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A comparison of different oral therapies versus no treatment for erectile dysfunction in 196 radical nerve-sparing radical prostatectomy patients

International Journal of Impotence Research volume 27, pages 1–5 (2015)Cite this article

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Abstract

We retrospectively analyzed the effects on the erectile function (EF) of no treatment (NT), and an oral therapy (OT; on-demand therapy (OD) or a regimented rehabilitation (RR) program with phosphodiesterase type 5 inhibitors (PDE5-Is)), in a cohort of 196 consecutive patients following nerve-sparing radical retropubic prostatectomy (NSRRP). Patients undergoing bilateral NSRRP (BP; n=147) and unilateral NSRRP (UP; n=49), chose between OT (PDE5-Is OD or RR program) and NT. Patients who chose OD therapy received PDE5-Is (100 mg sildenafil, 20 mg tadalafil and vardenafil), whereas patients who chose the RR program received 100 mg sildenafil or 20 mg vardenafil three times a week, or 20 mg tadalafil twice a week at bedtime. The t-test for unpaired data and Fisher test were used for univariate analyses, logistic regression multivariate analysis was used to test the accuracy of available variables to predict EF recovery after radical prostatectomy. Potency rates were significantly correlated with the surgical technique and with OT when compared to NT (P<0.02), respectively 68.7% for BP (61% with no therapy and 71% with PDE5-Is) and 44% for UP (29% with no therapy and 51% with PDE5-Is), while no statistically significative differences were found between OD and rehabilitation protocols (72% with rehabilitation and 70% with OD therapy in BP, 52% with rehabilitation and 50% with OD therapy in UP; P=NS). Early OT with PDE5-Is (OD or RR program) was superior to NT in recovery of EF in NSRRP. Furthermore, an RR program with PDE5-Is did not appear to be superior to OD therapy.

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References

  1. Dall’Era JE, Mills JN, Koul HK, Meacham RB . Penile rehabilitation after radical prostatectomy: important therapy or wishful thinking? Rev Urol 2006; 8: 209–215.

    PubMed  PubMed Central  Google Scholar 

  2. McCullough AR . Rehabilitation of erectile function following radical prostatectomy. Asian J Androl 2008; 10: 61–74.

    Article  Google Scholar 

  3. Ayyathurai R, Manoharan M, Nieder AM, Kava B, Soloway MS . Factors affecting erectile function after radical retropubic prostatectomy: results from 1620 consecutive patients. BJU Int 2008; 101: 833–836.

    Article  Google Scholar 

  4. Burnett AL . Erectile function outcomes in the current era of anatomic nerve-sparing radical prostatectomy. Rev Urol 2006; 8: 47–53.

    PubMed  PubMed Central  Google Scholar 

  5. Dubbelman YD, Dohle GR, Schröder FH . Sexual function before and after radical retropubic prostatectomy: a systematic review of prognostic indicators for a successful outcome. Eur Urol 2006; 50: 711–718.

    Article  Google Scholar 

  6. Zippe C, Nandipati K, Agarwal A, Raina R . Sexual dysfunction after pelvic surgery. Int J Impot Res 2006; 18: 1–18.

    Article  CAS  Google Scholar 

  7. Mulhall JP, Morgentaler A . Penile rehabilitation should become the norm for radical prostatectomy patients. J Sex Med 2007; 4: 538–543.

    Article  Google Scholar 

  8. Montorsi F, Guazzoni G, Strambi LF, Da Pozzo LF, Nava L, Barbieri L et al. Recovery of spontaneous erectile function after nerve-sparing radical retropubic prostatectomy with and without early intracavernous injections of alprostadil: results of a prospective, randomized trial. J Urol 1997; 158: 1408–1410.

    Article  CAS  Google Scholar 

  9. Schwartz EJ, Wong P, Graydon RJ . Sildenafil preserves intracorporeal smooth muscle after radical retropubic prostatectomy. J Urol 2004; 171: 771–774.

    Article  Google Scholar 

  10. Mulhall JP, Müller A, Donohue JF, Mullerad M, Kobylarz K, Paduch DA et al. The functional and structural consequences of cavernous nerve injury are ameliorated by sildenafil citrate. J Sex Med 2008; 5: 1126–1136.

    Article  CAS  Google Scholar 

  11. Ferrini MG, Davila HH, Kovanecz I, Sanchez SP, Gonzales-Cadavid NF, Rajfer J . Vardenafil prevents fibrosis and loss of corporal smooth muscle that occurs after bilateral cavernosal nerve resection in the rat. Urology 2006; 68: 429–435.

    Article  Google Scholar 

  12. Vignozzi L, Filippi S, Morelli A, Ambrosini S, Luconi M, Vannelli GB et al. Effect of chronic tadalafil administration on penile hypoxia induced by cavernous neurotomy in the rat. J Sex Med 2006; 3: 419–431.

    Article  CAS  Google Scholar 

  13. Desouza C, Parulkar A, Lumpkin D, Akers D, Fonseca VA . Acute and prolonged effects of sildenafil on brachial artery flow-mediated dilatation in type 2 diabetes. Diabetes Care 2002; 25: 1336–1339.

    Article  CAS  Google Scholar 

  14. Mulhall J, Land S, Parker M, Waters WB, Flanigan RC . The use of an erectogenic pharmacotherapy regimen following radical prostatectomy improves recovery of spontaneous erectile function. J Sex Med 2005; 2: 532–542.

    Article  CAS  Google Scholar 

  15. Wang R . Penile rehabilitation after radical prostatectomy: where do we stand and where are we going? J Sex Med 2007; 4: 1085–1097.

    Article  Google Scholar 

  16. Lagoda G, Jin L, Lehrfeld TJ, Liu T, Burnet AL . FK506 and sildenafil promote erectile function recovery after cavernous nerve injury through anti-oxidative mechanisms. J Sex Med 2007; 4: 908–916.

    Article  CAS  Google Scholar 

  17. Mulhall J, Land S, Parker M, Waters WB, Flanigan RC . The use of anerectogenic pharmacotherapy regimen following radical prostatectomy improves recovery of spontaneous erectile function. J Sex Med 2005; 3: 532–540.

    Article  Google Scholar 

  18. Giuliano F, Amar E, Chevallier D, Montaigne O, Joubert JM, Chartier-Kastler E . How urologists manage erectile dysfunction after radical prostatectomy: a national survey (REPAIR) by the French urological association. J Sex Med 2008; 5: 448–457.

    Article  Google Scholar 

  19. Serni S, Masieri L, Lapini A, Nesi G, Carini M . A low incidence of positive surgical margins in prostate cancer at high risk of extracapsular extension after a modified anterograde radical prostatectomy. BJU Int 2004; 93: 279–283.

    Article  CAS  Google Scholar 

  20. Campbell EW . Total prostatectomy with preliminary ligation of the vascular pedicles. J Urol 1959; 81: 464–467.

    Article  CAS  Google Scholar 

  21. Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM . Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res 1999; 11: 319–326.

    Article  CAS  Google Scholar 

  22. Padma-Nathan H, McCullough AR, Levine LA, Lipshultz LI, Siegel R, Montorsi F et alStudy Group. Randomized, double-blind, placebo-controlled study of postoperative nightly sildenafil citrate for the prevention of erectile dysfunction after bilateral nerve-sparing radical prostatectomy. Int J Impot Res 2008; 20: 479–486.

    Article  CAS  Google Scholar 

  23. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mshra A . The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49: 822–830.

    Article  CAS  Google Scholar 

  24. Walsh PC, Marschke P, Ricker D, Burnett AL . Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. Urology 2000; 55: 58–61.

    Article  CAS  Google Scholar 

  25. Bannowsky A, Schulze H, van der Host C, Seif C, Braun PM, Junemann KP . Nocturnal tumescence: a parameter for postoperative erectile integrity after nerve sparing radical prostatectomy. J Urol 2006; 175: 2214–2217.

    Article  Google Scholar 

  26. Nandipati K, Raina R, Agarwal A, Zippe CD . Early combination therapy: intracavernosal injections and sildenafil following radical prostatectomy increases sexual activity and the return of natural erections. Int J Impot Res 2006; 18: 446–451.

    Article  CAS  Google Scholar 

  27. Bannowsky A, Schulze H, van der Horst C, Hautmann S, Jünemann KP . Recovery of erectile function after nerve-sparing radical prostatectomy: improvement with nightly low-dose sildenafil. BJU Int 2008; 101: 1279–1283.

    Article  CAS  Google Scholar 

  28. Walsh PC . Radical prostatectomy for localised prostate cancer provides durable cancer control with excellent quality of life: a structured debate. J Urol 2000; 163: 1802–1807.

    Article  CAS  Google Scholar 

  29. Katz R, Salomon L, Hoznek A, de la Taille A, Vordos D, Cicco A et al. Patient reported sexual function following laparoscopic radical prostatectomy. J Urol 2002; 168: 2078–2082.

    Article  Google Scholar 

  30. Montorsi F, Briganti A, Salonia A, Rigatti P, Burnett AL . Current and future strategies for preventing and managing erectile dysfunction following radical prostatectomy. Eur Urol 2004; 45: 123–133.

    Article  Google Scholar 

  31. Salonia A, Gallina A, Zanni G, Briganti A, Dehò F, Saccà A et al. Acceptance of and discontinuation rate from erectile dysfunction oral treatment in patients following bilateral nerve-sparing radical prostatectomy. Eur Urol 2008; 53: 564–570.

    Article  Google Scholar 

  32. Jiann BP, Yu CC, Su CC, Tsai JY . Compliance of sildenafil treatment for erectile dysfunction and factors affecting it. Int J Impot Res 2006; 18: 146–149.

    Article  CAS  Google Scholar 

  33. Montorsi F, Brock G, Lee J, Shapiro J, Van Poppel H, Graefen M et al. Effect of nightly versus on-demand vardenafil on recovery of erectile function in men following bilateral nerve sparing radical prostatectomy. Eur Urol 2008; 54: 924–931.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Uro-Andrological Unit, University of Florence, Florence, Italy

    A Natali, L Masieri, M Lanciotti, S Giancane, G Vignolini, M Carini & S Serni

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  1. A Natali
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  2. L Masieri
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  3. M Lanciotti
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  4. S Giancane
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  5. G Vignolini
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  6. M Carini
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  7. S Serni
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Correspondence to A Natali.

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Natali, A., Masieri, L., Lanciotti, M. et al. A comparison of different oral therapies versus no treatment for erectile dysfunction in 196 radical nerve-sparing radical prostatectomy patients. Int J Impot Res 27, 1–5 (2015). https://doi.org/10.1038/ijir.2014.27

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