How should patients with ED post-radical prostatectomy be counseled?

Clinicians should consider counseling  patients with post-radical prostatectomy  (nerve sparing) ED that recovery from the  neurapraxia may be gradual and delayed,  and noninvasive erectogenic treatment  should not be abandoned until adequate  recovery time has passed. In general patients  should be advised that a number of baseline  parameters will significantly influence the  final postoperative outcome in terms of recovery  of erectile function. They include: patient  age at time of surgery (patients younger than  60 years do better); potency status (patients  preoperatively having rigid erections sufficient  to complete a satisfactory sexual intercourse  do better); use of PDE5 inhibitor  (patients who regularly use a PDE5 inhibitor  to achieve good erections prior to surgery  usually report worse results postoperatively);  and systemic comorbidities (patients without  vascular comorbidities do better) [39,46,47]. 

Surgical expertise remains of fundamental  importance, in that the extent of neurovascular  bundle preservation is an independent  predictor of erectile function recovery [48].  Based on our (F.M.) clinical experience, in a  patient with the above mentioned baseline  conditions and treated with a bilateral nerve  sparing radical prostatectomy, a PDE5 inhibi-  Supplement  150 Vol. 2, No. 1, pp. 141–157, March 2005  tor may be expected to enhance the erectile  response and help generate erections sufficient  to engage in sexual activity within 6–  18 months after surgery.  Part 2 - Safety and Tolerability  Introduction  This report is the second of two parts designed  to provide primary care clinicians with  answers to frequently asked questions about  tadalafil. The first answered frequently asked  questions about optimizing the efficacy of  tadalafil in treating men with ED. The second  part answers frequently asked questions about  how the safety and tolerability of tadalafil have  been established.