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DGDispatch
Postoperative Nightly Sildenafil (Viagra) Promotes Erectile Function Post-prostatectomy: Presented at AUA
By Paula Moyer
CHICAGO, IL -- May 1, 2003 -- Nightly use of sildenafil (Viagra) after nerve-sparing radical retropubic prostatectomy (NSRRP) appears to help promote the return of normal spontaneous erectile function.
"Nightly use of sildenafil after prostatectomy is the bridge between two key issues in men's urogenital health -- erectile dysfunction and prostate cancer," said Harin Padma-Nathan, MD, a clinical professor of urology, Keck School of Medicine, University of Southern California in Los Angeles. He is also in private practice in Beverly Hills.
Dr. Padma-Nathan presented the findings here April 29th at the 98th Annual Meeting of the American Urological Association.
The findings show that nightly administration of sildenafil for 9 months after NSRRP increased the return of spontaneous erections seven-fold compared with placebo, and that treatment was well tolerated, he said.
He noted that NSRRP has better potency outcomes over radical prostatectomy.
"However, even in experienced surgical hands, a large number of patients don't return to normal erectile function," Dr. Padma-Nathan said. "The majority [of patients] are highly potent before their surgical procedure, and therefore, what they want is not the same as a man who is being treated for erectile dysfunction."
He said that one hypothesis is that, during surgery, the nerves to the penis are traumatized. Even though the nerves do recover, long-term ED could occur due to muscle atrophy during convalescence as the result of neuropraxia and hypoxia.
Conversely, he said, nightly sildenafil may promote oxygenation. Therefore, the investigators wanted to see if nightly treatment with sildenafil would facilitate the return to normal erectile function.
The rationale was that early postoperative intervention with intracavernosal alprostadil was shown to promote post-NSRRP erections. Other research has shown that nightly sildenafil improves nocturnal erections. Therefore, Dr. Padma-Nathan and his colleagues wanted to see whether nightly sildenafil would promote the return of normal erections after bilateral NSRRP.
The investigators followed 76 men with prostate cancer who were to undergo NSRRP. They all had normal preoperative erectile function, which the investigators defined as a combined score of at least 8 for questions 3 and 4 from the International Index of Erectile Function (IIEF) questionnaire, and as a normal erectile function as measured by nocturnal penile tumescence testing. Normal tumescence was defined as at least 10 continuous minutes of erection with at least 55% base rigidity.
Four weeks after NSRRP the patients were randomized to 1 of 3 nightly treatment groups: 23 received 50 mg of sildenafil; 28 received 100 mg of sildenafil, and 25 received a placebo. The men were treated for 36 weeks in a double-blind fashion.
The investigators assessed their erectile function 8 weeks after they discontinued treatment by asking the question, "Over the past 4 weeks, have your erections been good enough for satisfactory sexual activity?"
The investigators also administered the IIEF questionnaire, and patients' erections were assessed with nocturnal penile tumescence measurement. The investigators defined responders as those who had a combined score of at least 8 for questions 3 and 4 on the IIEF and a positive response to the sexual activity question.
At the time of this assessment, 48 weeks after bilateral NSRRP, 27% of the 51 patients receiving sildenafil demonstrated a return of spontaneous erectile function. Among the 25 placebo patients, 4% had a similar response (P=0.0156). The postoperative nocturnal penile tumescence assessments were consistent with this finding, Dr. Padma-Nathan said.
The patients reported no treatment-related serious adverse events, although 2 patients discontinued due to treatment-related adverse events.
These results support using nightly sildenafil as a postoperative treatment regimen for these patients, Dr. Padma-Nathan concluded.
[Study title: Postoperative Nightly Administration of Sildenafil Citrate Significantly Improves the Return of Normal Spontaneous Erectile Function After Bilateral Nerve-Sparing Radical Prostatectomy. Abstract 1402]
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