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Penile Rehabilitation Strategy after Nerve Sparing Radical Prostatectomy: A Systematic Review and Network Meta-Analysis of Randomized Trials
R. Sari Motlagh, M. Abufaraj, L. Yang, K. Mori, B. Pradere, E. Laukhtina, H. Mostafaei, VM. Schuettfort, F. Quhal, F. Montorsi, M. Amjadi, C. Gratzke, SF. Shariat
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články, metaanalýza, systematický přehled
- MeSH
- Bayesova věta MeSH
- erektilní dysfunkce rehabilitace MeSH
- lidé MeSH
- obnova funkce MeSH
- pooperační komplikace rehabilitace MeSH
- prostatektomie metody MeSH
- randomizované kontrolované studie jako téma MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- systematický přehled MeSH
PURPOSE: Despite the advances in nerve sparing and minimally invasive radical prostatectomy, erectile dysfunction remains an important adverse event after radical prostatectomy. Penile rehabilitation strategies have been developed to expedite and improve erectile function recovery. However, the differential efficacy and the best penile rehabilitation strategy are unclear as yet. We conducted a systematic review and network meta-analysis to investigate and compare the efficacy of different penile rehabilitation strategies. MATERIALS AND METHODS: A systematic search was performed in May 2020 using PubMed® and Web of Science™ databases according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) extension statement for network meta-analysis. Studies that compared the erectile function recovery rate and adverse events between penile rehabilitation treatment groups (eg medications, devices and actions) and control group were included. We used the Bayesian approach in the network meta-analysis. RESULTS: A total of 22 studies (2,711 patients) met our eligibility criteria. Out of 16 different penile rehabilitation strategies and schedules vs placebo, only pelvic floor muscle training (OR 5.21, 95% CrI 1.24-29.8) and 100 mg sildenafil regular doses, ie once daily or nightly (OR 4.00, 95% CrI 1.40-13.4) were associated with a significantly higher likelihood of erectile function recovery. The certainty of results for 100 mg sildenafil regular dose was moderate, while pelvic floor muscle training had low certainty. The sensitivity analysis confirmed that the regular high dose of phosphodiesterase-5 inhibitors regardless of type vs placebo (OR 2.09, 95% CrI 1.06-4.17) was associated with a significantly higher likelihood of erectile function recovery with a moderate certainty. The on-demand doses of phosphodiesterase-5 inhibitors were not proven to be more beneficial than placebo. Secondary outcomes such as adverse events were not analyzed due to incomplete data in the literature. However, no serious adverse events were reported in any of the studies. CONCLUSIONS: Sildenafil 100 mg regular dose is the best penile rehabilitation strategy to improve erectile function recovery rates after radical prostatectomy. Although pelvic floor muscle training has been shown to be effective in increasing the erectile function recovery rate, well designed randomized controlled trials with larger sample sizes are needed to confirm the presented early results. The on-demand dose of phosphodiesterase-5 inhibitors should not be considered as a penile rehabilitation strategy.
Department of Special Surgery Jordan University Hospital The University of Jordan Amman Jordan
Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic
Department of Urology CHRU Tours Francois Rabelais University Tours France
Department of Urology Medical University of Vienna Vienna Austria
Department of Urology Tabriz University of Medical Sciences Tabriz Iran
Department of Urology The Jikei University School of Medicine Tokyo Japan
Department of Urology University Hospital Freiburg Freiburg Germany
Department of Urology University Medical Center Hamburg Eppendorf Hamburg Germany
Department of Urology University of Texas Southwestern Dallas Texas
Department of Urology Weil Cornell Medical College New York New York
Departments of Oncology and Community Health Sciences University of Calgary Calgary Canada
European Association of Urology Research Foundation Arnhem Netherlands
Institute for Urology and Reproductive Health Sechenov University Moscow Russia
Karl Landsteiner Institute of Urology and Andrology Vienna Austria
King Fahad Specialist Hospital Dammam Saudi Arabia
Research Center for Evidence Based Medicine Tabriz University of Medical Sciences Tabriz Iran
The National Center for Diabetes Endocrinology and Genetics The University of Jordan Amman Jordan
Citace poskytuje Crossref.org
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