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Meta-Analysis
. 2018 Oct 23;10(10):CD012414.
doi: 10.1002/14651858.CD012414.pub2.

Penile rehabilitation for postprostatectomy erectile dysfunction

Yiannis A Philippou  1 , Jae Hung Jung, Martin J Steggall, Stephen T O'Driscoll, Caitlin J Bakker, Joshua A Bodie, Philipp Dahm
Affiliations
Meta-Analysis

Penile rehabilitation for postprostatectomy erectile dysfunction

Yiannis A Philippou et al. Cochrane Database Syst Rev. .

Abstract

Background: Despite efforts to preserve the neurovascular bundles with nerve-sparing surgery, erectile dysfunction remains common following radical prostatectomy. Postoperative penile rehabilitation seeks to restore erectile function but results have been conflicting.

Objectives: To evaluate the effects of penile rehabilitation strategies in restoring erectile function following radical prostatectomy for prostate cancer.

Search methods: We performed a comprehensive search of multiple databases (CENTRAL, MEDLINE, Embase), the Cochrane Library, Web of Science, clinical trial registries (ClinicalTrials.gov, International Clinical Trials Registry Platform) and a grey literature repository (Grey Literature Report) from their inception through to 3 January 2018. We also searched the reference lists of other relevant publications and abstract proceedings. We applied no language restrictions.

Selection criteria: We included randomised or quasi-randomised trials with a parallel or cross-over design.

Data collection and analysis: We used standard Cochrane methodological procedures. Two review authors independently screened the literature, extracted data, assessed risk of bias and rated quality of evidence according to GRADE on a per-outcome basis. Primary outcomes were self-reported potency, erectile function measured by validated questionnaires (with potency defined as an International Index of Erectile Function (IIEF-EF) score of 19 or greater and or an IIEF-5 of score of 17 or greater) and serious adverse events. For all quality of life assessments on a continuous scale, higher values indicated better quality of life.

Main results: We included eight randomised controlled trials with 1699 participants across three comparisons. This abstract focuses on the primary outcomes of this review only.Scheduled phosphodiesterase type 5 inhibitors (PDE5I) versus placebo or no treatmentScheduled PDE5I may have little or no effect on short-term (up to 12 months) self-reported potency (risk ratio (RR) 1.13, 95% confidence interval (CI) 0.91 to1.41; very low quality evidence), which corresponds to 47 more men with self-reported potency per 1000 (95% CI 33 fewer to 149 more) and short-term erectile function as assessed by a validated instrument (RR 1.11, 95% CI 0.80 to 1.55; very low quality evidence), which corresponds to 28 more men per 1000 (95% CI 50 fewer to 138 more), but we are very uncertain of both of these findings. Scheduled PDE5I may result in fewer serious adverse events compared to placebo (RR 0.32, 95% CI 0.11 to 0.94; low quality evidence), though this does not appear biologically plausible and may represent a chance finding. We are also very uncertain of this finding. We found no long-term (longer than 12 months) data for any of the three primary outcomes.Scheduled PDE5I versus on-demand PDE5I Daily PDE5I appears to result in little to no difference in both short-term and long-term (greater than 12 months) self-reported potency (short term: RR 0.97, 95% CI 0.62 to 1.53; long term: RR 1.00, 95% CI 0.60 to 1.67; both very low quality evidence); this corresponds to nine fewer men with self-reported short-term potency per 1000 (95% CI 119 fewer to 166 more) and zero fewer men with self-reported long-term potency per 1000 (95% CI 153 fewer to 257 more). We are very uncertain of these findings. Daily PDE5I appears to result in little to no difference in short-term and long-term erectile function (short term: RR 1.00, 95% CI 0.65 to 1.55; long term; RR 0.74, 95% CI 0.48 to 1.14; both very-low quality evidence), which corresponds to zero men with short-term erectile dysfunction per 1000 (95% CI 80 fewer to 125 more) and 119 fewer men with long-term erectile dysfunction per 1000 (95% CI 239 fewer to 64 more). We are very uncertain of these findings. Scheduled PDE5I may result in little or no effects on short-term adverse events (RR 0.69 95% CI 0.12 to 4.04; very low quality evidence), which corresponds to seven fewer men with short-term serious adverse events (95% CI 18 fewer to 64 more), but we are very uncertain of these findings. We found no long-term data for serious adverse events.Scheduled PDE5I versus scheduled intraurethral prostaglandin E1At short-term follow-up, daily PDE5I may result in little or no effect on self-reported potency (RR 1.10, 95% CI 0.79, to 1.52; very low quality evidence), which corresponds to 46 more men per 1000 (95% CI 97 fewer to 241 more). Daily PDE5I may result in a small improvement of erectile function (RR 1.64, 95% CI 0.84 to 3.20; very low quality evidence), which corresponds to 92 more men per 1000 (95% CI 23 fewer to 318 more) but we are very uncertain of both these findings. We found no long-term (longer than 12 months) data for any of the three primary outcomes.We found no evidence for any other comparisons and were unable to perform any of the preplanned subgroup analyses based on nerve-sparing approach, age or baseline erectile function.

