Penile Rehabilitation Strategy after Nerve Sparing Radical Prostatectomy: A Systematic Review and Network Meta-Analysis of Randomized Trials
2021; Lippincott Williams & Wilkins; Volume: 205; Issue: 4 Linguagem: Inglês
10.1097/ju.0000000000001584
ISSN1527-3792
AutoresReza Sari Motlagh, Mohammad Abufaraj, Lin Yang, Keiichiro Mori, Benjamin Pradère, Ekaterina Laukhtina, Hadi Mostafaei, Victor M. Schuettfort, Fahad Quhal, Francesco Montorsi, Mohsen Amjadi, Christian Gratzke, Shahrokh F. Shariat,
Tópico(s)Genital Health and Disease
ResumoNo AccessJournal of UrologyReview Article1 Apr 2021Penile Rehabilitation Strategy after Nerve Sparing Radical Prostatectomy: A Systematic Review and Network Meta-Analysis of Randomized Trials Reza Sari Motlagh, Mohammad Abufaraj, Lin Yang, Keiichiro Mori, Benjamin Pradere, Ekaterina Laukhtina, Hadi Mostafaei, Victor M. Schuettfort, Fahad Quhal, Francesco Montorsi, Mohsen Amjadi, Christian Gratzke, and Shahrokh F. Shariat Reza Sari MotlaghReza Sari Motlagh Department of Urology, Medical University of Vienna, Vienna, Austria Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran , Mohammad AbufarajMohammad Abufaraj Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan The National Center for Diabetes, Endocrinology and Genetics, The University of Jordan, Amman, Jordan , Lin YangLin Yang Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Canada Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada , Keiichiro MoriKeiichiro Mori Department of Urology, Medical University of Vienna, Vienna, Austria Department of Urology, The Jikei University School of Medicine, Tokyo, Japan , Benjamin PradereBenjamin Pradere Department of Urology, Medical University of Vienna, Vienna, Austria Department of Urology, CHRU Tours, Francois Rabelais University, Tours, France , Ekaterina LaukhtinaEkaterina Laukhtina Department of Urology, Medical University of Vienna, Vienna, Austria Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia , Hadi MostafaeiHadi Mostafaei Department of Urology, Medical University of Vienna, Vienna, Austria Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran , Victor M. SchuettfortVictor M. Schuettfort Department of Urology, Medical University of Vienna, Vienna, Austria Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany , Fahad QuhalFahad Quhal Department of Urology, Medical University of Vienna, Vienna, Austria King Fahad Specialist Hospital, Dammam, Saudi Arabia , Francesco MontorsiFrancesco Montorsi Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy , Mohsen AmjadiMohsen Amjadi Department of Urology, Tabriz University of Medical Sciences, Tabriz, Iran , Christian GratzkeChristian Gratzke Department of Urology, University Hospital Freiburg, Freiburg, Germany , and Shahrokh F. ShariatShahrokh F. Shariat *Correspondence: Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090Vienna , Austria telephone: 43 1 4040026150; E-mail Address: [email protected] Department of Urology, Medical University of Vienna, Vienna, Austria Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia Department of Urology, Weil Cornell Medical College, New York, New York Department of Urology, University of Texas Southwestern, Dallas, Texas Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic European Association of Urology Research Foundation, Arnhem, Netherlands View All Author Informationhttps://doi.org/10.1097/JU.0000000000001584AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Despite the advances in nerve sparing and minimally invasive radical prostatectomy, erectile dysfunction remains an important adverse event after radical prostatectomy. Penile rehabilitation strategies have been developed to expedite and improve erectile function recovery. However, the differential efficacy and the best penile rehabilitation strategy are unclear as yet. We conducted a systematic review and network meta-analysis to investigate and compare the efficacy of different penile rehabilitation strategies. Materials and Methods: A systematic search was performed in May 2020 using PubMed® and Web of Science™ databases according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) extension statement for network meta-analysis. Studies that compared the erectile function recovery rate and adverse events between penile rehabilitation treatment groups (eg medications, devices and actions) and control group were included. We used the Bayesian approach in the network meta-analysis. Results: A total of 22 studies (2,711 patients) met our eligibility criteria. Out of 16 different penile rehabilitation strategies and schedules vs placebo, only pelvic floor muscle training (OR 5.21, 95% CrI 