Cancer - Prostate(구연) (E-130)

근치적 전립선 절제술을 받은 환자에 있어 타다라필 5mg을 이용한 음경재활의 최적의 시작 시점에 대한 전향적 연구
고려대학교 안암병원
심지성, 현창완, 강하은, 진현중, 태종현, 노태일, 강성구, 천준, 이정구, 강석호
Although phosphodiesterase type 5 inhibitors (PDE5-Is) are one of the standard treatments for erectile dysfunction (ED) after radical prostatectomy, consensus has not been reached on their use. The aim of study is to compare the efficacy of tadalafil 5mg once daily according to rehabilitation initiating timing in improving erectile function (EF) following nerve-sparing robot assisted radical prostatectomy (nsRARP).
Materials and methods
A total of 41 consecutive patients with adenocarcinoma of the prostate who were underwent bilateral nsRARP were prospectively randomised. The patients were divided into 2 groups according to tadalafil rehabilitation initiating timing (preRARP; n = 20; 2 wks before /postRARP; n = 21; 4 wks after). Included patients were those with ≥ 1 year of follow-up and who were potent preoperatively, determined by abridged five-item version of the International Index of Erectile Function (IIEF-5) questionnaire (≥ 17). Recovery of ED after nsRARP was defined as return to baseline sexual function (IIEF-5 ≥ 17) or patient’s answer to have successful intercourse. The difference of pre/post IIEF-5 score were evaluated and compared between groups.
The mean age was 60.4 yr of age (standard deviation: 5.7 yr); 82% and 79% of patients in the preRARP and postRARP groups achieved ED recovery after nsRARP at 1 yr. At the end of treatment, the IIEF-5 score in the preRARP group was significantly greater than postRARP group (15.6±2.1 vs. 12.8±3.5, p<0.001). Between baseline and post operative follow up, mean difference of IIEF-5 score were - 11.7±3.2, - 5.6±1.5 and - 4.1±1.1 in preRARP group while - 14.7±4.7, - 9.7±3.8 and - 5.9±3.1 in postRARP group (p = 0.208, 1 mo; p = 0.003, 6 mo; p = 0.015, 1yr follow up).
Data from our study suggest that pre operative early penile rehabilitation with once daily tadalafil 5 mg may offer benefits leading to better erectile function recovery compared with post operative initiated group.
keywords : Erectile dysfunction, Prostatectomy, PDE5i