35 | 1A | 1937 | Systematic review | Effects of conservative management for urinary incontinence after prostatectomy (sexual rehabilitation was included but not main focus) | Varied | Varied |
| Intracorporeal injections | ||||||
| Montorsi et al. 36 | 1B | 30 | RCT | ICI three times per week for 12 weeks vs. no treatment | 1 month post surgery | 6 months |
| Mulhall et al. 37 | 3B | 132 (58 active treatment vs. 74 in no treatment group) | Non-randomised study | Trimix/Bimix three times per week vs. no treatment or as needed (nonresponders switched to sildenafil) | 4 months post surgery | 18 months |
| Yiou et al. 38 | 4 | 87 | Uncontrolled cohort study | 2.5 μg intracavernous alprostadil injection | 1 month | 12 months |
| Intraurethral PGE-1/Alprostadil | ||||||
| Costabile et al. 39 | 2B | 384 | Controlled clinical trial | Intraurethral PGE-1 initially then active drug vs. placebo | ≤ 3 months after surgery | 3 months (follow up) |
| Gontero et al. 40 | 4 | 76 | Randomised study | 20 mg prostaglandin E1 injection | 1–12 months | 12 months |
| Raina et al. 41 | 4 | 91 | Case comparison study | MUSE (125 or 250 μg three times per week) vs. on-demand treatment | 3 weeks | 6 months |
| Raina et al. 42 | 4 | 54 | Case series (single cohort) | Transurethral alprostadil (PGE1) (MUSE) four times per month | 3 weeks | 6 months |
| Vacuum erection device | ||||||
| Köhler et al. 43 | 1B | 28 | RCT | Daily VED (10 min), early vs. delayed after RP | 1 month after RP vs. 6 months after RP | 6 months |
| Raina et al. 44 | 1B | 109 | RCT | VED twice a week vs. no treatment | 1 month | 9 months |
| Phosphodiesterase type 5 inhibitor (PDE5i) | ||||||
| Aydogdu et al. 45 | 1B | 65 | RCT | Tadalafil vs. No treatment | 1 week | 6–12 months |
| Bannowsky 46 | 1B | 43 | RCT | Nightly sildenafil 25 mg/day vs. control (no sildenafil) | After catheter removal (7–14 days) | 12 months |
| Brock et al. 47 | 1B | 440 | RCT | Vardenafil, 10 and 20 mg vs. placebo | 6 months–5 years post surgery | 3 months |
| McCullough 48 | 1B | 139 | RCT | Intraurethral alprostadil or oral sildenafil citrate (50–100 mg) | Within 1 month | 9 months |
| Montorsi 49 | 1B | 628 | RCT | Placebo, nightly vardenafil, or on demand vardenafil | 14 days | 12 months |
| Montorsi et al. 50 | 1B | 303 | RCT | Tadalafil 20 mg, on demand vs. placebo | 12–48 months | 3 months |
| Mosbah et al. 51 | 1B | 18 | RCT | Sildenafil twice per week to be shifted to ICI of PGE1 in not responders | 2 and 6 months post surgery | 6 months |
| Nehra et al. 52 | 1B | 440 | RCT | Placebo, 10 mg vardenafil or 20 mg vardenafil | 4 weeks | 3 months |
| Pace et al. 53 | 1B | 40 | RCT | Flexible-dose sildenafil vs. no treatment | 14 days | 6 months |
| Padma-Nathan et al. 54 | 1B | 76 | RCT | Sildenafil, 50 or 100 mg, daily and nightly | 4 weeks | 9 months followed by 8 week drug free period |
| Rectal cancer: Lindsey 55 | 1B | 32 | RCT | Sildenafil vs. placebo | 5.6 years | 1 month |
| Briganti et al. 56 | 2B | 435 | Single cohort | Test the effects of: No treatment after surgery On-demand PDE5i Daily use of PDE5i (every day or every other) | Varied | 36 months |
| Müller 57 | 2C | 92 | Retrospective database analysis | Sildenafil or ICI therapy (if oral therapy failed) | Within 12 months | 18 months |
| Schwartz et al. 58 | 3B | 40 | Case control study | 50 mg sildenafil and 100 mg sildenafil every other night | At catheter removal | 6 months |
| Briganti et al. 59 | 4 | 435 | Single cohort | PDE5-I treatment schedule (daily and on-demand) | Varied | 3–6 months (treatment) 36 month (follow up) |
| Mulhall 60 | 4 | 48 | Single cohort | Sildenafil, and if unsuccessful, then ICI | < 6 months (early) vs. ≥ 6 months after RP (delayed) | 24 months |
| Zippe et al. 61 | 4 | 49 | Survey | Sildenafil – varied | Immediately; 6 and ≥ 12 months | 12 months |
| NS radical cystectomy: El-Bahnasawy et al. 62 | 4 | 100 | Open-label, study | 50 and 100 mg sildenafil | 80.7 months | 3 months |
| Rectal cancer: Nishizawa 10 | 4 | 207 | Single cohort uncontrolled study | On demand treatment with sildenafil | 3 months | 12 months |
| Combination therapy | ||||||
| Titta et al. 63 | 1B | 57 | RCT | Sexual counselling + PGE1-ICI therapy vs. only ICI | ∼1 month | 18 months |
| Mydlo et al. 64 | 2B | 34 | Retrospective study | Sildenafil or vardenafil. After a max of eight doses treated with ICI therapy using 15 or 20 mg alprostadil + oral therapy | Varied | 7 months |
| Yassin et al. 65 | 3B | 69 | Controlled study, non-randomised | Sildenafil, 25 mg three times per week or tadalafil, 5 mg, twice weekly + VED twice daily | 11 days | 3 months |
| Basal et al. 66 | 4 | 203 | Retrospective case series | Review of patients on penile rehab | Varied | 15–72 months |
| Kimura et al. 67 | 4 | 676 | Case series | PDE5i + VED – review of factors affecting rehab | N/A | N/A |
| Lee et al. 68 | 4 | 77 | Case series | Sildenafil citrate or tadalafil three times per week | Varied | 8 months |
| Moskovic et al. 69 | 4 | 29 | Case series | Sildenafil 25 mg nightly + 250 μg alprostadil suppository three times per week. At 1 month, additional daily use of VED (10 min/day) + 100 mg of sildenafil on demand prior to sexual attempt | Prior to surgery and 3 days after RP | 6 months |
| Nandipati et al. 70 | 4 | 22 | Uncontrolled study | Sildenafil 50 mg/day at discharge + PGE1-4 μg or low-dose Trimix (20 U) two to three times per week | At hospital discharge | 12 months |
RP, radical prostatectomy, RCT, randomised controlled trial; VED, vacuum erection device; ICI, intracorporeal injection.