Male erectile dysfunction
ICD-10 F52.2; N48.4 · ICD-11 HA01.1

Erectile Dysfunction After Radical Prostatectomy or Curative Pelvic Surgery

Men who have undergone radical prostatectomy or curative pelvic surgery for prostate cancer frequently experience erectile dysfunction as a consequence of treatment. Structured penile rehabilitation initiated promptly after surgery is central to managing this condition.

Clinical scenario

This protocol targets patients with a history of radical prostatectomy or curative pelvic surgery for prostate cancer. PDE5 inhibitors are recognised as first-line therapy in patients who have undergone nerve-sparing surgery, regardless of the specific surgical technique used. Early initiation of pro-erectile treatment — starting at the earliest opportunity after surgery — is the guiding principle.

Treatment approach (partial overview)

The protocol involves early-start oral therapy from a specific inhibitor class, supported by evidence from a large network of rehabilitation trials. Combination approaches incorporating a mechanical device are also addressed. The complete regimen — including sequencing, specific options, and supporting evidence — is available in the full protocol.

Treatment goal

Recovery of erectile function sufficient for satisfactory intercourse.

Instant Access to Structured Evidence-Based Regimens

References

  1. Start pro-erectile treatments at the earliest opportunity after radical prostatectomy/pelvic surgery and other curative treatments for PCa.
  2. PDE5Is have been considered as the first-line therapy in patients who have undergone nerve-sparing surgery, regardless of the surgical technique used.
  3. An updated meta-analysis including 22 trials comparing 16 different rehabilitation protocols showed that daily administration of sildenafil 100mg was the most effective strategy to recover EF after RP.
  4. Findings from two network meta-analyses showed that combination therapy with VED and PDE5Is offers clear advantages over monotherapy, even in post-RP patients.
  5. Efficacy is defined as an erection, with rigidity, sufficient for satisfactory intercourse.
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