Authors' conclusions: Based on mostly very-low and some low-quality evidence, penile rehabilitation strategies consisting of scheduled PDE5I use following radical prostatectomy may not promote self-reported potency and erectile function any more than on demand use.

PubMed Disclaimer

Conflict of interest statement

YP: none.

JHJ: none.

MS: none.

SO: none.

CB: none.

JB: none

PD: none.

Figures

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1
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Study flow diagram.
See this image and copyright information in PMC

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  • doi: 10.1002/14651858.CD012414

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References

References to studies included in this review

Aydogdu 2011 {published data only}
    1. Aydogdu O, Gokce MI, Burgu B, Baltacı S, Yaman O. Tadalafil rehabilitation therapy preserves penile size after bilateral nerve sparing radical retropubic prostatectomy. International Brazilian Journal of Urology 2011;37(3):336‐44. - PubMed
Kim 2016 {published data only}
    1. Hawksworth DJ, Kim DJ, Travis JA, Cullen J, Hurwitz L, Rosner IL, et al. Evaluation of nocturnal tumescence and its response to nightly sildenafil citrate during acute recovery following radical prostatectomy: a randomized, double blind, placebo‐controlled study. Journal of Sexual Medicine 2014;11:189‐90.
    1. Kim DJ, Hawksworth DJ, Hurwitz LM, Cullen J, Rosner IL, Lue TF, et al. A prospective, randomized, placebo‐controlled trial of on‐demand vs. nightly sildenafil citrate as assessed by Rigiscan and the International Index of Erectile Function. Andrology 2016;4(1):27‐32. - PubMed
McCullough 2010 {published data only}
    1. McCullough AR, Hellstrom WG, Wang R, Lepor H, Wagner KR, Engel JD. Recovery of erectile function after nerve sparing radical prostatectomy and penile rehabilitation with nightly intraurethral alprostadil versus sildenafil citrate. Journal of Urology 2010;183(6):2451‐6. - PubMed
Montorsi 2008 {published data only}
    1. Montorsi F, Brock G, Lee J, Shapiro J, Poppel H, Graefen M, et al. Effect of nightly versus on‐demand vardenafil on recovery of erectile function in men following bilateral nerve‐sparing radical prostatectomy. European Urology 2008;54(4):924‐31. - PubMed
Montorsi 2014 {published data only}
    1. Brock G, Montorsi F, Costa P, Shah N, Jabaloyas JM, Hammerer P, et al. Tadalafil once a day significantly reduces penile length‐loss in patients post bilateral nerve‐sparing radical prostatectomy (NSRP) – results from a randomized controlled trial. Journal of Urology 2014;191(4 Suppl):e530‐1.
    1. Brock G, Montorsi F, Costa P, Shah N, Martinez‐Jabaloyas JM, Hammerer P, et al. Effect of tadalafil once daily on penile length loss and morning erections in patients after bilateral nerve‐sparing radical prostatectomy: results from a randomized controlled trial. Urology 2015;85(5):1090‐6. - PubMed
    1. Moncada I, Bethencourt F, Turbi C, Buettner H, Henneges C, Salamanca J. Effects of tadalafil once daily (OaD) or on‐demand (PRN) versus placebo on time to recovery of erectile function (EF) in patients post bilateral nerve‐sparing radical prostatectomy (NSRP). Journal of Sexual Medicine 2014;11:19‐20.
    1. Moncada I, Bethencourt FR, Turbi C, Buttner H, Henneges C, Martinez Salamanca JI. Effects of tadalafil once daily (OaD) or on‐demand (PRN) versus placebo on time to recovery of erectile function (EF) in patients post bilateral nerve‐sparing radical prostatectomy (nsRP). European Urology, Supplements 2014;13(1):e598‐a.
    1. Moncada I, Bethencourt FR, Lledó‐García E, Romero‐Otero J, Turbi C, Büttner H, et al. Effects of tadalafil once daily or on demand versus placebo on time to recovery of erectile function in patients after bilateral nerve‐sparing radical prostatectomy. World Journal of Urology 2015;33(7):1031‐8. - PMC - PubMed
Pace 2010 {published data only}
    1. Pace G, Rosso A, Vicentini C. Penile rehabilitation therapy following radical prostatectomy. Disability and Rehabilitation 2010;32(14):1204‐8. - PubMed
Padma‐Nathan 2008 {published data only}
    1. Padma‐Nathan H, McCullough AR, Levine LA, Lipshultz LI, Siegel R, Montorsi F, et al. Randomized, double‐blind, placebo‐controlled study of postoperative nightly sildenafil citrate for the prevention of erectile dysfunction after bilateral nerve‐sparing radical prostatectomy. International Journal of Impotence Research 2008;20(5):479‐86. - PubMed
Pavlovich 2013 {published data only}
    1. Pavlovich CP, Levinson AW, Su LM, Mettee LZ, Feng Z, Bivalacqua TJ, et al. Nightly vs on‐demand sildenafil for penile rehabilitation after minimally invasive nerve‐sparing radical prostatectomy: results of a randomized double‐blind trial with placebo. BJU International 2013;112(6):844‐51. - PubMed

