Background: Phosphodiesterase 5 inhibitors (PDE5I) represent the first-line treatment
in the management of post-operative erectile dysfunction (ED) after pelvic oncological surgery.
The aim of our study is to evaluate the available evidence on the efficacy of PDE5Is, including
new formulations and penile rehabilitation post-pelvic surgery.
Evidence Acquisition: A systematic review of the literature was performed until May 2020. The
following databases were searched: Scopus, Medline and Web of Science. The MeSH search was
conducted by combining the following terms: ‘erectile dysfunction’, ‘radical prostatectomy’
‘pelvic’ ‘bladder’ ‘phosphodiesterase’ inhibitors’ ‘avanafil’ ‘sildenafil’ ‘tadalafil’ ’lodenafil’ ‘mirodenafil’
‘udenafil’ ‘vardenafil’ ‘sublingual’ ‘orodispersible’ ‘penile’ ‘rehabilitation’.
Evidence Synthesis: Sildenafil, Tadalafil, vardenafil and Avanafil improve EF compared with
placebo in men with all levels of ED severity after radical prostatectomy with good tolerability. No
specific recommendations can be suggested regarding the superiority of a drug over the other. The
optimal dose, continuous vs. on-demand and duration of treatment, is still under investigation. In
vitro and preclinical studies suggest the possible role for lodenafil, mirodenafil and oro-dispersible
formulations in patients undergoing oncological pelvic surgery. Few studies demonstrated the efficacy
of udenafil in improving ED after rectal surgery or radical prostatectomy. Complete recovery
of EF after surgery is still an unmet need in the field of penile rehabilitation after pelvic surgery.
Conclusion: PDE5Is have a crucial role in the management of post pelvic surgery of ED. New
drugs and new formulations have shown excellent results in patients with ED; however, data in patients
after surgery is still scarce. Further well designed RCT should clarify the role of these new
compounds and oro-dispersible formulations in the management of ED in patients undergoing