Recovery of erectile function after nerve‐sparing radical prostatectomy: improvement with nightly low‐dose sildenafil

Bannowsky, A.; Schulze, H.; Horst, Christof van der; Hautmann, S.; Jünemann, K. P.

doi:10.1111/j.1464-410x.2008.07515.x

Cited by 139 publications

(124 citation statements)

References 24 publications

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“…43 Penile rehabilitation after nerve-sparing radical prostatectomy: Clinical evidence Despite all the evidence in favor of chronic treatment with PDE5-I, only a few trials have assessed the role of penile rehabilitation in men who underwent RP. [46][47][48][49][50][51][52] Montorsi et al 46 demonstrated that, by using intracorporeal injections of alprostadil early after bilateral NSRP (BNSRP), the rate of recovery of spontaneous erections was significantly higher than the rate with observation alone. Those data also recently were confirmed by Mulhall et al,47 who demonstrated that the prophylactic use of intracorporeal injections of alprostadil in patients who did not respond to oral sildenafil resulted in higher rates of spontaneous functional erections and erectogenic drug response 18 months after NSRP.…”

Section: Pharmacologic Prophylaxis Of Postoperative Erectile Dysfunctmentioning

confidence: 99%

“…50 Recently, Bannowsky et al evaluated the effect of daily sildenafil 25 mg in a small cohort of patients who underwent NSRP and who maintained nocturnal erections early after surgery. 51 Patients assigned nonrandomly to receive either daily sildenafil 25 mg or no treatment after surgery. In that study, the patients who received nightly sildenafil had higher mean IIEF-5 scores and a shorter time to recovery of erectile function (P < .001) compared with the patients who remained untreated after surgery (potency rate, 86% vs 66%, respectively).…”

Section: Pharmacologic Prophylaxis Of Postoperative Erectile Dysfunctmentioning

confidence: 99%

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Prediction of sexual function after radical prostatectomy

Briganti

Capitanio

Chun

et al. 2009

Cancer

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Radical prostatectomy (RP) is a commonly used procedure in the treatment of clinically localized prostate cancer. For this report, the authors critically analyzed the factors associated with recovery of erectile function after surgery. A systematic review of the literature using the Medline and CancerLit databases was conducted. Keywords for the literature search included prostate cancer, radical prostatectomy, erectile dysfunction, impotence, treatment, and prophylaxis. Accurate patient selection (based on patient age, preoperative erectile function, and comorbidity profile) and adequate surgical technique (ie, the preservation of neurovascular bundles) were the major determinants of postoperative erectile function. Moreover, better results were achieved when an appropriate pharmacologic treatment using either oral or local approaches was given. Therefore, the authors concluded that, if patients are stratified correctly according to preoperative, intraoperative, and postoperative factors, then a satisfactory functional recovery may be expected after surgery. For these reasons, an ideal multivariate model predicting the restoration of erectile function after surgery should include patient, surgeon, and postsurgical treatment variables. The authors also concluded that the stratification of patients with regard to their risk of developing erectile dysfunction after surgery was feasible based on several parameters, which should be taken into account for correct patient treatment and counseling. To address this objective, accurate tools for predicting the likelihood of complete functional recovery after surgery are needed. Radical prostatectomy (RP) is used increasingly as a therapeutic option for patients who have clinically localized prostate cancer and a life expectancy 10 years. The pioneering work by Walsh and Donker 1 contributed significantly to our understanding of the surgical anatomy of the prostate and represented the basis for the subsequent development of the anatomic RP technique. The objective of this surgical approach is complete excision of the prostate to provide optimal cancer control while maintaining the integrity of the anatomic structures devoted to the functions of urinary continence and sexual potency. [2][3][4] Since the initial reports on this technique, increasing numbers of studies have reported satisfactory *Predictive Modeling in Prostate Cancer, Supplement to Cancer

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Section: Pharmacologic Prophylaxis Of Postoperative Erectile Dysfunctmentioning

confidence: 99%

Section: Pharmacologic Prophylaxis Of Postoperative Erectile Dysfunctmentioning

confidence: 99%

Prediction of sexual function after radical prostatectomy

Briganti

Capitanio

Chun

et al. 2009

Cancer

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“…69 It has been shown that nightly sildenafil significantly improves nocturnal erections after nerve-sparing prostatectomy, which is theorized to be critical in the penile rehabilitative process by preventing penile hypoxia and resulting fibrosis and veno-occlusive dysfunction. 70,71 This was demonstrated by Montorsi and colleagues, 70 who showed that in more than 70% of patients, the administration of sildenafil produced nocturnal erections that were significantly stronger than those after administration of a placebo. However, it should be emphasized that in this study a number of inclusion and exclusion criteria were followed, producing a selected study population and limiting its findings to a more general patient base.…”

Section: Phosphodiesterase Type 5 Inhibitorsmentioning

confidence: 79%

Penile rehabilitation following treatment for prostate cancer: an analysis of the current state of the art

