Table 1. The main characteristics of the included studies in network meta-analysis.
| Study | Country | Participants (age# and number) | GS | PSA* (ng/mL) | DM | TPDC | SUA | CLS | NES | Intervention | Outcome measures& | LoE |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Aydogdu et al. [2011] | Turkey | N=74 (87.8% completed study); IG =32; 56.2; CG =33; 58.1 |
<8 | 6.1 (3.6–9.6) | CG: 4/33; IG: 5/32 |
At baseline, 3, 6, 12 months | RRP | ≤ Ic | BNES | IG: 3 days/week Tadalafil 20 mg/day) for 6 months following the removal of urethral catheter; CG: no use of tadalafil |
IIEF-EF; SEP-2; SEP-3 | 1b |
| Montorsi et al. [2008] | Europe, Canada, South Africa, and USA | N=628 (95.3% completed the study); IG1=207; 57.4; IG2=204; 56.8; CG =206; 57.1 |
≤7 | <10 | NS | At 0, 1, 3, 6, 9, 10, 11, 12, 13 months | NS | I-II | BNES | IG1=9 months 10 mg vardenafil nightly (which could be decreased to 5 mg if required); IG2=9 months flexible-dose (starting at 10 mg with the option to titrate to 5 mg or 20 mg), on-demand vardenafil; CG =9 months placebo |
IIEF-EF; SEP-2; SEP-3 | 1b |
| Montorsi et al. [2014] | nine European countries and Canada | N=423 (83% completed the study); IG1=139; 58.6 (5.07); IG2=143; 57.5 (5.91); CG =141; 57.6 (5.69) |
≤7 | <10 | None | At 0, 9 months | ORP; RARP; LRP | I1c-II2c | BNES | IG1=9 months, 5 mg tadalafil once daily; IG2=9 months, 20 mg tadalafil on demand; CG = placebo |
IIEF-EF; SEP-3; penile length | 1b |
| Padma-Nathan et al. [2008] | North America, France, Belgium and Australia | N=123 (61.7% completed the study); IG1=23; 55 [6] IG2=28; 55 [6] CG=25; 57 [7] |
<8 | <20 μg/L | NS | At baseline, 3, 6, 9 months |
RRP | I-II | BNES | IG1=50 mg nightly sildenafil once daily; IG2=100 mg nightly sildenafil once daily; CG = placebo |
IIEF-EF; RigiScan | 2b |
| Pavlovich et al. [2013] | USA | N=100 (100% completed the study); IG =50; 54.3 [42–63]; CG =50; 53.6 [40–64] |
<8 | NS | 1% | At 1, 3, 6, 9, 12, 13 months | LRP; RARP | I1c-II2a | Yes | IG = nightly 50 mg sildenafil for 1 year; CG = on demand 50 mg sildenafil for 1 year (maximum six tablets/month) |
IIEF-EF; EPIC | 1b |
| Bannowsky et al. [2012] | Germany | N=36 (100% completed the study); 61.4 [52–71]; IG1=12; IG2=12; CG =12; |
<7 | ≤10 | NS | At baseline, 3, 6, and 12 months | RRP | I-II | UNES | IG1=12 months, 5 mg/day vardenafil; IG2=12 months,10 mg/day vardenafil; CG =12 months, placebo |
IIEF-5 | 1b |
| Canat et al. [2015] | Turkey | N=112 (100% completed the study); IG1=38; 62.63 [50–72]; IG2=62.95 [54–72]; CG =34; 63.52 [52–74] |
≤7 | <10 | IG1=6/38; IG2=6/40; CG =6/34 |
At 6 weeks, 12 months | RRP | I1-II2a | BNES | IG1=20 mg tadalafil three times per week; IG2=20 mg gadalafil on demand; CG = on treatment. Duriation: 12 months |
IIEF-6 | 1b |
| Montorsi et al. [2004] | Canada, Germany, Italy, The Netherlands, Spain, UK and USA | N=303; (78.2% completed the study); IG =201; 59.6 (5.0); CG =102; 59.8 (5.2) |
NS | NS | NS | At baseline, 3 months | RRP | ≤III | BNES | IG =20 mg tadalafil for 12 weeks; CT =20 mg placebo |
IIEF-EF; SEP-2; SEP-3; GAQ | 2b |
| Mulhall et al. [2013] | USA | N=298 (84.6% completed the study); IG1=99; 58.9 (5.88); IG2=99; 57.5 (6.60); IG3=58.6 (5.87) |
≤7 | NS | None | At 0, 1, 2, 3 months | RRP; ORP; LRP; RARP | ≤II | BNES | IG1=100 mg avanafil; IG2=200 mg avanafil; CG = placebo; Duration: 3 months |
