Use of ED pharmacotherapy highest immediately after lap/robotic RP

Radical prostatectomy patients are most likely to employ pharmacotherapy for erectile dysfunction in the immediate postoperative period, with those who undergo laparoscopic/robotic prostatectomy having the greatest rate of usage, investigators from Brigham and Women's Hospital and Harvard Medical School in Boston reported here.

Results of the study came from 14,727 men who underwent prostatectomy between 2003 and 2005. Researchers assessed the use of pharmacotherapy for ED at baseline (up to 3 months prior to prostatectomy) and up to 18 months following surgery.

"It was interesting to find that men undergoing radical prostatectomy, particularly via the laparoscopic/robotic approach, were more likely to employ phosphodiesterase type-5 inhibitor therapy in the period 0 to 6 months postoperatively," said Michaella M. Prasad, MD, who worked on the study with Jim C. Hu, MD, and colleagues.

Dr. Prasad added that while the immediate postoperative period is "early to consider pharmacotherapy for erectile dysfunction," it is when the highest percentage of new prescriptions were distributed in the Harvard study.

The majority of subjects (11,719) in the analysis underwent retropubic radical prostatectomy. A smaller proportion (2,352) received laparoscopic/robotic surgery, while 656 had the perineal approach.

Mean age did not differ significantly by surgical approach (p>.05). Use of PDE-5 inhibitors was greater than that of injectable and alprostadil suppository (MUSE) therapies.

Prior to surgery, subjects exhibited similar usage of PDE-5 inhibitors across surgical methods, with little use of injectable and suppository therapies. But usage increased significantly from baseline at the 6-, 12-, and 18-month follow-up marks, with the greatest amount of PDE-5 inhibitor use coming in the laparoscopic/robotic group at 6 months.