(116) Utilisation and Long-Term Adherence to Erectile Aids Before and Following Radical Prostatectomy: Insights from a Five-Year Follow-Up Study

Abstract Introduction Radical prostatectomy (RP) significantly impacts erectile function and sexual well-being. Current EAU guidelines emphasize the early initiation of pro-erectile therapies, such as PDE5 inhibitors, vacuum erection devices and intracavernosal injections, to support erectile tissue health. Nevertheless, long-term adherence to erectile aids (EAs) remains low, and the factors influencing discontinuation are insufficiently understood. Objective To evaluate the utilization of EAs before and up to five years after RP, and to explore sexual activity, perceived importance, satisfaction with sex life, and reasons for EA discontinuation. Methods Patients who underwent radical prostatectomy (RP) without neoadjuvant therapy were prospectively surveyed using standardized questionnaires preoperatively and at five defined postoperative time points. These assessments were conducted annually, with T1–T5 representing one to five years after RP, respectively. Collected data included sociodemographic and clinical parameters, sexual activity, perceived importance of sex life, satisfaction with sex life, and erectile function, which was evaluated using the Erection Hardness Score (EHS). Open-ended responses were analyzed to identify reasons for discontinuation of EAs. Results A total of 493 men (mean age 65.5 ± 8.2 years) were included in the analysis. Preoperatively, 77.0% of men were sexually active, declining to 53.3%, 51.8%, 49.7%, 48.9%, and 45.0% at T1–T5, respectively. The perceived importance of sex life remained relatively high (pre: 64.3%; post: 48.9%, 49.3%, 48.8%, 47.1%, 43.9%), whereas satisfaction with sex life dropped markedly (pre: 71.8%; post: 27.1%, 28.3%, 32.0%, 33.6%, 30.0%). The proportion of men reporting moderate-to-severe erectile dysfunction (EHS 0–2) increased from 34.0% preoperatively to 78.5%, 72.5%, 69.7%, 70.2%, and 69.7% at T1–T5 The use of EAs increased from 12.2% before surgery to 38.4% at one year postoperatively, and then declined to 24.5% at five years. PDE5 inhibitors were the most commonly used EAs, with rates ranging from a minimum of 33.9% to a maximum of 40.6% across T1–T5, followed by vacuum erection devices (9.5–17.2%) and intracavernosal injections (3.0–5.4%). The main reasons for EA discontinuation included sufficient spontaneous erections (27.4%), side effects (22.3%), complexity of use (15.5%), lack of partner acceptance (12.8%), and costs (6.8%). Conclusions Despite a persistently high perceived importance of sex life, sexual activity, satisfaction with sex life, and long-term EA adherence remain low after RP. Early and individualized counseling on pro-erectile therapies - addressing side effects, usability, and partner-related factors - should be an integral part of perioperative care. Disclosure No