Post-prostatectomy Rates of ED Have Not Improved

I remember being at a medical convention about 10 years ago and overhearing a conversation between two doctors, specialty unknown, who were speaking positively about Dr. Patrick Walsh’s famous contribution, the nerve-sparing radical prostatectomy (RP). As I later learned, he first applied his technique in 1982, and the patient regained potency about a year after the surgery. In the 3+ decades since then, Dr. Walsh’s technique has undergone many modifications by himself and others, and robot-assisted laparoscopic prostatectomy has made the surgery much less invasive. Now there are many highly experienced urologic surgeons who have performed thousands of robotic RPs, and it’s not hard to find published post-prostatectomy results of 90%+ return to potency within 24 months. However, a new study from Europe suggests that the majority of doctors who perform RP are not getting the same results as the experts, nor have average potency rates improved in nearly two decades.[i]

The research, published in July 2015, was conducted by a Swiss and Austrian team who asked: Have potency rates following RP improved over the years? They analyzed randomized controlled trials on post-RP penile rehabilitation (clinical interventions such as medication or injections to encourage a return to erections sufficient for penetration). The total number of men involved was 2009, including each study’s control arm of matched patients who were simply observed or on a placebo. There were 685 men in the control arms, and these were the focus of the research since they were basically not undergoing rehab but rather letting nature take its course. To track potency, eight of the trials used a questionnaire called the Sofile (SEP). This is a sort of diary that the men kept to record their performance at each sexual encounter. The two questions used to establish return to potency are numbers 2 and 3, stated as

SEP-Q2 – Were you able to insert your penis into your partner’s vagina? (Yes or no)

SEP-Q3 – Did your erection last long enough for you to have successful intercourse? (Yes or no)

Here is a summary of the responses:

Year of publication Percent control arm who regained potency
1997 20%
2003 10%
2004 19%
2008 25%
2010 21%
2011 67%
2013 10%
2014 22%

 

Despite the obvious variance in percentages (from 10-67%) the team wrote that their analysis “…shows (i) that the rate of undisturbed erectile function is in the range 20-25% in most studies and (ii) that these rates have not substantially improved or changed over the past 17 years.” Perhaps the steady development of focal prostate cancer treatment is in part a patient-driven response to this situation. It comes from all of us who desire a better way to destroy cancer without damaging manhood.

 


 

[i] Schauer I, Keller E, Müller A, Madersbacher S. Have rates of erectile dysfunction improved within the past 17 years after radical prostatectomy? A systematic analysis of the control arms of prospective randomized trials on penile rehabilitation. Andrology. 2015 Jul [Epub].

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