Elsevier

Urology

Volume 62, Issue 1, July 2003, Pages 110-115
Urology

Adult urology
Long-term effect of sildenafil citrate on erectile dysfunction after radical prostatectomy: 3-year follow-up1

https://doi.org/10.1016/S0090-4295(03)00157-2Get rights and content

Abstract

Objectives

To evaluate the long-term effect and safety of sildenafil citrate for the treatment of erectile dysfunction after radical prostatectomy (RP).

Methods

The study consisted of 91 patients with erectile dysfunction from our institution who received oral sildenafil citrate after RP. We surveyed these patients using a self-administered questionnaire during the first year of sildenafil citrate use to determine treatment satisfaction, patient compliance, and safety. Those who had responded positively to the drug were surveyed again 3 years later (n = 48). Sildenafil citrate was prescribed at a dose of 50 mg and increased to 100 mg if needed. Data were collected from a self-administered questionnaire using the abridged five-item version of the International Index of Erectile Function questionnaire, referred to as the Sexual Health Inventory of Men, and the Erectile Dysfunction Inventory of Treatment Satisfaction. The patients were stratified according to the type of nerve-sparing (NS) RP procedure they underwent: bilateral NS, unilateral NS, and non-NS.

Results

At 3 years, 31 (71%) of the 43 patients who had returned the second surveys were still responding to sildenafil. Of these 31 respondents, 10 (31%) had augmented their dose from 50 to 100 mg. The dropout rate was 27%; 6 of 12 had discontinued because of the return of natural erections, 5 because of a loss of efficacy, and 1 because his spouse had died. No differences were found in the 1-year and 3-year five-item International Index of Erectile Function (Sexual Health Inventory of Men) and Erectile Dysfunction Inventory of Treatment Satisfaction scores between the NS groups. The most common side effects at 3 years were headache (12%), flushing (10%), and blue or blurred vision (2%). No patient discontinued the drug at 3 years because of side effects.

Conclusions

The results of this study indicate that the vast majority of patients with erectile dysfunction after RP who initially respond to sildenafil continue to do so at 3 years and are satisfied and compliant with the treatment regimen.

Section snippets

Initial study: patient recruitment

We obtained and reviewed the records of two experienced surgeons (C.Z., E.K.) who, between 1994 and 1998, performed RP on 350 sexually active patients with localized prostate cancer. At a mean follow-up of 3 months, 208 (68%) of 350 patients experienced severe ED, with no patient able to achieve vaginal penetration. All 208 patients with ED were initially evaluated by an internist in our group (M.L.) who took a comprehensive sexual history and performed a physical examination. At that time, the

Results

No statistically significant differences were found between the non-NS and NS groups in age, interval between RP and start of sildenafil, preoperative and predrug erectile status, nocturnal erections, and ability to penetrate, as assessed by our retrospective chart review (Table I).

Comment

Our 3-year follow-up study of the effect of sildenafil citrate after RP demonstrates its long-term efficacy and compliance. Most patients who responded at 1 year (72%) continued to have effective erections with sildenafil citrate at 3 years. The SHIM (IIEF-5) and EDITS scores were comparable at 1 and 3 years. When the responses at 1 and 3 years were stratified according to neurovascular bundle status, the magnitude of improvement in SHIM (IIEF-5) was still greater in the bilateral NS group than

Conclusions

After NS RP, patients who initially respond to sildenafil continued to show excellent long-term efficacy and compliance at 3 years by SHIM analysis. The degree of neurovascular preservation continued to determine the response rates to sildenafil. Discontinuation was primarily due to a return of natural erections (15%) and loss of efficacy (12%), with no patient stopping because of adverse side effects.

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    Citation Excerpt :

    There is consistent evidence that sildenafil not only is efficacious in the treatment of ED but also significantly improves several psychosocial outcomes. These include (i) the IIEF satisfaction domain, (ii) the ED Effect on Quality of Life Questionnaire, (iii) broadly based psychometric questionnaires, (iv) the Beck Depression Inventory, (v) the Fugl-Meyer Life Satisfaction Checklist, (vi) the ED Inventory of Treatment Satisfaction (EDITS) for patient and partner, (vii) the Hamilton Depression (HAM-D) score, (viii) the Center for Epidemiologic Studies Depression (CESD) Scale, (ix) the Arizona Sexual Experience Scale, (x) the Erectile Distress Scale, and (xi) the Self-Esteem and Relationship Questionnaire.35–58,60–63,65–68,70–72,74–80,82–91,99–101 The most common adverse events associated with sildenafil include headache, flushing, dyspepsia, and nasal congestion.

  • Erectile dysfunction following radical prostatectomy: A review

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1

C. D. Zippe is a member of the speaker’s bureau for Pfizer. M. M. Lakin is a consultant to, and a member of the speaker’s bureau for, Pfizer.

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