The minimal observed difference is most likely due to interobserver variability. A study presented at the AUA meeting in 200715 that compared potency outcomes between open versus robotic RP using the same self-administered instrument and definition of potency showed a slight but not statistically significant advantage of open versus robotic surgery. The study that Dr. Engel referred to earlier, where robotic RP was performed at George Inhibitors,research,lifescience,medical Washington University and open RP was performed at New York University, also failed to show an advantage of either technique. What is the timeline for natural return of erectile function after RP? Jason D. Engel,

MD: Patients should not expect appreciable return of natural potency until 6 months postprostatectomy, and, if lucky enough to start to recover at that point, erectile function will typically continue to improve over a 2- to 3-year span. Erection rates are most commonly reported at 1 year, but in fact a very small minority Inhibitors,research,lifescience,medical of patients Inhibitors,research,lifescience,medical will have natural, spontaneous erections at 1 year. This has led many major centers to start reporting their rates at 18 months

to 2 years. A great study would follow a cohort for 5 years. Such a study would show that several men have their first spontaneous intercourse between years 2 and 3. This is exactly why I push my patients to have Inhibitors,research,lifescience,medical artificial erections as early as possible because they will typically wait a long time for spontaneous recovery. Herbert Lepor, MD: My group just published an article16 that queried men whether their erection changed between 2 and Inhibitors,research,lifescience,medical 4 years postoperatively. Approximately 20% of men indicated that their erections improved moderately or markedly. Therefore, we should not tell men their maximal return of erectile function occurs by 18 months. Men who have good function seem to be the ones who improve the most after

2 years. What is the concept of penile rehabilitation? Andrew learn more McCullough, MD: The concept of end-organ rehabilitation after a nerve injury is not new. Every neurologist and orthopedist quickly refers a patient for muscle rehabilitation after a nerve injury. Why should it be different for the penis? Montorsi14 was the first Oxygenase to show that pharmacologic intervention could affect the outcome of nerve-sparing surgery. Animal models have likewise shown the benefit of pharmacologic intervention with PDE-5 inhibitors and immunophyllin ligands. Padma-Nathan and colleagues17 showed a 7-fold benefit with nightly sildenafil over placebo at 1 year. Despite the mounting evidence and general agreement that penile rehabilitation is important, urologists are still lacking a consensus as to the right regimen.