References to studies excluded from this review

Bannowsky 2008 {published data only}
    1. Bannowsky A, Schulze H, Horst C, Hautmann S, Junemann KP. Recovery of erectile function after nerve‐sparing radical prostatectomy: improvement with nightly low‐dose sildenafil. BJU International 2008;101(10):1279‐83. - PubMed
Bannowsky 2010 {published data only}
    1. Bannowsky A, Schulze H, Junemann KP. Rehabilitative therapy for erectile function after nerve‐sparing radical prostatectomy. Journal of Men's Health December 2010;7(4):390‐395.
    1. Bannowsky A, Schulze H, Uckert S, Junemann KP. Rehabilitation of erectile function two years after nerve‐sparing radical prostatectomy: Is there a real significant effect with nightly low‐dose sildenafil (25 mg)?. [German]. Journal fur Urologie und Urogynakologie 2014;21(3):16‐21.
    1. Bannowsky A, Schulze H, Horst C, Junemann KP. Nerve‐sparing radical prostatectomy with nightly low‐dose sildenafil. Rehabilitation of erectile function. Urologe 2010;49(12):1516‐21. - PubMed
Bannowsky 2012 {published data only}
    1. Bannowsky A, Ahlen H, Loch, T. Increasing the dose of vardenafil on a daily basis does not improve erectile function after unilateral nerve‐sparing radical prostatectomy. Journal of Sexual Medicine 2012;9(5):1448‐53. - PubMed
Brock 2003 {published data only}
    1. Brock G, Nehra A, Lipshultz LI, Karlin GS, Gleave M, Seger M, et al. Safety and efficacy of vardenafil for the treatment of men with erectile dysfunction after radical retropubic prostatectomy. Journal of Urology 2003;170(4 Pt 1):1278‐83. - PubMed
Canat 2015 {published data only}
    1. Canat L, Guner B, Gurbuz C, Atis G, Caskurlu T. Effects of three‐times‐per‐week versus on‐demand tadalafil treatment on erectile function and continence recovery following bilateral nerve sparing radical prostatectomy: results of a prospective, randomized, and single‐center study. Kaohsiung Journal of Medical Sciences 2015;31(2):90‐5. - PMC - PubMed
Cavallini 2005 {published data only}
    1. Cavallini G, Modenini F, Vitali G, Koverech A. Acetyl‐L‐carnitine plus propionyl‐L‐carnitine improve efficacy of sildenafil in treatment of erectile dysfunction after bilateral nerve‐sparing radical retropubic prostatectomy. Urology 2005;66(5):1080‐5. - PubMed
Chambers 2015 {published data only}
    1. Chambers SK, Occhipinti S, Schover L, Nielsen L, Zajdlewicz L, Clutton S, et al. A randomised controlled trial of a couples‐based sexuality intervention for men with localised prostate cancer and their female partners. Psycho‐Oncology 2015;24(7):748‐56. - PubMed
Engel 2011 {published data only}
    1. Engel JD. Effect on sexual function of a vacuum erection device post‐prostatectomy. Canadian Journal of Urology 2011;18(3):5721‐5. - PubMed
Fode 2014 {published data only}
    1. Fode M, Borre M, Ohl DA, Lichtbach J, Sonksen J. Penile vibratory stimulation in the recovery of urinary continence and erectile function after nerve‐sparing radical prostatectomy: a randomized, controlled trial. BJU International 2014;114(1):111‐7. - PMC - PubMed
Kim 2017 {published data only}
    1. Kim KS, Kim TH, Noh JH, Bae JH, Oh CY, Cho JS, et al. Comparison of efficacy and safety for erectile dysfunction of mirodenalfil 50mg once daily and 100mg on‐demand in patients with radical prostatectomy: multicenter, randomized trial. Journal of Urology 2017;197(4 Suppl 1):e1345.
Kohler 2007 {published data only}
    1. Kohler TS, Pedro R, Hendlin K, Utz W, Ugarte R, Reddy P, et al. A pilot study on the early use of the vacuum erection device after radical retropubic prostatectomy. BJU International 2007;100(4):858‐62. - PubMed
Kosev 2013 {published data only}
    1. Kosev P, Anakievski D, Chankov P, Hinev A. Sexual rehabilitation after radical prostatectomy. European Urology, Supplements 2013;12(4):e1117.
McCullough 2008 {published data only}
    1. McCullough AR, LevineLA, Padma‐Nathan H. Return of nocturnal erections and erectile function after bilateral nerve‐sparing radical prostatectomy in men treated nightly with sildenafil citrate: subanalysis of a longitudinal randomized double‐blind placebo‐controlled trial. Journal of Sexual Medicine Feb 2008;5(2):476‐84. - PubMed
Montorsi 1997 {published data only}
    1. Montorsi F, Guazzoni G, Strambi LF, Pozzo LF, Nava L, Barbieri L, et al. Recovery of spontaneous erectile function after nerve‐sparing radical retropubic prostatectomy with and without early intracavernous injections of alprostadil: results of a prospective, randomized trial. Journal of Urology 1997;158(4):1408‐10. - PubMed
Montorsi 2004 {published data only}
    1. Montorsi F, Nathan HP, McCullough A, Brock GB, Broderick G, Ahuja S, et al. Tadalafil in the treatment of erectile dysfunction following bilateral nerve sparing radical retropubic prostatectomy: a randomized, double‐blind, placebo controlled trial. Journal of Urology 2004;172(3):1036‐41. - PubMed
Mulhall 2013 {published data only}
    1. Mulhall JP, Burnett AL, Wang R, McVary KT, Moul JW, Bowden CH, et al. A phase 3, placebo controlled study of the safety and efficacy of avanafil for the treatment of erectile dysfunction after nerve sparing radical prostatectomy. Journal of Urology 2013;189(6):2229‐36. - PubMed
    1. Mulhall JP, Moul JW, Wang R, Shin D, Engel JD, Day WW, et al. A randomized, double‐blind, placebo controlled, parallel group, multicenter study of the safety and efficacy of avanafil in the treatment of erectile dysfunction following bilateral, nerve‐sparing radical prostatectomy. Journal of Sexual Medicine 2013;10:147.
Naccarato 2016 {published data only}
    1. Naccarato AM, Reis LO, Ferreira U, Denardi F. Psychotherapy and phosphodiesterase‐5 inhibitor in early rehabilitation after radical prostatectomy: a prospective randomised controlled trial. Andrologia 2016;48(10):1183‐7. - PubMed
Nehra 2005 {published data only}
    1. Nehra A, Grantmyre J, Nadel A, Thibonnier M, Brock G. Vardenafil improved patient satisfaction with erectile hardness, orgasmic function and sexual experience in men with erectile dysfunction following nerve sparing radical prostatectomy. Journal of Urology 2005;173(6):2067‐71. - PubMed
Raina 2007 {published data only}
    1. Raina R, Pahlajani G, Agarwal A, Zippe CD. The early use of transurethral alprostadil after radical prostatectomy potentially facilitates an earlier return of erectile function and successful sexual activity. BJU International 2007;100(6):1317‐21. - PubMed
Seo 2014 {published data only}
    1. Seo YE, Kim SD, Kim TH, Sung GT. The efficacy and safety of tadalafil 5 mg once daily in the treatment of erectile dysfunction after robot‐assisted laparoscopic radical prostatectomy: 1‐year follow‐up. Korean Journal of Urology 2014;55(2):112‐9. - PMC - PubMed
Yassin 2010 {published data only}
    1. Yassin AA, Haider A, Bernhard Mohr. Combination of vacuum device and PDE‐5 inhibitors for penis rehabilitation in patients after nerve‐sparing radical prostatectomy. A randomised prospective study. Sexologies 2010;19:259.

Additional references

Alemozaffar 2011
    1. Alemozaffar M, Regan MM, Cooperberg MR, Wei JT, Michalski JM, Sandler HM, et al. Prediction of erectile function following treatment for prostate cancer. JAMA 2011;306(11):1205‐14. [PUBMED: 21934053] - PMC - PubMed
American Cancer Society 2014
    1. American Cancer Society. Cancer treatment and survivorship facts and figures 2014‐2015. www.cancer.org/content/dam/cancer‐org/research/cancer‐facts‐and‐statisti... (accessed prior to 26 August 2018).
Burnett 2005
    1. Burnett AL. Erectile dysfunction following radical prostatectomy. JAMA 2005;293(21):2648‐53. - PubMed
Burnett 2013
    1. Burnett AL. Current rehabilitation strategy: clinical evidence for erection recovery after radical prostatectomy. Translational Andrology and Urology 2013;2(1):24‐31. - PMC - PubMed
CADTH 2017
    1. CADTH. Phosphodiesterase type 5 inhibitors for penile rehabilitation post radical prostatectomy: a review of clinical effectiveness and guidelines. www.cadth.ca/phosphodiesterase‐type‐5‐inhibitors‐penile‐rehabilitation‐p... (accessed 7 November 2017). - PubMed
Cancer Research UK
    1. Cancer Research UK. Prostate cancer statistics. www.cancerresearchuk.org/health‐professional/cancer‐statistics/statistic... (accessed 8 December 2017).
Chang 2011
    1. Chang P, Szymanski KM, Dunn RL, Chipman JJ, Litwin MS, Nguyen PL, et al. Expanded Prostate cancer Index Composite for clinical practice: development and validation of a practical health related quality of life instrument for use in the routine clinical care of patients with prostate cancer. Journal of Urology 2011;186(3):865‐72. - PMC - PubMed
Chung 2013
    1. Chung E, Brock G. Sexual rehabilitation and cancer survivorship: a state of the art review of current literature and management strategies in male sexual dysfunction among prostate cancer survivors. Journal of Sexual Medicine 2013;10(Suppl 1):102‐11. - PubMed
Covidence [Computer program]
    1. Veritas Health Innovation. Covidence systematic review software. Melbourne, Australia: Veritas Health Innovation, 2013.
Cui 2016
    1. Cui Y, Liu X, Shi L, Gao Z. Efficacy and safety of phosphodiesterase type 5 (PDE 5) inhibitors in treating erectile dysfunction after bilateral nerve‐sparing radical prostatectomy. Andrologia 2016;48(1):20‐8. - PubMed
Egger 1997
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. BMJ 1997;315:629. - PMC - PubMed
Ficarra 2012
    1. Ficarra V, Novora G, Alhering TE, Costello A, Eastham JA, Graefen M, et al. Systematic review and meta‐analysis of studies reporting potency rates after robot‐assisted radical prostatectomy. European Urology 2012;62:418‐30. - PubMed
Fode 2013
    1. Fode M, Ohl DA, Ralph D, Sonksen J. Penile rehabilitation after radical prostatectomy: what the evidence really says. BJU international 2013;112(7):998‐1008. [PUBMED: 23826962] - PubMed
Fowler 1993
    1. Fowler FJ Jr, Barry MJ, Lu‐Yao G, Roman A, Wasson J, Wennberg JE. Patient‐reported complications and follow‐up treatment after radical prostatectomy. The National Medicare Experience: 1988‐1990 (updated June 1993). Urology 1993;42(6):622‐9. [PUBMED: 8256394] - PubMed
Gebert 2014
    1. Gebert S. Are penile prostheses a viable option to recommend for gay men?. International Journal of Urological Nursing 2014;8(3):111‐3.
GRADEpro GDT [Computer program]
    1. GRADE Working Group, McMaster University. GRADEpro GDT. Version accessed 23 September 2016. Hamilton (ON): GRADE Working Group, McMaster University, 2014.
Guyatt 2011a
    1. Guyatt GH, Oxman AD, Kunz R, Brozek J, Alonso‐Coello P, Rind D, et al. GRADE guidelines 6. Rating the quality of evidence – imprecision. Journal of Clinical Epidemiology 2011;64(12):1283‐93. - PubMed