IIEF-EF; SEP-2; SEP-3 | 1b |
| Raina et al. [2006] | USA | N=109 (87% completed the study); 58.2; IG =74; CG =35 | ≤6 | <10 | NS | At baseline, 0, 9 months | NS | I-II | No limitation |
IG: VCD use daily for 9 months; CG: no treatment |
IIEF-5; penile length and circumference | 1b |
| Köhler et al. [2007] | USA | N=28 (100% completed the study); IG =17; 58.2; CG =11; 60.5 |
IG: 6.5; CG: 6.7 |
IG: 7.0; CG: 5.5 |
IG: 1/17; CG: 2/11 |
At baseline, 1, 3, 6, 9, 12 months | RRP | I-II | BNES; UNES | IG: early intervention (1 months after RP), 10 min/day VCD for 5 months; CG: control group (6 months after RP) |
IIEF-5; penile flaccid length, stretched length, prepubic fat pad, and midshaft circumference |
1b |
| Engel et al. [2011] | USA | N=23 (87% completed the study); IG =13; CG =10 |
NS | NS | None | At 3, 6, 9, 12 months | RARP | NS | BNES | IG: 20 mg/day tadalafil three times per week plus a VCD, 10 minutes unbanded per day for at least 5 days weekly; CG: 20 mg/day tadalafil three times per week |
IIEF-5; penile erection hardness | 1b |
| Liu et al. [2016] | China | N=64 (100% completed the study); IG =32; 57.6 (4.1); CG =32; 56.9 (4.5) |
NS | NS | NS | At 0, 3 months | ORP | NS | No limitation |
IG: 3 months, 50 mg/day sildenafil nightly and VCD; CG: 3 months, 50 mg/day sildenafil nightly |
IIEF-5; penile length and circumference; erectile hardness |
1b |
| Laurienzo et al. [2018] | Brazil | N=132 (93.1% completed the study); IG1=41; 58.5 (5.4); IG2=42; 58 (5.7); CG =40; 57.3 (6.5) |
NS | NS | NS | At baseline, 1, 3, 6 months | NS | II2a-III3b | NS | IG1: PFMT, in dorsal decubitus, with flexed lower limbs, perform contraction of the pelvic floor, followed by relaxation; IG2: PFMT and ES, twice a week for 7 weeks, totaling 14 sessions; CG: no treatment |
IIEF-5 | 1b |
| Glazener et al. [2011] | UK | N=411 (95.1% completed the study); IG =205; 62.4 (5.8); CG =206; 62.3 (5.6) |
NS | NS | NS | At 3, 6, 9, 12 months | LRP; abdominal; perineal | NS | NS | IG: therapist-guided PFMT, four one to one sessions, 3 months; CG: no treatment |
Number of men unable to achieve any erection 12 months after prostate surgery | 1b |
| Geraerts et al. [2016] | Belgium | N=33 (100% completed the study); IG =16; 61.1; CG =17; 61.5 |
NS | NS | NS | At 0, 3 months | ORP; RARP | NS | BNES; UNES | IG: therapist-guided PFMT and ES, during 10 min (biphasic symmetric current (constant voltage), intensity as high as possible, not painful, frequency: 50 Hz and pulse duration: 600 ìs; CG: no treatment |
IIEF-EF; VAS | 1b |
| Prota et al. [2012] | Brazil | N=52 (62.5% completed the study); IG =17; 62.4 (6.4); CG =16; 64.0 (8.0) |
NS | NS | IG: 17.6%; CG: 12.5% | At 1,3,6 and 12 months | RRP | II-III | NS | IG: PFMT and BF, once a week for 12 weeks after catheter removal at postoperatively day 15; CG: no treatment |
IIEF-5 | 2b |
| de Lira et al. [2019] | Brazil | N=31 (100% completed the study); IG =16; 67.3 (5.63); CG =15; 63.53 (7.62) |
No limitation |
IG: 9.20 (4.65); CG: 14.1 (11.19) | NS | At baseline, 3 months | Open RRP | II2c-III3b | NS | IG: PFMT and BF, two pre-RP physical therapist-guided PFMT sessions, including exercises and electromyographic biofeedback, and verbal and written instructions to continue PFMT until RP, which was then resumed after urethral catheter removal; CG: only usual post-prostatectomy care |
