AB272. Penile rehabilitation following radical prostatectomy: practice patterns among Japanese Urological Association members

OBJECTIVE: A compromise in erectile function is commonly experienced after radical prostatectomy (RP). Despite the fact that the benefits are still unclear, penile rehabilitation after RP has become the standard of care for many urologists. Given the lack of definitive proof regarding the benefits, however, a standard program or optimal algorithm does not exist. Furthermore, financial, insurance, and cultural considerations might cause regional differences in the practice of penile rehabilitation. We sought to explore contemporary trends in penile rehabilitation practice patterns of Japanese Urological Association (JUA) members. We also review the epidemiology, rational and current literature on penile rehabilitation after RP. METHODS: The proprietary questionnaire was comprised of 35 questions that addressed practitioner demographic factors and current practice status regarding rehabilitation. The questionnaire was mailed to all the representatives of urology departments authorized by the JUA. RESULTS: 376 physicians completed the questionnaire, representing a response rate of 31%. Twenty percent of the responders were members of the Japanese Society for Sexual Medicine (JSSM), 10% had formal sexual medicine specialty training, 68% were urologic oncology specialists, and 91% performed RP. Of the responders, 47% were not aware of the concept of penile rehabilitation and 29% performed some form of rehabilitation. As part of the primary rehabilitation strategy, 97% used phosphodiesterase type 5 inhibitors (PDE5i), 8% used a vacuum device, 13% used intracavernosal injections, and 2% used intra-urethral prostaglandin. Twenty percent commenced rehabilitation immediately after urethral catheter removal, and 36% within the first three months after RP. 37%, 21%, and 18% ceased rehabilitation at ≤12, 13-18, and 19-24 months, respectively. With regard to the primary reason for not performing rehabilitation: 52% said they were not familiar with the concept; 22% said patients could not afford it, and 22% gave another reason. Performing rehabilitation was positively associated with being a member of JSSM (P<0.001), seeing post-RP patients (P<0.001), sexual medicine specialty training (P<0.001), being a urologic oncologist (P=0.01), performing RP (P=0.034), and surgeons using the laparoscopic or robotic-assisted approach (P<0.001). CONCLUSIONS: Among the respondents, penile rehabilitation is not common. The most commonly employed strategy is PDE5i use and intracavernosal injections were not in common use. Clinicians who are engaged in the field of sexual medicine and see a lot of such patients are more likely to use rehabilitation practice.