Phosphodiesterase-5 inhibitors for erectile function rehabilitation in patients undergoing nerve sparing radical prostatectomy: a scoping review

The aim of this study was to conduct a scoping review on the efficacy of phosphodiesterase-5 inhibitors (PDE-5Is) in rehabilitating erectile function in patients undergoing cavernous nerve sparing radical prostatectomy (NSRP). The databases used were MEDLINE, EMBASE, CENTRAL, LILACS and Web of Science. Systematic reviews with meta-analyses on the subject were included until March 5, 2024, with no language restrictions. Publications that did not address any of the aforementioned relationships were excluded. The data was organized into tables for descriptive analysis. The methodological quality of the included studies was assessed using the ROBIS tool. Eight studies were selected and all concluded that the use of PDE-5Is is effective in penile rehabilitation. Only one of the reviews found that use for more than six months was superior to short-term use, and another concluded that daily use was superior to on-demand use. In addition, the articles identified more adverse effects in the experimental group compared to the control group, but without compromising therapeutic adherence. Six of the studies were classified as low risk of bias, while the other two had uncertain risk. PDE-5Is are effective in restoring erectile function in patients undergoing NSRP, especially when used regularly and over the long term, and follow-up is not hampered by adverse effects. However, due to the scarcity of data, new studies should be carried out to determine the best form of use of these drugs.