IIEF-5; ICIQ-SF | 1b |
| Oh et al. [2020] | Korea | N=84 (97.6% completed the study); IG =40; 67.5 (6.9); CG =42; 65.9 (6.8) |
No limitation |
NS | IG: 5/40; CG: 9/42 | At baseline, 1,2,3 months | RARP | NS | BNES; UNES | IG: PFMT and BF, (I) four times per day; (II) 10 minutes per session of exercise; (III) a minimum of 10 seconds of tension duration with maximal tension intensity; CG: PFMT |
IIEF-5 | 1b |
| Chiles et al. [2018] | USA | N=109 (85.3% completed the study); IG =40; CG =43 |
NS | NS | None | At baseline, 12, 18 months | RARP | NS | BNES | IG: 100% oxygen in a hyperbaric chamber, 10 sessions (90 minutes of 100% oxygen at 2.2 ATA) beginning day 1 after hospital discharge. Sessions were continued daily on Monday through Friday for an additional 9 days. CG: air; Both groups received 50 mg sildenafil daily for 12 months beginning at the completion of hyperbaric treatment at 15 days after surgery |
IIEF; EPIC-26 | 1b |
| McCullough et al. [2010] | USA | N=212 (73.5% completed the study); IG =97; 56.8 (6.4); CG =59; 55.6 (5.9) |
>7 | 20 | NS | At baseline, 0, 1, 3, 6, 9, 10, 11 months | ORP; RARP | NS | BNES | IG: nightly intraurethral alprostadil, initially 125 μg and dose titrated 250 μg at 1 month and maintained for 8 months; CG: 9 months 50 mg sildenafil nightly |
IIEF-EF | 2b |
| Mulhall et al. [2018] | USA | N=131 (94.6% completed the study); IG =59; 55.1 (6.2); CG =65; 54.1 (6.2) |
NS | NS | None | At 1 w, 3 w, 5 w, 9 w, 3 m, 6 m, 12 m, 18 m | ORP | I-II | BNES | IG: tacrolimus 2–3 mg daily for 27 weeks (1 week prior to and 6 months after RP) and followed up for 2 years after RP; CG: placebo |
IIEF-EF | 1b |
| Siltari et al. [2019] | Finland; Denmark | N=158 (74.6% completed the study); IG =60; 64 (58.5–68); CG =58; 64 [58–69] |
No limitation |
No limitation |
IG: 10%; CG: 12% | At baseline, 3, 6, 9, 12 months | NS | I-III | No limitation |
IG: 80 mg atorvastatin daily from study inclusion to the day of surgery; CG: placebo |
IIEF-5 | 2b |
| Hong et al. [2007] | Korea | N=50 (86% completed the study); IG =20; 61.3 (4.3); CG =23; 60.6 (2.3) |
IG: 6.2 (0.7); CG: 6.1 (1.2) | IG: 7.97 (2.3); CG: 7.44 (4.5) | None | At baseline, 0, 6 months | RRP | I-II | BNES | IG: 10 mg atorvastatin daily from postoperative days 1 to 90 and on demand 50 mg sildenafil; CG: on demand 50 mg sildenafil |
IIEF-5 | 1b |
#, age reported as mean and SD unless specified; &, only measures related to erectile function are reported; *, PSA before treatment. IG, intervention group; CG, control group; BF, biofeedback; EF, erectile function; ES, electrical stimulation; GS, Gleason score; RP, radical prostatectomy; PDE5is, phosphodiesterase type 5 inhibitors; IIEF, International Index Erectile of Function; PSA, prostate specific antigen; DM, diabetes mellitus; TPDC, time points of data collection; NES, nerve sparing; bilateral NES, BNES; unilateral NES, UNES; SUA, Surgical approach; CLS, Clinical stage; LoE, level of evidence; RRP, radical retropubic prostatectomy; NS, not specified; EF, erectile function; SEP, sexual encounter profile; ORP, open RP; LRP, laparoscopic RP; RARP, robot-assisted RP; EPIC, Expanded Prostate Cancer Index Composite; GAQ, global assessment question; VAS, visual analog scale; PFMT, pelvic floor muscle training.