UroToday - Return of Nocturnal Erections and Erectile Function after Bilateral Nerve-sparing Radical Prostatectomy in Men Treated Nightly with Sildenafil Citrate: Subanalysis of a Longitudinal Randomized Double-blind Placebo-controlled Trial - Abstra

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Friday, 25 January 2008

New York University Medical

Center—Urology, New York, NY,

USA

After

bilateral nerve-sparing radical retropubic prostatectomy (BNSRRP), nocturnal

and sexually mediated erections may help to preserve normal erectile function

(EF).

To

investigate nocturnal penile tumescence and rigidity (NPTR) in a subset (N = 54

men) from a randomized, double-blind trial (N = 76) of nightly sildenafil after

BNSRRP.

Inclusion

required preoperative " normal " EF (defined as a combined score of

>/=8 for International Index of Erectile Function questions 3 (penetration)

and 4 (maintained erection after penetration) and NPTR testing (>/=10

continuous minutes of >/=55% rigidity [R >/= 55%] at the base).

Postoperative assessments were at weeks 4 (pretreatment), 16, 28, 40 (during 36

weeks of nightly prophylaxis: sildenafil 50 mg [N = 17], 100 mg [N = 18] or

placebo [N = 19]), and 48 (after 8 weeks of no erectile dysfunction therapy,

when " responders " were delineated by the defined normal EF and a " yes "

response to " Over the past 4 weeks, have your erections been good enough

for satisfactory sexual activity? " ). Base and tip rigidity and tumescence

were measured using penile plethysmography

Duration

of R >/= 55% and area under the curves for rigidity and tumescence

Postoperatively,

rapid profound reduction in nocturnal EF was noted in all groups. There was a

gradual dose-dependent improvement in base and tip rigidity in the sildenafil

groups but little improvement in the placebo group. Eight weeks after treatment

termination (48 weeks postoperatively), 24% (4/17) of 50-mg sildenafil

recipients, 33% (6/18) of 100-mg sildenafil recipients, and 5% (1/19) of

placebo recipients were responders. Tip R >/= 55% was the most discriminating

NPTR measure between nonresponders and responders to sildenafil, in whom it

regained baseline (preoperative) levels (whereas base R >/= 55% did not). It

was most prolonged in responders to sildenafil 100 mg.

In our

subset analysis, nightly sildenafil for 9 months post-BNSRRP objectively

improved nocturnal erections and pharmaceutically unassisted EF.

Written

by

McCullough AR, Levine LA, Padma- H.

Reference

J Sex Med. 2007 Dec 14 [Epub ahead of print]

PubMed

Abstract

PMID:18086170