Guyatt 2011b
    1. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction – GRADE evidence profiles and summary of findings tables. Journal of Clinical Epidemiology 2011;64(4):383‐94. [PUBMED: 21195583] - PubMed
Hatzimouratidis 2009
    1. Hatzimouratidis K, Burnett AL, Hatzichristou D, McCullough AR, Montorsi F, Mulhall JP. Phosphodiesterase type 5 inhibitors in postprostatectomy erectile dysfunction: a critical analysis of the basic science rationale and clinical application. European Urology 2009;55:334‐47. - PubMed
Heidenreich 2014
    1. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, Kwast T, et al. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent‐update 2013. European Urology 2014;65(1):124‐37. [PUBMED: 24207135] - PubMed
Higgins 2002
    1. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta‐analysis. Statistics in Medicine 2002;21:1539‐58. - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analysis. BMJ 2003;327:557‐60. - PMC - PubMed
Higgins 2011a
    1. Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 (updated March 2011). The Cochrane Collaboration. Available from handbook.cochrane.org.
Higgins 2011b
    1. Higgins JP, Deeks JJ, Altman DG. Chapter 16: Special topics in statistics. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Higgins 2011c
    1. Higgins JP, Deeks JJ, Altman DG. Chapter 16: Special topics in statistics. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Hunsley 1992
    1. Hunsley J. Development of the Treatment Acceptability Questionnaire. Journal of Psychopathology and Behavioral Assessment 1992;14(1):55‐64.
Jaeschke 1989
    1. Jaeschke R, Singer J, Guyatt GH. Measurement of health status. Ascertaining the minimal clinically important difference. Controlled Clinical Trials 1989;10(4):407‐15. - PubMed
Johnston 2013
    1. Johnston BC, Patrick DL, Busse JW, Schünemann HJ, Agarwal A, Guyatt GH. Patient‐reported outcomes in meta‐analyses – Part 1: assessing risk of bias and combining outcomes. Health and Quality of Life Outcomes 2013;11:109. - PMC - PubMed
Jüni 2001
    1. Jüni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials. BMJ 2001;323(7303):42‐6. - PMC - PubMed
Kacker 2013
    1. Kacker R, O'Leary MP. Penile rehabilitation after radical prostatectomy. Trends in Urology & Men's Health 2013;September/October:12‐17.
Kendirci 2006
    1. Kendirci M, Bejma J, Hellstrom WJG. Update on erectile dysfunction in prostate cancer patients. Current Opinion in Urology 2006;16(3):186‐95. - PubMed
Kubin 2003
    1. Kubin M, Wagner G, Fugl‐Meyer AR. Epidemiology of erectile dysfunction. International Journal of Impotence Research 2003;15(1):63‐71. - PubMed
Kundu 2004
    1. Kundu SD, Roehl KA, Eggener SE, Antenor JA, Han M, Catalona WJ. Potency, continence and complications in 3,477 consecutive radical retropubic prostatectomies. Journal of Urology 2004;172(6 Pt 1):2227‐31. [PUBMED: 15538237] - PubMed
Lalong‐Muh 2012
    1. Lalong‐Muh J, Treacy C, Steggall M. Erectile dysfunction following retropubic prostatectomy. British Journal of Nursing 2012;22(4):S4‐S9. - PubMed
Li 2014
    1. Li J, Shi Q, Pu C, Tang Y, Bai Y, Yuan H, et al. Phosphodiesterase type 5 inhibitors for the treatment of post‐nerve sparing radical prostatectomy erectile dysfunction in men. Scientific Reports 2014;4:5801. - PMC - PubMed
Liberati 2009
    1. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta‐analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Medicine 2009;6(7):e1000100. [DOI: 10.1371/journal.pmed.1000100] - DOI - PMC - PubMed
Lowrance 2012
