[Nerve-sparing radical prostatectomy with nightly low-dose sildenafil : rehabilitation of erectile function].
OBJECTIVE
The purpose of this study was to evaluate the effect of low-dose sildenafil (25 mg) for rehabilitation of erectile function after nerve-sparing radical prostatectomy.


METHODS
In a prospective study, 43 sexually active patients underwent nerve-sparing retropubic radical prostatectomy. Rigiscan® measurement of nocturnal penile tumescence and rigidity (NPTR) was carried out 7-14 days after surgery. A group of 23 patients with preserved nocturnal erections received sildenafil 25 mg/day at night to support recovery of erectile function. A control group of 18 patients underwent follow-up without PDE-5 inhibitors. Evaluation using the IIEF-5 questionnaire was performed 6, 12, 24, 36, 52 and 78 weeks after the operation.


RESULTS
Of 43 patients, 41 (95%) showed 1-5 erections during the first night after catheter removal. In the group receiving daily sildenafil, the mean IIEF-5 score decreased or increased from 20.8 preoperatively to 3.6 at 6 weeks, 3.8 at 12 weeks, 5.9 at 24 weeks, 9.6 at 36 weeks, 14.1 at 52 weeks and 19.3 at 78 weeks after prostatectomy. In the control group, the mean preoperative IIEF-5 score of 21.2 decreased or increased to 2.4 at 6 weeks, 3.8 at 12 weeks, 5.3 at 24 weeks, 6.4 at 36 weeks, 9.3 at 52 weeks and 13.2 at 78 weeks. Statistical evaluation showed significant differences regarding the IIEF-5 score and recovery period of erectile function between the groups (p<0.001), with potency rates of 92 vs 68%.


CONCLUSIONS
The measurement of NPTR after nerve-sparing radical prostatectomy showed erectile function as early as the first night after catheter removal. In cases of early penile erections, daily low-dose PDE-5 inhibitors lead to a significant improvement/acceleration of erectile function recovery.
Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein,Campus Kiel, Kiel, Deutschland. andreas.bannowsky@klinikum-os.de
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Bannowsky
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Schulze
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van der Horst
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Jünemann
D000368:Aged; D004305:Dose-Response Relationship, Drug; D007172:Erectile Dysfunction / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000008:administration & dosage*; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011687:Purines / Q000008:administration & dosage; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000008:administration & dosage*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage
D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate