Penile Rehabilitation Therapy Following Radical Prostatectomy: A Meta-Analysis

Chunhui Liu, David Lopez, Ming Chen, Run Wang

Research output: Contribution to journalReview article

15 Citations (Scopus)

Abstract

Background Penile rehabilitation, defined as the use of any drug or device at or after radical prostatectomy to maximize erectile function recovery, is commonly used for post-prostatectomy erectile dysfunction; however, conflicting results based on each study make it difficult to give a recommendation for clinical practice. Aim To clarify the effect of oral phosphodiesterase type 5 inhibitors (PDE5is), vacuum erection devices, intracorporeal injection therapy, and the combination of these treatments on penile rehabilitation. Methods A comprehensive publication search was done through the PubMed and Embase databases up to February 8, 2017. The reference lists of the retrieved studies also were investigated. Data were analyzed using STATA 12.0. A fixed- or random-effects model was used to calculate the overall combined odds ratio (OR) or standard mean differences (SMDs). Publication bias was assessed using the Begg and Egger tests. Outcomes Change in sexual function before and after treatment. Results After screening, 11 randomized controlled trials and 5 case-control studies were included. The overall meta-analysis showed that penile rehabilitation with PDE5is, vacuum erection devices, and intracorporeal injection significantly increased the number of patients with erectile function improvement (OR = 2.800, 95% CI = 1.932–4.059, P =.000) and International Index of Erectile Function (IIEF) score (SMD = 5.896, 95% CI = 4.032–7.760, P =.000). In subgroup analysis based on study design, randomized controlled trials and case-control studies showed that penile rehabilitation increased the number of patients with erectile function improvement (randomized controlled trials: OR = 2.154, 95% CI = 1.600–2.895, P =.000; case-control studies: OR = 2.800, 95% CI = 1.932–4.059, P =.000). Subgroup analysis for PDE5i treatment also only demonstrated an increased patient response rate (OR = 2.161, 95% CI = 1.675–2.788, P =.000) and IIEF scores (SMD = 0.922, 95% CI = 0.545–1.300, P =.000). However, after PDE5i washout, there was no improvement of spontaneous erectile function (OR = 1.027, 95% CI = 0.713–1.478, P =.610). Clinical Translation This study provides information about the efficacy of penile rehabilitation that can help clinicians decide treatment strategies. Strengths and Limitations This meta-analysis has higher statistical power than each study. Preoperative patient characteristics, various treatment methods, and different follow-up times might bring bias to pooled effects. Conclusion Our meta-analysis confirmed that administration of PDE5is, vacuum erection devices, and intracorporeal injection after radical prostatectomy can increase erection function during treatments. However, current evidence does not support that penile rehabilitation with PDE5is can improve recovery of spontaneous erectile function. Further studies with adequate follow-up and larger samples should be conducted to generate a comprehensive conclusion. Liu C, Lopez DS, Chen M, Wang R. Penile Rehabilitation Therapy Following Radical Prostatectomy: A Meta-Analysis. J Sex Med 2017;14:1496–1503.

Original languageEnglish (US)
Pages (from-to)1496-1503
Number of pages8
JournalJournal of Sexual Medicine
Volume14
Issue number12
DOIs
StatePublished - Dec 1 2017
Externally publishedYes

Fingerprint

Prostatectomy
Meta-Analysis
Rehabilitation
Phosphodiesterase 5 Inhibitors
Odds Ratio
Vacuum
Case-Control Studies
Equipment and Supplies
Randomized Controlled Trials
Therapeutics
Injections
Publication Bias
Recovery of Function
Erectile Dysfunction
PubMed
Publications
Databases
Pharmaceutical Preparations

Keywords

  • Erectile Dysfunction
  • Meta-Analysis
  • Radical Prostatectomy
  • Rehabilitation

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology
  • Urology

Cite this

Penile Rehabilitation Therapy Following Radical Prostatectomy : A Meta-Analysis. / Liu, Chunhui; Lopez, David; Chen, Ming; Wang, Run.

In: Journal of Sexual Medicine, Vol. 14, No. 12, 01.12.2017, p. 1496-1503.

Research output: Contribution to journalReview article

Liu, Chunhui ; Lopez, David ; Chen, Ming ; Wang, Run. / Penile Rehabilitation Therapy Following Radical Prostatectomy : A Meta-Analysis. In: Journal of Sexual Medicine. 2017 ; Vol. 14, No. 12. pp. 1496-1503.
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abstract = "Background Penile rehabilitation, defined as the use of any drug or device at or after radical prostatectomy to maximize erectile function recovery, is commonly used for post-prostatectomy erectile dysfunction; however, conflicting results based on each study make it difficult to give a recommendation for clinical practice. Aim To clarify the effect of oral phosphodiesterase type 5 inhibitors (PDE5is), vacuum erection devices, intracorporeal injection therapy, and the combination of these treatments on penile rehabilitation. Methods A comprehensive publication search was done through the PubMed and Embase databases up to February 8, 2017. The reference lists of the retrieved studies also were investigated. Data were analyzed using STATA 12.0. A fixed- or random-effects model was used to calculate the overall combined odds ratio (OR) or standard mean differences (SMDs). Publication bias was assessed using the Begg and Egger tests. Outcomes Change in sexual function before and after treatment. Results After screening, 11 randomized controlled trials and 5 case-control studies were included. The overall meta-analysis showed that penile rehabilitation with PDE5is, vacuum erection devices, and intracorporeal injection significantly increased the number of patients with erectile function improvement (OR = 2.800, 95{\%} CI = 1.932–4.059, P =.000) and International Index of Erectile Function (IIEF) score (SMD = 5.896, 95{\%} CI = 4.032–7.760, P =.000). In subgroup analysis based on study design, randomized controlled trials and case-control studies showed that penile rehabilitation increased the number of patients with erectile function improvement (randomized controlled trials: OR = 2.154, 95{\%} CI = 1.600–2.895, P =.000; case-control studies: OR = 2.800, 95{\%} CI = 1.932–4.059, P =.000). Subgroup analysis for PDE5i treatment also only demonstrated an increased patient response rate (OR = 2.161, 95{\%} CI = 1.675–2.788, P =.000) and IIEF scores (SMD = 0.922, 95{\%} CI = 0.545–1.300, P =.000). However, after PDE5i washout, there was no improvement of spontaneous erectile function (OR = 1.027, 95{\%} CI = 0.713–1.478, P =.610). Clinical Translation This study provides information about the efficacy of penile rehabilitation that can help clinicians decide treatment strategies. Strengths and Limitations This meta-analysis has higher statistical power than each study. Preoperative patient characteristics, various treatment methods, and different follow-up times might bring bias to pooled effects. Conclusion Our meta-analysis confirmed that administration of PDE5is, vacuum erection devices, and intracorporeal injection after radical prostatectomy can increase erection function during treatments. However, current evidence does not support that penile rehabilitation with PDE5is can improve recovery of spontaneous erectile function. Further studies with adequate follow-up and larger samples should be conducted to generate a comprehensive conclusion. Liu C, Lopez DS, Chen M, Wang R. Penile Rehabilitation Therapy Following Radical Prostatectomy: A Meta-Analysis. J Sex Med 2017;14:1496–1503.",
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N2 - Background Penile rehabilitation, defined as the use of any drug or device at or after radical prostatectomy to maximize erectile function recovery, is commonly used for post-prostatectomy erectile dysfunction; however, conflicting results based on each study make it difficult to give a recommendation for clinical practice. Aim To clarify the effect of oral phosphodiesterase type 5 inhibitors (PDE5is), vacuum erection devices, intracorporeal injection therapy, and the combination of these treatments on penile rehabilitation. Methods A comprehensive publication search was done through the PubMed and Embase databases up to February 8, 2017. The reference lists of the retrieved studies also were investigated. Data were analyzed using STATA 12.0. A fixed- or random-effects model was used to calculate the overall combined odds ratio (OR) or standard mean differences (SMDs). Publication bias was assessed using the Begg and Egger tests. Outcomes Change in sexual function before and after treatment. Results After screening, 11 randomized controlled trials and 5 case-control studies were included. The overall meta-analysis showed that penile rehabilitation with PDE5is, vacuum erection devices, and intracorporeal injection significantly increased the number of patients with erectile function improvement (OR = 2.800, 95% CI = 1.932–4.059, P =.000) and International Index of Erectile Function (IIEF) score (SMD = 5.896, 95% CI = 4.032–7.760, P =.000). In subgroup analysis based on study design, randomized controlled trials and case-control studies showed that penile rehabilitation increased the number of patients with erectile function improvement (randomized controlled trials: OR = 2.154, 95% CI = 1.600–2.895, P =.000; case-control studies: OR = 2.800, 95% CI = 1.932–4.059, P =.000). Subgroup analysis for PDE5i treatment also only demonstrated an increased patient response rate (OR = 2.161, 95% CI = 1.675–2.788, P =.000) and IIEF scores (SMD = 0.922, 95% CI = 0.545–1.300, P =.000). However, after PDE5i washout, there was no improvement of spontaneous erectile function (OR = 1.027, 95% CI = 0.713–1.478, P =.610). Clinical Translation This study provides information about the efficacy of penile rehabilitation that can help clinicians decide treatment strategies. Strengths and Limitations This meta-analysis has higher statistical power than each study. Preoperative patient characteristics, various treatment methods, and different follow-up times might bring bias to pooled effects. Conclusion Our meta-analysis confirmed that administration of PDE5is, vacuum erection devices, and intracorporeal injection after radical prostatectomy can increase erection function during treatments. However, current evidence does not support that penile rehabilitation with PDE5is can improve recovery of spontaneous erectile function. Further studies with adequate follow-up and larger samples should be conducted to generate a comprehensive conclusion. Liu C, Lopez DS, Chen M, Wang R. Penile Rehabilitation Therapy Following Radical Prostatectomy: A Meta-Analysis. J Sex Med 2017;14:1496–1503.