    1. Lowrance WT, Eastham JA, Savage C, Maschino AC, Laudone VP, Dechet CB, et al. Contemporary open and robotic radical prostatectomy practice patterns among urologists in the United States. Journal of Urology 2012;187(6):2087‐92. - PMC - PubMed
Mulhall 2009
    1. Mulhall JP. Defining and reporting erectile function outcomes after radical prostatectomy: challenges and misconceptions. Journal of Urology 2009;181(2):462‐71. [PUBMED: 19084865] - PubMed
Mulhall 2010
    1. Mulhall JP, Bella AJ, Briganti A, McCullough A, Brock G. Erectile function rehabilitation in the radical prostatectomy patient. Journal of Sexual Medicine 2010;7(4 (Pt 2)):1687‐98. - PubMed
National Cancer Institute
    1. National Cancer Institute. Common toxicity criteria. ctep.cancer.gov/protocoldevelopment/electronic_applications/ctc.htm (accessed 9 November 2017).
NIH Consensus Conference 1993
    1. NIH Consensus Conference. Impotence – Consensus Development Panel on Impotence. Journal of the American Medical Association 1993;270:83‐90.
Penson 2008
    1. Penson DF, McLerran D, Feng Z, Li L, Albertsen PC, Gilliland FD, et al. 5‐year urinary and sexual outcomes after radical prostatectomy: results from the Prostate Cancer Outcomes Study. Journal of Urology 2008;179(5 Suppl):S40‐4. [PUBMED: 18405749] - PubMed
Philippou 2016
    1. Philippou YA, Steggall MJ, Treacy CL, Hirani S, O'Driscoll ST, Bakker CJ, et al. Penile rehabilitation for post‐prostatectomy erectile dysfunction. Cochrane Database of Systematic Reviews 2016, Issue 11. [DOI: 10.1002/14651858.CD012414] - DOI - PMC - PubMed
Qiu 2016
    1. Qiu S, Tang Z, Deng L, Liu L, Han P, Yang L, et al. Comparisons of regular and on‐demand regimen of PED5‐Is in the treatment of ED after nerve‐sparing radical prostatectomy for prostate cancer. Scientific Reports 2016;6:32853. - PMC - PubMed
Rabbani 2000
    1. Rabbani F, Stapleton AM, Kattan MW, Wheeler TM, Scardino PT. Factors predicting recovery of erections after radical prostatectomy. Journal of Urology 2000;164(6):1929‐34. [PUBMED: 11061884] - PubMed
Rabbani 2010
    1. Rabbani F, Schiff J, Peicuch M, Yunis LH, Eastham JA, Scardino PT, et al. Time course of recovery of erectile function after radical retropubic prostatectomy: does anyone recovery after 2 years?. Journal of Sexual Medicine 2010;7:3984‐90. - PubMed
Raina 2010
    1. Raina R, Pahlajani G, Agarwal A, Jones S, Zippe C. Long‐term potency after early use of a vacuum erection device following radical prostatectomy. British Journal of Urology International 2010;106(11):1719‐22. - PubMed
Review Manager 2014 [Computer program]
    1. Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Rosen 1997
    1. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997;49(6):822‐30. - PubMed
Rosen 2011
    1. Rosen RC, Allen KR, Ni X, Araujo AB. Minimal clinically important differences in the erectile function domain of the International Index of Erectile Function scale. European Urology 2011;60(5):1010‐6. - PubMed
Rozet 2005
    1. Rozet F, Galiano M, Cathelineau X, Barret E, Cathala N, Vallancien G. Extraperitoneal laparoscopic radical prostatectomy: a prospective evaluation of 600 cases. Journal of Urology 2005;174(3):908‐11. [PUBMED: 16093985] - PubMed
Salonia 2017
    1. Salonia A, Adaikan G, Buvat J, Carrier S, El‐Meliegy A, Hatzimouratidis K, et al. Sexual rehabilitation after treatment for prostate cancer—Part 2: recommendations from the Fourth International Consultation for Sexual Medicine (ICSM 2015). Journal of Sexual Medicine 2017;14:297‐315. - PubMed
Sanda 2017
