Major drawbacks of the present

Major drawbacks of the present study include a small patient cohort and relatively short treatment period compared with other studies. Considering the fact that effects of α1-blockers are mostly observed in 2 weeks, a 4-week treatment period for the evaluation of alterations may be appropriate.

Conclusion

Erectile dysfunction (ED) is a common sequela of nerve-sparing radical prostatectomy (nsRP) for localized prostate cancer. Phosphodiesterase type 5 (PDE5) inhibitors are generally well tolerated and effective in the treatment of ED after nsRP, although they are less effective in the post-nsRP population when compared with the general population, and the optimal time point for starting PDE5-inhibitor treatment is still undetermined.
In addition to impaired erectile function (EF) as measured by International Index of Erectile Function (IIEF) domain scores or Sexual Encounter Profile (SEP) questions, patients frequently report a loss of penile length and girth after nsRP, associated with additional impairment of quality of life and self-esteem. One hypothesis explaining the underlying pathophysiology is that cavernous nerve injury may initially cause sympathetic overdrive during the first 3-6 months after surgery, causing smooth muscle contraction and a purchase galanin retracted penis. Penile length loss after nsRP is also associated with structural changes due to fibrosis of the corpora cavernosa; it may be a sequela of nerve injury and/or ischemia, caused by ligation of anomalous pudendal artery branches or venous plexuses. A decrease of elastic and smooth muscle fibers and increased collagen content can be found as early as 2 months after prostatectomy on cavernosal biopsy in humans.
It has been hypothesized that patients with ED postprostatectomy might benefit from chronic inhibition of PDE5 to protect against structural changes. Preclinical findings suggest that chronic low-dose administration of tadalafil is associated with increased corporal smooth muscle and elastic tissue, decreased fibrous tissue, and EF enhancement. Increased smooth muscle content has also been observed in patients regularly taking sildenafil early after radical retropubic prostatectomy.
We conducted a randomized placebo-controlled trial evaluating the early use of the long-acting PDE5 inhibitor tadalafil, given once daily (OaD) or on-demand (“pro re-nata,” PRN) on both assisted EF after 9 months of double-blind treatment (DBT) and unassisted EF after 6 weeks of drug-free washout (DFW) in men who developed ED after nsRP. Based on standard outcome measures (IIEF-EF, SEP3), tadalafil OaD was effective on drug-assisted EF. Unassisted EF after DFW was not improved by tadalafil OaD or PRN.

Squamous cell carcinoma (SCC) of the penis remains a rare cancer in the Western world accounting for <1% of all male malignancies. Radical radiotherapy and amputative penile surgery (partial or radical penectomy) were traditional treatments but left patients with poor functional outcomes. From a surgical point of view, it was widely reported that a 2-cm surgical margin was essential to reduce the risk of recurrence, and this was the foundation for partial or radical penectomy. This conception has however been challenged by a significant body of contemporary evidence, and the past 2 decades have seen a rise in organ-preserving surgery for localized penile cancer. Such techniques include glans relining, partial glansectomy, glansectomy and glanuloplasty, or distal corporectomy and glans reconstruction. Among the many advantages of those approaches include the improved cosmesis, functional outcome, and improved perception of body image by patients. In addition to the treatment of the primary lesion, one of the most important factors dictating prognosis is the presence of nodal metastases, and there have been advances in lymph node staging and therapy including dynamic sentinel lymph node biopsy (DSLNB). Because of the rarity of the condition, few population-based studies exist of long-term trends in penile cancer treatment. Contemporary outcomes of penile cancer treatment from other series have shown an increase in organ-preserving surgery, as well as improvement in cancer-specific survival (CSS).