50 | TREND ON ERECTILE REHABILITATION AFTER RADICAL PROSTATECTOMY: RESULTS OF AN INTERNATIONAL SURVEY AMONG UROLOGIST

Introduction and aim of the study: In the last two decades, several therapeutic schemes have been proposed for erectile rehabilitation (ER) after radical prosta- tectomy (RP), but none has been standardized or vali- dated due to the lack of high‐level evidence in the literature. We performed an international Survey focused on the current worldwide approach to ER, highlighting the contact and divergent aspects.Materials and methods: An online Survey was developed between July and December 2020 using email lists and Twitter, aiming to evaluate the ER protocols after RP performed by urologists and an- drologists in daily practice. The following sections were investigated: 1) Demographics; 2) Number and type of RP performed; 3) Type and schedule, timing and duration of ER erectile programs; 4) Standard treatment protocol. The specialists were contacted with the support of Confederación Americana de Urología (CAU), Urological SOcial MEdia (UroSoMe) Working Group, Functional Urology‐ Techno Urology‐ Research (FUTURe) Group and by a dedi- cated uro‐andrologists spaces on Twitter platform of iTRUE Group and e‐mail.Results: The Survey was completed by 518 re- sponders from 52 worldwide countries. The main criteria to candidate patients for ER were nerve sparing surgery (72.8%), lack of significant comorbidities (66.4%), pa- tient's request (55.4%), valid pre‐operative EF (55%), age (48.1%), and partner's willing (19.1%). Surgical techni- ques reported were: 38.9% open RP, 22.9% video laparo- scopic RP, 38.2% robot‐ assisted RP. There were no significant differences (p>0.05) comparing among the main surgical techniques (open, laparoscopic, robot‐ assisted RP) the time of beginning EF recovery, main protocol used, and mean duration of ER. Most re- sponders were experienced urologists (71.4%). The use of specific ER protocols was reported by 61.4%. Thebeginning of ER was reported by 33% of the responders at the catheter removal, after one month from surgery by 22%, and before RP by 15%.PDE5i were the most used as first line treatment (99.4%). Tadalafil 20 mg was the most prescribed in monotherapy, and it was the most used daily (48.2%), and 2‐3 times/week in 46%. PGE1 intra‐cavernosal in- jection (67.9%) was the second most common prescribed monotherapy (one‐two times/week, 61%), followed by the association of PDE5i and vacuum device (29.6%). The duration of ER was: in 16.2% <6 months, in 39% between 6 and 11 months; in 31.9% between 12 and 18 months; in 9.2% between 19‐24 months, and in 3.7% >24 months. In case of first‐line failure, the majority of the responders shifted to another treatment after at least 3 months (71%). During COVID‐19 outbreak, the 37.4% of re- sponders did not perform EF recovery consultations, while 26.8% had normal consultations, and 35.7% used telemedicine.Interpretation of results: Our results showed that there are many different patterns in the ER management, highlighting no general consensus in the use of specific protocols due to the absence of international evidence‐based guidelines. Most of the responders were experienced urologists and physi- cians with high requisite in andrology. However, only 61.4% of them reported the use of specific ER proto- cols for selection and treatment after RP. This finding may be a consequence of the lack of standardized, and worldwide accepted, schemes. The main variables were the exact ER start timing (although accordance on the early beginning), administration of mono‐ or combination therapy, the type and posology of PDE5i, and the duration of the treatment. However, similar characteristics in ER protocols were the indication to ER in case of NSS, the administration of PDE5i and the avoidance of PGE1 monotherapy as first‐line management, and the use of VED in mono‐ or com- bination therapy with PDE5i in second‐line. It is re- markable that a quarter of the responders treated males only on patient's request, although the useful- ness of ER after RP has already been demonstratedThe type of surgical approach did not influence the choice of the ER protocol. This finding may be par- tially due to the practice of multiple RP surgeries by the same surgeon. The responders reported several indications to ER, although NSS was the main pre- ference. Interestingly, NSS did not influence the choice of the ER protocol. In males underwent non‐ NSS, PDE5i in monotherapy was the drug most commonly administered, as it was for men who per- formed NSS. In non‐NSS a successful effect of the sole PDE5i treatment is less expected, therefore it was ABSTRACTS| S67 presumable a significantly higher use of PGE1 as first line treatment after non‐NSS. However, the avoidance of an invasive treatment may be an explanation of this clinical approach, and may explicate the preference of PDE5i also in non‐NSS patients.Conclusions: This Survey showed an inhomo geneous approach to ER, reflecting the lack of high‐level evidence on this topic. A worldwide accepted guideline on ER is therefore needed.