title: Postoperative phosphodiesterase type 5 inhibitor administration increases the rate of urinary continence recovery after bilateral nerve-sparing radical prostatectomy.
abstract: OBJECTIVE
  To investigate the effect of phosphodiesterase type 5 inhibitor on urinary continence recovery after bilateral nerve-sparing radical prostatectomy.
  
  
  METHODS
  We analyzed data of 393 open bilateral nerve-sparing radical prostatectomies carried out between 2005 and 2010. Patients who recovered urinary continence within the first month after catheter removal (n = 52) were excluded. This resulted in 341 evaluable patients. Urinary continence recovery was defined as being completely pad free over a period of 24 h. Patients were stratified according to postoperative daily (n = 58; 17%), on-demand (n = 112; 32.8%) and no (n = 171; 50.1%) phosphodiesterase type 5 inhibitor use. The effect of phosphodiesterase type 5 inhibitor use on urinary continence was assessed using the Kaplan-Meier method. Uni- and multivariable Cox regression analyses were used to test the association between phosphodiesterase type 5 inhibitor and urinary continence recovery after adjusting for cofounders.
  
  
  RESULTS
  At a mean follow up of 36.4 months after surgery (median: 33), 288 patients (84.5%) recovered urinary continence after bilateral nerve-sparing radical prostatectomy. Patients who did not use phosphodiesterase type 5 inhibitor after surgery had lower rates of urinary continence recovery at 1- and 2-year follow up as compared with patients taking phosphodiesterase type 5 inhibitor (67.1 vs 86.7% and 76 vs 94.4%, respectively; P < 0.001). After adjusting for all confounders, multivariable analysis showed that phosphodiesterase type 5 inhibitor use, either on demand or daily, had a positive impact on urinary continence recovery (P = 0.03).
  
  
  CONCLUSIONS
  Patients taking phosphodiesterase type 5 inhibitor have higher urinary continence recovery rates as compared with patients left untreated after bilateral nerve-sparing radical prostatectomy. An improvement in sphincteric and pelvic floor blood supply might be responsible for this beneficial effect associated with the use of phosphodiesterase type 5 inhibitor.
authors.affiliation: Department of Urology, Urological Research Institute, University Vita-Salute San Raffaele, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gandaglia
authors.forename: Maarten
authors.initials: M
authors.lastname: Albersen
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.forename: Andrea
authors.initials: A
authors.lastname: Gallina
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Fabio
authors.initials: F
authors.lastname: Castiglione
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
authors.forename: Patrizio
authors.initials: P
authors.lastname: Rigatti
authors.forename: Petter
authors.initials: P
authors.lastname: Hedlund
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
mesh_terms: D000368:Aged; D007172:Erectile Dysfunction / Q000188:drug therapy; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D059351:Organ Sparing Treatments / Q000379:methods; D058986:Phosphodiesterase 5 Inhibitors / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000188:drug therapy*; D016016:Proportional Hazards Models; D011468:Prostatectomy / Q000379:methods*; D020127:Recovery of Function / Q000187:drug effects*; D014549:Urinary Incontinence / Q000188:drug therapy*; D014551:Urinary Tract / Q000187:drug effects / Q000294:innervation / Q000601:surgery
chemical_list: D058986:Phosphodiesterase 5 Inhibitors