Postoperative tadalafil for recovery of continence and voiding function after radical prostatectomy for prostate cancer: a single-center experience.

[PURPOSE] To evaluate the impact of postoperative tadalafil on the recovery of erectile function, voiding function, and urinary continence in patients undergoing radical prostatectomy (RP) for prostate cancer.

[MATERIALS AND METHODS] A retrospective analysis was conducted on 4,173 patients who underwent RP. Patients were categorized based on postoperative use of tadalafil. Functional outcomes were assessed using the International Index of Erectile Function (IIEF-5) and the International Prostate Symptom Score (IPSS), along with continence status and oncologic parameters. Statistical analyses included chi-square and t-tests.

[RESULTS] In the final cohort, 916 patients received postoperative tadalafil and were compared to 3,257 patients without any phosphodiesterase type 5 (PDE5) inhibitor therapy. While early postoperative erectile function was lower in the tadalafil cohort at 1 month, recovery was superior by 12 months (IIEF-5: 5.9 ± 5.5 vs. 4.8 ± 5.6, p = 0.002). Voiding function also declined less markedly postoperatively (IPSS increase: 1.4 vs. 2.4 points), with significant improvement maintained through 12 months. Social continence rates were higher in the tadalafil group (95.1% vs. 92.6 %, p = 0.009), and biochemical recurrence was lower (11.7% vs. 25.7%, p < 0.001).

[CONCLUSIONS] Postoperative tadalafil is associated with improved recovery of erectile and voiding function, as well as higher continence rates, without compromising oncologic outcomes. These findings support its consideration as part of routine postoperative management in selected RP patients.