MP37-20 THE EFFECT OF PENILE REHABILITATION AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY ON URINARY CONTINENCE AND ERECTILE FUNCTION RECOVERY. RESULTS FROM a HIGH-VOLUME, SINGLE-SURGEON SERIES

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I (MP37)1 May 2024MP37-20 THE EFFECT OF PENILE REHABILITATION AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY ON URINARY CONTINENCE AND ERECTILE FUNCTION RECOVERY. RESULTS FROM a HIGH-VOLUME, SINGLE-SURGEON SERIES Mattia Longoni, Pietro Scilipoti, Leonardo Quarta, Donato Cannoletta, Nocera Luigi, Paolo Zaurito, Margherita Ciabattini, Alice Mannazzu, Armando Stabile, Elio Mazzone, Gabriele Sorce, Mario De Angelis, Pellegrino Francesco, Francesco Barletta, Simone Scuderi, Giorgio Gandaglia, Pierre I. Karakiewicz, Francesco Montorsi, Andrea Salonia, and Alberto Briganti Mattia LongoniMattia Longoni , Pietro ScilipotiPietro Scilipoti , Leonardo QuartaLeonardo Quarta , Donato CannolettaDonato Cannoletta , Nocera LuigiNocera Luigi , Paolo ZauritoPaolo Zaurito , Margherita CiabattiniMargherita Ciabattini , Alice MannazzuAlice Mannazzu , Armando StabileArmando Stabile , Elio MazzoneElio Mazzone , Gabriele SorceGabriele Sorce , Mario De AngelisMario De Angelis , Pellegrino FrancescoPellegrino Francesco , Francesco BarlettaFrancesco Barletta , Simone ScuderiSimone Scuderi , Giorgio GandagliaGiorgio Gandaglia , Pierre I. KarakiewiczPierre I. Karakiewicz , Francesco MontorsiFrancesco Montorsi , Andrea SaloniaAndrea Salonia , and Alberto BrigantiAlberto Briganti View All Author Informationhttps://doi.org/10.1097/01.JU.0001008948.02935.01.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bilateral nerve-sparing (BNS) and penile rehabilitation (PR) have been proposed to help erectile function (EF) and urinary continence (UC) recovery after robot-assisted radical prostatectomy (RARP). We hypothesized that not all surgically managed prostate cancer (PCa) patients would benefit from these interventions at the same extent. METHODS: Overall, 308 PCa patients undergoing RARP between 2019 and 2022 at our Institution were retrospectively identified. Surgery was performed by a single expert surgeon and BNS was used when oncologically safe (n=215). PR consisted of daily dose of phosphodiesterase-5 inhibitor (PDE5I) + either on-demand full dose of PDE5I (n=103;56.3%) or intracavernosal injections (ICI) (n=80;43.7%) for 6 mo. Follow-up assesed potency and UC, defined as intercourse-sufficient erection and no pad within 24h, respectively. Patients were stratified according to BNS status and risk groups for post-operative erectile disfunction (ED): low- (age ≤65, IIEF-EF ≥26, CCI ≤1; n=135), intermediate- (age 66–69 or IIEF-EF 11–25, CCI ≤1; n=74), and high-risk (age ≥70 or IIEF-EF ≤10 or CCI ≥2; n=99). Kaplan-Meier (KM) curves depicted UC and EF recovery according to PR and BNS status. Multivariable analysis (MVA) tested independent predictors of UC and EF recovery. An interaction test assessed whether the effect of PR on functional outcomes varied according to BNS status. RESULTS: Within BNS patients, those using PR showed higher EF recovery vs. those who did not, regardless of ED risk (38 vs. 72% for low-, 13 vs. 51% for intermediate-, 18 vs. 66% for high-risk; all p<0.05). Conversely, among non-nerve sparing (NNS) men, only high-risk class did benefit from PR (3 vs. 60%; p=0.01). Patients receiving PR showed significantly higher UC recovery rates regardless of BNS status (55 vs. 85%; p=0.003). These results were confirmed at MVA, where PR was associated with EF recovery within low- (HR 2.3; 95% CI 1.2-4.4), interm- (HR 4.7; 95% CI 1.9-3.2), high-risk BNS (HR 4.5; 95% CI 1.6-12.9) and NNS-high-risk patients (HR 4.8; 95% CI 1.1-8.5) and with UC in NNS-patients (HR 2.0; 95% CI 1.1-3.6) after adjusting for age, CCI, BMI, and pT stage (all p<0.05). At interaction analyses the impact of PR did not vary according to NS status for both UC and EF recovery (p=0.1). CONCLUSIONS: Use of PR is associated with better EF recovery after BNS RARP, regardless of ED risk, and only in high-risk patients after NNS RARP. Conversely, PR was associated with better UC in all men, regardless of BNS status. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e611 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Mattia Longoni More articles by this author Pietro Scilipoti More articles by this author Leonardo Quarta More articles by this author Donato Cannoletta More articles by this author Nocera Luigi More articles by this author Paolo Zaurito More articles by this author Margherita Ciabattini More articles by this author Alice Mannazzu More articles by this author Armando Stabile More articles by this author Elio Mazzone More articles by this author Gabriele Sorce More articles by this author Mario De Angelis More articles by this author Pellegrino Francesco More articles by this author Francesco Barletta More articles by this author Simone Scuderi More articles by this author Giorgio Gandaglia More articles by this author Pierre I. Karakiewicz More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...