Impact of functional rehabilitation for erectile function recovery of prostate cancer patients underwent robotic radical prostatectomy with nerve-sparing approach from a bio-psycho-social perspective

Introduction: Prostate cancer is the most common malignancy among men, often detected at a localized stage in younger, healthier patients. Although robot-assisted radical prostatectomy (RARP) with nerve-sparing (NS) techniques aims to optimize recovery of erectile function (EF), outcomes remain variable, impacting quality of life. Rehabilitation rotocols combining pharmacologic and psychosexual interventions may enhance EF recovery. Materials and Methods: This retrospective cohort study included 640 patients who underwent RARP with NS techniques from 2020 to 2024. Patients with severe pre-existing rectile dysfunction (IIEF-5 score <17) or short follow-up (<24 months) were excluded. Surgical approaches were stratified into categories (bilateral intrafascial, bilateral nterfascial, interfascial/extrafascial) based on nerve preservation. Postoperative rehabilitation involved adalafil (20 mg, thrice weekly), vacuum erection devices (VED), intracavernosal injections (ICI), and optional psychosexual counseling for relational health assessment (Dyadic Adjustment Scale, PCS-12, MCS-12). EF recovery was measured using IIEF-5 scores at intervals over 24 months. Multimodal logistic estimates, Kaplan Meier curves and Cox’s promotional hazard models were used to investigate the functional recovery. Results: At 12 months, patients with bilateral intrafascial NS and combined PDE5i + VED therapy showed the highest EF recovery, particularly in younger patients (<65 years), with median IIEF-5 scores significantly improved. Psychosexual counseling positively correlated with relational and EF recovery. Kaplan-Meier curves demonstrated quicker EF recovery for younger patients and those with bilateral NS, with 86% achieving baseline EF by 24 months. Conclusions: Robot-assisted RARP, combined with structured PDE5i + VED therapy, significantly enhances EF recovery, particularly for younger individuals with bilateral intrafascial NS. Psychosexual support further aids recovery, highlighting the importance of a biopsychosocial approach in post-RARP rehabilitation. Future multicenter studies are recommended to standardize penile rehabilitation protocols.