Al-Shaiji

Domes

Brock

2013

CUAJ

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Despite recent advances in surgical technique using laparoscopic and robotic approaches for the management of early organconfined prostate cancer, most contemporary reports demonstrate significant rates of erectile dysfunction comparable to standard open approaches. Controversy remains related to many of the preand postoperative management strategies, including agents to enhance nerve recovery, erectogenic drugs, antioxidants, vasoactive injectables, vacuum erection devices and nerve grafting procedures. Additionally, the optimal timing of these interventions and their duration, dose, frequency and outcome thresholds remain ill-defined. In our paper, we provide a comprehensive literature review involving both the basic and clinical data surrounding rehabilitative approaches. RésuméMalgré des avancées récentes dans les techniques chirurgicales utilisant la laparoscopie et la robotique pour la prise en charge du cancer de la prostate au stade précoce, la majorité des rapports récents font état de taux significatifs de dysfonction érectile se comparant aux taux associés aux approches ouvertes standard. Bon nombre des stratégies de traitement préopératoires et postopératoires, comme les agents favorisant la récupération nerveuse, les médicaments érec-togènes, les antioxydants, les agents vasoactifs injectables, les pompes péniennes et les greffes de nerfs, font toujours l'objet de controverses. Par ailleurs, le moment optimal pour effectuer ces interventions, la durée de ces dernières, la dose, la fréquence et le seuil d'évaluation des résultats demeurent encore bien mal défi-nis. Cet article de synthèse présente une revue approfondie de la littérature comprenant les données de recherche fondamentale et les données cliniques concernant les approches de réadaptation.going surgery and are thus expressing concern about preservation of erectile function after the procedure, a fact that is true for older men as well. Since Walsh and Donker 4 published their landmark article describing the etiology and prevention of impotence following retropubic RP in 1982, the nerve-sparing technique they described is widely employed and believed to improve postoperative erectile function. 5 Furthermore, there continue to be modifications to the nervesparing technique in an attempt to minimize nerve compromise and improve postoperative potency, as reported by Chuang and coauthors 6 and Masterson and colleagues. 7 However, optimal sexual functioning often requires 18 to 42 months to return, even among men in whom bilateral nerve sparing was performed, with reported recovery rates varying from 16% to 86%. 8,9 Sexual dysfunction has been reported to be an independent determinant of a poorer general health-related quality of life at 2 years after primary treatment for prostate cancer. 10 Recent advances in the understanding of the pathophysiology of postprostatectomy erectile dysfunction (PED) have stimulated great attention directed toward the concept of penile rehabilitation, in which prophylactic measures are instituted to prom...

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“…Among elderly patients, the development of hypoxia-induced tissue damage and fibrosis of the corpora cavernosa are the major cause of ED after RP. 23 Reviews of the literatures have shown that age, obesity and urinary tract symptoms are the mostimportant factors attributed to the occurrence of ED. 1,5,[8][9][10]12,23 The appropriate dose of PGE1 used for ED treatment depends on the etiology.…”

Section: Discussionmentioning

confidence: 99%

Experience with intracavernous injection in the treatment of erectile dysfunction after radical prostatectomy: dose considerations

Lakin

et al. 2011

Int J Impot Res

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We sought to identify factors influencing dose maintenance of intracavernous (IC) injection among patients with ED following radical prostatectomy. A total of 93 patients underwent prostatectomy and received IC treatment for ED, including PGE1 single therapy (n ¼ 53) and triple therapy (n ¼ 40). In the PGE1-only group, the maintenance dosage was significantly correlated with preoperative sexual function and nerve sparing (NS) (Po0.05). For example, the maintenance dose among patients with no, unilateral and bilateral NS was 10.8 ± 6.6 lg (0.54 ± 0.33 ml), 10.8 ± 3.8 lg (0.54 ± 0.19 ml) and 6.4 ± 4.6 lg (0.32 ± 0.23 ml), respectively. In terms of preoperative sexual function, the maintenance dose among non-ED versus ED patients was 0.38±0.25 ml (7.6±5.0 lg) and 0.59±0.31 ml (11.8±6.2 lg), respectively. No significant correlation was observed between the maintenance dose and NS or preoperative sexual function among the triple-therapy patients or between the maintenance dose and age, body mass index, systemic diseases and initiation of ED treatment among all patients (P40.05). Thus, maintenance dose of PGE1 therapy could be partly determined by NS status and prior ED of patients.

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Recovery of erectile function after nerve‐sparing radical prostatectomy: improvement with nightly low‐dose sildenafil

Cited by 139 publications

References 24 publications

Prediction of sexual function after radical prostatectomy

Prediction of sexual function after radical prostatectomy

Penile rehabilitation following treatment for prostate cancer: an analysis of the current state of the art

Experience with intracavernous injection in the treatment of erectile dysfunction after radical prostatectomy: dose considerations

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