Factors Predicting Outcomes of Penile Rehabilitation With Udenafil 50 mg Following Radical Prostatectomy

T-H Kim; Y-S Ha; SH Choi; ES Yoo; BW Kim; S-J Yun; W-J Kim; YS Kwon; TG Kwon


Int J Impot Res. 2016;28(1):25-30. 

In This Article

Abstract and Introduction


Udenafil is a selective phosphodiesterase type 5 inhibitor made available in recent years for the treatment of erectile dysfunction. Herein, we evaluated independent predictors of potency recovery in radical prostatectomy (RP) patients who underwent penile rehabilitation with udenafil 50 mg. One hundred and forty-three men who underwent RP were enrolled in a penile rehabilitation program using udenafil 50 mg every other day. The rate of regained potency in the study group was significantly higher compared with the recovery rate seen in patients who were not part of the penile rehabilitation program (41.3% vs 13.0%; P<0.001). On the multivariate Cox analyses, preoperative International Index of Erectile Function-5 scores (hazard ratio (HR), 1.049; P=0.040), alcohol consumption (HR, 2.043; P=0.020) and Gleason biopsy score (HR, 0.368; P=0.024) were independent preoperative predictors for potency recovery. Among post-RP variables, the use of robotic procedures (HR, 2.287; P=0.030) and pathologic stage (HR, 0.506; P=0.038) were significantly associated with potency recovery. This study identified predictive factors for the recovery of potency in patients undergoing penile rehabilitation with udenafil following RP. Our results could provide physicians with useful information for counseling RP patients and selecting optimal candidates for penile rehabilitation.


Prostate cancer is the most common solid malignancy and remains the second leading cause of death from cancer in men, with ~233 000 new diagnoses in 2014 and 29 480 deaths from the disease in the United States.[1] There has been a rapid rise in the incidence of prostate cancer in several Asian countries, with prostate cancer steadily becoming one of the leading cancers in Asian men.[2] Similarly, in Korea, the incidence rate of prostate cancer has rapidly increased during the past decade.[3] The introduction of prostate-specific antigen testing and early detection programs for prostate cancer has led to a significant migration toward earlier stages, as well as decreasing patient age, at the time of diagnosis.[4] Therefore, these factors have invariably led to a younger patient population undergoing radical prostatectomy (RP).[5–7]

Although RP remains the gold standard surgical treatment for patients with localized prostate cancer, erectile dysfunction (ED) is a significant postoperative side effect.[8–10] Following the introduction of neurovascular bundle sparing RP by Dr Patrick Walsh, potency after RP has increased significantly.[11,12] From several recent reports, postsurgical potency rates were above 80–90%,[13,14] and such significant improvements in potency after RP has been mostly attributed to surgical refinement. However, Woo et al.[15] suggest that the current high rates of potency following RP are because of the introduction of phosphodiesterase type 5 inhibitors (PDE5Is) and not surgical technique.

In practice, penile rehabilitation using PDE5Is has been advocated as a means to promote postoperative erectile function recovery.[16–18] Animal studies show that chronic administration of PDE5I favors the maintenance of penile smooth muscle integrity, decreases collagen deposition and reduces fibrosis in penile tissue.[19,20] Udenafil (Zydena; Dong-A Pharmaceutical Company, Seoul, South Korea) is a newly developed long-acting PDE5I with efficacy and safety profiles comparable to those of other PDE5Is;[21,22] however, there are no published reports on the effect of udenafil in men with post-RP ED. In this study, we evaluated independent predictors of potency recovery in RP patients who underwent penile rehabilitation with udenafil 50 mg.