Nightly sildenafil use after radical prostatectomy has adverse effects on urinary convalescence: Results from a randomized trial of nightly vs on-demand dosing regimens

Hyndman, M. Eric; Bivalacqua, Trinity J.; Mettee, Lynda Z.; Su, Li Ming; Trock, Bruce J.; Pavlovich, Christian P.

doi:10.5489/cuaj.3169

Cited by 7 publications

(2 citation statements)

References 22 publications

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“…The concomitant use of VED in these studies is not clear, which adds another limitation to their interpretation. Also of interest is a follow-up study to the study by Pavlovich et al [172] suggesting poorer EPIC scores with nightly sildenafil 50 mg compared to PRN dosing, largely in the urinary irritative and bother subscales of the questionnaire [125]. Further study is required to clarify the implications of this report.…”

Section: Oral Pde 5 Inhibitorsmentioning

confidence: 81%

Preventing Erectile Dysfunction after Radical Prostatectomy: Nerve-Sparing Techniques, Penile Rehabilitation, and Novel Regenerative Therapies

Whalen¹

2019

Prostatectomy

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Erectile dysfunction is a known and much-dreaded functional consequence of radical prostatectomy. Dr. Patrick Walsh pioneered the nerve-sparing radical retropubic prostatectomy in the early 1980s, which has mitigated the morbidity of this surgery. Postoperative potency rates range widely from 20 to 80%, however, and depend on myriad factors including age, preoperative potency, and degree of nerve-sparing during surgery. Over the past four decades several developments have continued to offer hope to patients and clinicians alike, including refined understanding of cavernosal nerve neuroanatomy, beneficial modifications in surgical technique, as well as the advent of robotic surgery. Furthermore, multiple pre-and post-operative penile rehabilitation techniques using mechanotherapy and pharmaceuticals have also improved functional recovery. This paper examines erectile dysfunction as a consequence of radical prostatectomy, including the physiology of erections, the pathophysiology of post-operative erectile dysfunction, novel surgical techniques to enhance neurovascular bundle preservation, and penile rehabilitation strategies involving hyperbaric oxygen, neuroprotective pharmaceuticals, dehydrated human amnion-chorion membrane allografts, and mesenchymal stem cell therapy.

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Section: Oral Pde 5 Inhibitorsmentioning

confidence: 81%

Preventing Erectile Dysfunction after Radical Prostatectomy: Nerve-Sparing Techniques, Penile Rehabilitation, and Novel Regenerative Therapies

Whalen¹

2019

Prostatectomy

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“…Studies have shown that PDE5i therapy after RARP may also improve urinary continence outcomes (19, 37, 38). Kaiho et al (24) showed that immediate PDE5i therapy may temporarily worsen immediate incontinence compared to late therapy.…”

Section: Discussionmentioning

confidence: 99%

Immediate post-operative PDE5i Therapy improves early Erectile Function Outcomes after Robot Assisted Radical Prostatectomy (RARP)

Nathan

Shukla

Sinha

et al. 2020

Preprint

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Objectives To assess whether the timing of post-operative Phosphodiesterase Inhibitor (PDE5i) therapy after Robot Assisted Radical Prostatectomy (RARP) is associated with a change in early erectile function outcomes. Additionally, to determine whether there are differences in continence or safety outcomes. Subjects/patients and methods Data was prospectively collected from a single surgeon in one tertiary centre and retrospectively evaluated. 158 patients were treated with PDE5i therapy post RARP over a two-year period. PDE5i therapy was started: immediately (day 1-2) post-op in 29%, early (day 3-14) post-op in 37% and late (after day 14) post-op in 34%. EPIC-26 Erectile Function (EF) scores were collected pre-op and post-op with a median follow-up time of 43 days. Results The median age was 64 and the median BMI was 27. 9% of the series had Charlson Co-Morbidities. There were no significant differences in pre-operative characteristics between the therapy groups. Patients that had bilateral nerve sparing had a mean drop in Erectile Function (EF) score by 5.4 compared to 8.8 in the unilateral group. Additionally, 34.9% of bilateral nerve sparing patients returned to baseline compared to 12.1% of unilateral. Drop in EF scores and percentage return to baseline for unilateral nerve sparing was respectively 9 and 11.1% of immediate therapy, 7 and 14.8% of early therapy and 9.7 and 9.5% of late therapy (p=0.9 and p=0.6). For bilateral nerve sparing this was respectively 3.5 and 42.9% immediate therapy, 5.5 and 35.5% early therapy and 7.3 and 25% late therapy (p=0.017 and p=0.045). Pad free and social continence was achieved in 54% and 37% of those receiving immediate therapy, 60% and 33% for early therapy and 26% and 54% for late therapy. There were no differences in compliance, complication or readmission outcomes. Conclusion In patients with bilateral nerve sparing RARP, immediate post-operative PDE5i therapy may protect EF. Early onset (3-14 days) may also provide a benefit compared to initiating PDE5i therapy later (after 14 days). Expediting therapy for patients undergoing unilateral nerve sparing may also provide a benefit; however, the differences are less pronounced. Immediate or early PDE5i therapy also improved early continence outcomes for patients with bilateral nerve sparing, compared to late therapy. There were no differences in compliance, complication or readmission rates between the groups. Therefore, immediate PDE5i therapy should be considered in patients following nerve sparing RARP in order to maximise functional outcomes, especially in those undergoing bilateral nerve spare.

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Super-veil nerve-sparing extraperitoneal pure single-port robotic-assisted radical prostatectomy on da Vinci Si robotic system

Chang

Xiao

et al. 2022

World J Urol

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Nightly sildenafil use after radical prostatectomy has adverse effects on urinary convalescence: Results from a randomized trial of nightly vs on-demand dosing regimens

Cited by 7 publications

References 22 publications

Preventing Erectile Dysfunction after Radical Prostatectomy: Nerve-Sparing Techniques, Penile Rehabilitation, and Novel Regenerative Therapies

Preventing Erectile Dysfunction after Radical Prostatectomy: Nerve-Sparing Techniques, Penile Rehabilitation, and Novel Regenerative Therapies

Immediate post-operative PDE5i Therapy improves early Erectile Function Outcomes after Robot Assisted Radical Prostatectomy (RARP)

Super-veil nerve-sparing extraperitoneal pure single-port robotic-assisted radical prostatectomy on da Vinci Si robotic system

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