PDE5 inhibitors improve erectile function after prostatectomy
Loss of erectile function is common after radical prostatectomy, even when the surgeon has spared the neurovascular bundles that run alongside the prostate.
With time, erectile function improves in many men. However, it has been suggested that active measures to help this return of function are important in preventing atrophy of the corpora cavernosa during the recovery period. A study has now found that sildenafil improves sexual function in patients post-prostatectomy and reduces the time to recovery of erectile function.
The study, from Germany, randomised 43 patients after nerve-sparing radical prostatectomy to sildenafil 25mg per day at night, starting the day after catheter removal, or a control group that received no PDE5 inhibitors. The International Index of Erectile Function (IIEF-5), a well validated questionnaire, was administered on five occasions during the one year follow-up to evaluate the recovery of erectile function in both groups.
In the group using daily sildenafil, the mean IIEF-5 score was 20.8 prior to surgery, decreasing to 3.6 at six weeks and gradually increasing to 14.1 at one year. In the control group, the respective scores were 21.2
pre-operatively, decreasing to 2.4 at six weeks and increasing to 9.3 at one year. There was a significant difference in IIEF-5 score and time to recovery of erectile function between the two groups (P= <0.001), with potency rates (after use of on demand sildenafil) of 86% and 66% for the sildenafil and control groups respectively at one year.
The evidence base for the use of PDE5 inhibitors, intracavernosal prostaglandins and vacuum devices after radical prostatectomy is increasingly convincing. With the growing number of radical prostatectomies performed for prostate cancer in the UK, GPs will increasingly be asked to prescribe these therapies to assist long-term recovery of erectile function.
Bannowsky A, Schulze H, van der Horst C et al. Recovery of erectile function after nerve-sparing radical prostatectomy: improvement with nightly low-dose sildenafil. BJU Int 2007 doi:10.1111/j.1464-410X.2008.07515Reviewer
Dr Jonathan Rees
GPwSI Urology, Bristol