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. 2015 Jan 20;2015(1):CD001843. doi: 10.1002/14651858.CD001843.pub5

Fode 2014.

Methods RCT
Participants Time of recruitment: pre‐operative
Population: 83 men undergoing nerve sparing radical prostatectomy (whole population, with or without UI)
Included: sexually active men with an IIEF score of at least 18 without aids, continent pre‐operatively
Excluded: condition that may prevent patient being able to have post‐operative treatment with PDE5‐inhibitor
Age (mean, range): A 62 (46‐73); B 65 (49 to 76)
Dropouts: 12 from group A (3 excluded because underwent non‐nerve sparing surgery, 2 withdrew consent, 1 lost a partner, 6 non‐compliance), 3 from group B (2 excluded because underwent non‐nerve sparing surgery, 1 withdrew consent). Differential dropout
Baseline characteristics: comparable except Group A significantly more LUTS pre‐operatively
Interventions Time of intervention: pre‐operative + post‐operative
A (30): pre‐operative session guided PFMT + instruction on how to use penile vibratory stimulation device, instructed to stimulate frenulum once daily, 10 seconds of stimulation then 10 second pause, repeated 10 times for 1 week pre‐operatively, Instructed to restart stimulation after catheter removal for 6 weeks
B (38): pre‐operative session guided PFMT 
All men were offered a PDE5 inhibitor after 1 month post‐operatively and also received telephone contact to ensure compliance with treatment 
Duration of treatment:  6 weeks
Follow up: 3, 6 and 12 months post‐operatively
Outcomes Primary outcome (number of men with UI)
Number of incontinent men (men reporting use of more than one pad daily)
3 months: A 14/42; B 15/41
6 months: A 7/42; B 3/41
12 months: A 3/30; B 2/38
(dropout figures added to 3 and 6 months) 
Other outcomes
Continence rate (patients reporting use of up to one pad daily for security reasons only)
3 months: A 65.5%; B 62.9%, P = 0.83
6 months : A 83.3%; B 91.9%, P = 0.28
12 months : A 90%; B 94.7%, P = 0.46
Median (range) pad use
3 months: A 1 (0 to 6); B 5 (0 to ‐34), P = 0.09
6 months: A 0 (0 to 3); B 1/3 (0 to 6), P = 0.14
12 months: A 0 (0 to 2); B 0 (0 to 3),  P = 0.56
Median (range) IIEF‐5
3 months : A 5 (0 to 25); B 5 (0‐25), P = 0.25
6 months : A 10.5 (0 to 25); B 5 (0‐25), P = 0.08
12 months : 18 (0 to 25); B 7.5 (0‐25), P = 0.09
IIEF ≥ 18, n/N (%)
3 months: 5/30 (17); B 4/38 (11), P = 0.46
6 months: 13/30 (43); B 9/38 (24), P = 0.09
12 months: 16/30 (53); B 12/38 (32), P = 0.07
Adverse effects: A: 5/30 reported side effects as a result of penile vibratory stimulation (1 red spots on glans penis, 1 small laceration + some bleeding, 2 complained of soreness, 1 frank pain post‐operatively)
B: 0/38
Quality of life
Median (range) DAN‐PSS post‐operatively
3 months: A 1 (0 to 34); B 5 (0‐34), P = 0.74
6 months: A 2 (0 to 41); B 1 (0‐48), P = 0.74
12 months: A 3 (0 to 36); B 0.5 (0‐21), P = 0.13
Notes Further information provided by authors
PDE5 (phosphodiesterase yype 5) inhibitor is used for erectile dysfunction
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk "randomized prospective trial" and “randomized by a draw”
Allocation concealment (selection bias) Low risk Used opaque sealed envelopes
Blinding of participants (performance bias) High risk “It was not possible to create a believable sham device, which could maintain blinding of the study subjects”
Blinding of personnel (performance bias) Unclear risk Not reported. Therefore judged to be unclear risk
Blinding of outcome assessment (detection bias) 
 All outcomes High risk Outcome assessor not blinded
Incomplete outcome data (attrition bias) 
 All outcomes High risk 12 from group A (3 excluded because underwent non‐nerve sparing surgery, 2 withdrew consent, 1 lost a partner, 6 non‐compliance), 3 from group B (2 excluded because underwent non‐nerve sparing surgery, 1 withdrew consent). Differential dropout
Selective reporting (reporting bias) Low risk Outcomes in methods reported
Financial support Low risk “This study was funded by unrestricted grants from the Velux Foundation and Grosserer L.F. Foghts Foundation”
Approved by medical ethics committee Low risk “The study was approved by the Danish ethical counsel and the Danish Data protection Agency”
Informed consent Low risk Assumed as they acquired ethical approval
ITT analysis Low risk Assumed from patient flow diagram