    1. Sanda MG, Cadeddu JA, Kirkby E, Chen RC, Crispino T, Fontanarosa J, Freedland SJ, Greene K, Klotz LH, Makarov DV, Nelson JB, Rodrigues G, Sandler HM Taplin ME, Treadwell JR. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. Part I: Risk Stratification, Shared Decision Making, and Care Options.. J Urol. 2017 Dec 15;199(3):683–690. - PubMed
Schünemann 2011
    1. Schünemann HJ, Oxman AD, Higgins JP, Vist GE, Glasziou P, Guyatt GH. Chapter 11: Presenting results and 'Summary of findings' tables. In: Higgins JP, Green S, editor(s), Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Segal 2013
    1. Segal RL, Bivalacqua TJ, Burnett AL. Current penile‐rehabilitation strategies: clinical evidence. Arab Journal of Urology 2013;11:230‐6. - PMC - PubMed
Skolarus 2015
    1. Skolarus TA, Dunn RL, Sanda MG, Chang P, Greenfield TK, Litwin MS, et al. Minimally important difference for the Expanded Prostate Cancer Index Composite Short Form. Urology 2015;85(1):101‐5. - PMC - PubMed
Spaliviero 2010
    1. Spaliviero M, Strom KH, Gu X, Araki M, Culkin DJ, Wong C. Does Greenlight HPS (™) laser photoselective vaporization prostatectomy affect sexual function?. Journal of Endourology 2010;24(12):2051‐7. - PubMed
Stanford 2000
    1. Stanford JL, Feng Z, Hamilton AS, Gilliland FD, Stephenson RA, Eley JW, et al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. JAMA 2000;283(3):354‐60. [PUBMED: 10647798] - PubMed
Steggall 2011
    1. Steggall MJ. Clinical management of erectile dysfunction. International Journal of Urological Nursing 2011;5(2):52‐8.
Sterne 2011
    1. Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta‐analyses of randomised controlled trials. BMJ (Clinical Research Ed.) 2011;343:d4002. [DOI: 10.1136/bmj.d4002] - DOI - PubMed
Szymanski 2010
    1. Szymanski KM, Wei JT, Dunn RL, Sanda MG. Development and validation of an abbreviated version of the Expanded Prostate cancer Index Composite instrument for measuring health‐related quality of life among prostate cancer survivors. Urology 2010;76(5):1245‐50. - PMC - PubMed
Tian 2017
    1. Tian D, Wang XY, Zong HT, Zhang Y. Efficacy and safety of short‐and long‐term, regular and on‐demand regimens of phosphodiesterase type 5 inhibitors in treating erectile dysfunction after nerve‐sparing radical prostatectomy: a systematic review and meta‐analysis.. Clinical Interventions in Aging 2017;12:405‐12. - PMC - PubMed
U.S. Cancer Statistics Working Group
    1. U.S. Cancer Statistics Working Group. U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999‐2014 Incidence and Mortality Web‐based Report. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2017. www.cdc.gov/uscs (accessed 8 December 2017).
Wang 2014
    1. Wang X, Wang X, Liu T, He Q, Wang Y, Zhang X. Systematic review and meta‐analysis of the use of phosphodiesterase type 5 inhibitors for treatment of erectile dysfunction following bilateral nerve‐sparing radical prostatectomy. PloS One 2014;9(3):e91327. - PMC - PubMed
Wei 2000
    1. Wei JT, Dunn RL, Litwin MS, Sandler HM, Sanda MG. Development and validation of the Expanded Prostate cancer Index Composite (EPIC) for comprehensive assessment of health‐related quality of life in men with prostate cancer. Urology 2000;56(6):899‐905. - PubMed
Weyne 2015
    1. Weyne E, Castiglione F, Aa F, Bivalacqua TJ, Albersen M. Landmarks in erectile function recovery after radical prostatectomy. Nature Reviews. Urology 2015;12(5):289‐97. [PUBMED: 25868558] - PubMed
Wood 2008
    1. Wood L, Egger M, Gluud LL, Schulz KF, Jüni P, Altman DG, et al. Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta‐epidemiological study. BMJ (Clinical Research Ed.) 2008;336(7644):601‐5. [DOI: 10.1136/bmj.39465.451748.AD] - DOI - PMC - PubMed

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