1.24–29.8) and 100 mg sildenafil regular doses, ie once daily or nightly (OR 4.00, 95% CrI 1.40–13.4) were associated with a significantly higher likelihood of erectile function recovery. The certainty of results for 100 mg sildenafil regular dose was moderate, while pelvic floor muscle training had low certainty. The sensitivity analysis confirmed that the regular high dose of phosphodiesterase-5 inhibitors regardless of type vs placebo (OR 2.09, 95% CrI 1.06–4.17) was associated with a significantly higher likelihood of erectile function recovery with a moderate certainty. The on-demand doses of phosphodiesterase-5 inhibitors were not proven to be more beneficial than placebo. Secondary outcomes such as adverse events were not analyzed due to incomplete data in the literature. However, no serious adverse events were reported in any of the studies. Conclusions: Sildenafil 100 mg regular dose is the best penile rehabilitation strategy to improve erectile function recovery rates after radical prostatectomy. Although pelvic floor muscle training has been shown to be effective in increasing the erectile function recovery rate, well designed randomized controlled trials with larger sample sizes are needed to confirm the presented early results. The on-demand dose of phosphodiesterase-5 inhibitors should not be considered as a penile rehabilitation strategy. References 1. : Penile Rehabilitation for Postprostatectomy Erectile Dysfunction. Edited by Cochrane Urology Group. Cochrane Database Systematic Reviews 2018. Available at: http://doi.wiley.com/10.1002/14651858.CD012414.pub2. Accessed May 19, 2020. Google Scholar 2. : Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy. Eur Urol 2012; 62: 418. 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Link, Google Scholar © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 205Issue 4April 2021Page: 1018-1030 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordsprostatic neoplasmspenisprostatectomyerectile dysfunctionurogenital surgical proceduresMetricsAuthor Information Reza Sari Motlagh Department of Urology, Medical University of Vienna, Vienna, Austria Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran More articles by this author Mohammad Abufaraj Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan The National Center for Diabetes, Endocrinology and Genetics, The University of Jordan, Amman, Jordan More articles by this author Lin Yang Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Canada Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada More articles by this author Keiichiro Mori Department of Urology, Medical University of Vienna, Vienna, Austria Department of Urology, The Jikei University School of Medicine, Tokyo, Japan More articles by this author Benjamin Pradere Department of Urology, Medical University of Vienna, Vienna, Austria Department of Urology, CHRU Tours, Francois Rabelais University, Tours, France More articles by this author Ekaterina Laukhtina Department of Urology, Medical University of Vienna, Vienna, Austria Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia More articles by this author Hadi Mostafaei Department of Urology, Medical University of Vienna, Vienna, Austria Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran More articles by this author Victor M. Schuettfort Department of Urology, Medical University of Vienna, Vienna, Austria Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany More articles by this author Fahad Quhal Department of Urology, Medical University of Vienna, Vienna, Austria King Fahad Specialist Hospital, Dammam, Saudi Arabia More articles by this author Francesco Montorsi Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy More articles by this author Mohsen Amjadi Department of Urology, Tabriz University of Medical Sciences, Tabriz, Iran More articles by this author Christian Gratzke Department of Urology, University Hospital Freiburg, Freiburg, Germany More articles by this author Shahrokh F. Shariat Department of Urology, Medical University of Vienna, Vienna, Austria Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia Department of Urology, Weil Cornell Medical College, New York, New York Department of Urology, University of Texas Southwestern, Dallas, Texas Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic European Association of Urology Research Foundation, Arnhem, Netherlands *Correspondence: Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090Vienna , Austria telephone: 43 1 4040026150; E-mail Address: [email protected] More articles by this author Expand All Advertisement Loading ...
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