AB - Background Penile rehabilitation, defined as the use of any drug or device at or after radical prostatectomy to maximize erectile function recovery, is commonly used for post-prostatectomy erectile dysfunction; however, conflicting results based on each study make it difficult to give a recommendation for clinical practice. Aim To clarify the effect of oral phosphodiesterase type 5 inhibitors (PDE5is), vacuum erection devices, intracorporeal injection therapy, and the combination of these treatments on penile rehabilitation. Methods A comprehensive publication search was done through the PubMed and Embase databases up to February 8, 2017. The reference lists of the retrieved studies also were investigated. Data were analyzed using STATA 12.0. A fixed- or random-effects model was used to calculate the overall combined odds ratio (OR) or standard mean differences (SMDs). Publication bias was assessed using the Begg and Egger tests. Outcomes Change in sexual function before and after treatment. Results After screening, 11 randomized controlled trials and 5 case-control studies were included. The overall meta-analysis showed that penile rehabilitation with PDE5is, vacuum erection devices, and intracorporeal injection significantly increased the number of patients with erectile function improvement (OR = 2.800, 95% CI = 1.932–4.059, P =.000) and International Index of Erectile Function (IIEF) score (SMD = 5.896, 95% CI = 4.032–7.760, P =.000). In subgroup analysis based on study design, randomized controlled trials and case-control studies showed that penile rehabilitation increased the number of patients with erectile function improvement (randomized controlled trials: OR = 2.154, 95% CI = 1.600–2.895, P =.000; case-control studies: OR = 2.800, 95% CI = 1.932–4.059, P =.000). Subgroup analysis for PDE5i treatment also only demonstrated an increased patient response rate (OR = 2.161, 95% CI = 1.675–2.788, P =.000) and IIEF scores (SMD = 0.922, 95% CI = 0.545–1.300, P =.000). However, after PDE5i washout, there was no improvement of spontaneous erectile function (OR = 1.027, 95% CI = 0.713–1.478, P =.610). Clinical Translation This study provides information about the efficacy of penile rehabilitation that can help clinicians decide treatment strategies. Strengths and Limitations This meta-analysis has higher statistical power than each study. Preoperative patient characteristics, various treatment methods, and different follow-up times might bring bias to pooled effects. Conclusion Our meta-analysis confirmed that administration of PDE5is, vacuum erection devices, and intracorporeal injection after radical prostatectomy can increase erection function during treatments. However, current evidence does not support that penile rehabilitation with PDE5is can improve recovery of spontaneous erectile function. Further studies with adequate follow-up and larger samples should be conducted to generate a comprehensive conclusion. Liu C, Lopez DS, Chen M, Wang R. Penile Rehabilitation Therapy Following Radical Prostatectomy: A Meta-Analysis. J Sex Med 2017;14:1496–1503.

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