Experimental data support the concept of cavernosal damage and suggest a protective role for daily dosage of a PDE5-I ; however , similar data have not yet been replicated in humans .
Penile rehabilitation programs are common in clinical practice , but there is no definitive evidence to support their use or the best treatment strategy .
PDE5-Is are efficacious and safe in young patients with normal preoperative erectile function who have undergone bilateral nerve-sparing radical prostatectomy .
On-dem and use of a PDE5-I may be at least as efficacious as daily use .
PDE5-I use in penile rehabilitation programs is not supported by rigorous level 1 evidence -based medicine .
PDE5-Is are an efficacious and safe treatment for post-RP ED in properly selected patients .
The experimental results on the protective role of daily dosages of PDE5-Is , while robust , have not been replicated in humans .
CONTEXT  Erectile dysfunction ( ED ) after radical prostatectomy ( RP ) has a significant negative impact on a patient 's health-related quality of life .
Phosphodiesterase type 5 inhibitors ( PDE5-Is ) have recently been utilized not only as a treatment of ED in this population but also as a preventive strategy in penile rehabilitation programs .
OBJECTIVE To eluci date the pathophysiologic mechanisms of post-RP ED , to assess the need for rehabilitation following surgery , and to analyze the basic scientific evidence and clinical applications of PDE5-Is for the prevention and treatment of ED .
EVIDENCE SYNTHESIS Post-RP ED has many factors .
Cavernosal nerve injury induces pro-apoptotic factors ( ie , loss of smooth muscle ) and pro-fibrotic factors ( ie , an increase in collagen ) within the corpora cavernosa .
Vardenafil improved patient satisfaction with erectile hardness, orgasmic function and sexual experience in men with erectile dysfunction following nerve sparing radical prostatectomy.
PURPOSE Nerve sparing radical retropubic prostatectomy ( NS-RRP ) results in erectile dysfunction in a significant number of patients . Vardenafil , a potent and selective phosphodiesterase type 5 inhibitor , is generally safe . It improves International Index of Erectile Function erectile function domain scores , and penetration and erection maintenance success rates in patients who have undergone NS-RRP . We report additional parameters important to patient perceptions regarding erection quality and satisfaction with sexual experience following NS-RRP . MATERIAL S AND METHODS A total of 440 men at 58 centers throughout the United States and Canada participated in this r and omized , placebo controlled , double-blind trial with 3 phases , namely baseline ( 4-week untreated period ) , treatment ( 12 weeks ) and followup ( 7 days ) . Participants received placebo ( 145 ) , 10 mg vardenafil ( 146 ) or 20 mg vardenafil ( 149 ) at home on dem and but no more than once per calendar day . Efficacy and satisfaction with erection quality and sexual experience were determined during the trial . RESULTS The 10 and 20 mg vardenafil doses were significantly superior to placebo for the International Index of Erectile Function domains for intercourse satisfaction , orgasmic function and overall satisfaction with sexual experience ( vs placebo p < 0.0009 ) . Significant improvement in the satisfaction rate with erection hardness were demonstrated for each vardenafil dose compared with placebo ( p < 0.0001 ) . Vardenafil was generally well tolerated . Common adverse events were headache , vasodilatation and rhinitis . CONCLUSIONS In this difficult to treat population of men with erectile dysfunction subsequent to NS-RRP on dem and treatment with vardenafil during a 3-month period significantly improved key aspects of the sexual experience important to patient quality of life
Experimental data support the concept of cavernosal damage and suggest a protective role for daily dosage of a PDE5-I ; however , similar data have not yet been replicated in humans .
Penile rehabilitation programs are common in clinical practice , but there is no definitive evidence to support their use or the best treatment strategy .
PDE5-Is are efficacious and safe in young patients with normal preoperative erectile function who have undergone bilateral nerve-sparing radical prostatectomy .
On-dem and use of a PDE5-I may be at least as efficacious as daily use .
PDE5-I use in penile rehabilitation programs is not supported by rigorous level 1 evidence -based medicine .
PDE5-Is are an efficacious and safe treatment for post-RP ED in properly selected patients .
The experimental results on the protective role of daily dosages of PDE5-Is , while robust , have not been replicated in humans .
CONTEXT  Erectile dysfunction ( ED ) after radical prostatectomy ( RP ) has a significant negative impact on a patient 's health-related quality of life .
Phosphodiesterase type 5 inhibitors ( PDE5-Is ) have recently been utilized not only as a treatment of ED in this population but also as a preventive strategy in penile rehabilitation programs .
OBJECTIVE To eluci date the pathophysiologic mechanisms of post-RP ED , to assess the need for rehabilitation following surgery , and to analyze the basic scientific evidence and clinical applications of PDE5-Is for the prevention and treatment of ED .
EVIDENCE SYNTHESIS Post-RP ED has many factors .
Cavernosal nerve injury induces pro-apoptotic factors ( ie , loss of smooth muscle ) and pro-fibrotic factors ( ie , an increase in collagen ) within the corpora cavernosa .