Recovery of erectile function after nerve-sparing radical prostatectomy: improvement with nightly low-dose sildenafil.
OBJECTIVE
To evaluate the effect of low-dose sildenafil for rehabilitating erectile function after nerve-sparing radical prostatectomy (NSRP), as the delay to recovery of erectile function after NSRP remains under debate.


METHODS
Forty-three sexually active patients had a NSRP; at 7-14 days after surgery they had a Rigiscan (Dacomed Corporation, Minneapolis, MN, USA) measurement of nocturnal penile tumescence and rigidity (NPTR). To support the recovery of spontaneous erectile function, 23 patients with preserved nocturnal erections received sildenafil 25 mg/day at night. A control group of 18 patients were then followed but had no phosphodiesterase-5 inhibitors. The International Index of Erectile Function (IIEF)-5 questionnaire was completed 6, 12, 24, 36 and 52 weeks after NSRP.


RESULTS
Of the 43 patients, 41 (95%) had one to five erections during the first night after catheter removal. In the group using daily sildenafil the mean IIEF-5 score decreased from 20.8 before NSRP to 3.6, 3.8, 5.9, 9.6 and 14.1 at 6, 12, 24, 36 and 52 weeks after NSRP, respectively. In the control group the respective scores were 21.2, decreasing to 2.4, 3.8, 5.3, 6.4 and 9.3. There was a significant difference in IIEF-5 score and time to recovery of erectile function between the groups (P < 0.001), with potency rates of 86% vs 66%.


CONCLUSIONS
The measurement of NPTR after NSRP showed erectile function even the 'first' night after catheter removal. In cases of early penile erection, daily low-dose sildenafil leads to a significant improvement in the recovery of erectile function.
Bannowsky
Andreas
A
Department of Urology, University Hospital Schleswig-Holstein, Campus Kiel, Germany. abannowsky@gmx.de
Schulze
Heiko
H
van der Horst
Christof
C
Hautmann
Stefan
S
Jünemann
Klaus-Peter
KP
D000368:Aged; D007172:Erectile Dysfunction / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000187:drug effects* / Q000502:physiology; D010413:Penis / Q000294:innervation* / Q000601:surgery; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage*; D010879:Piperazines / Q000008:administration & dosage*; D011468:Prostatectomy / Q000379:methods / Q000534:rehabilitation*; D011471:Prostatic Neoplasms / Q000534:rehabilitation / Q000601:surgery; D011687:Purines / Q000008:administration & dosage; D020127:Recovery of Function / Q000187:drug effects / Q000502:physiology; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000008:administration & dosage*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate