Recovery of erectile function after nerve sparing radical prostatectomy and
penile rehabilitation with nightly intraurethral alprostadil versus sildenafil
citrate.
Author(s): McCullough AR, Hellstrom WG, Wang R, Lepor H, Wagner KR, Engel JD.
Affiliation(s): Department of Urology, New York University School of Medicine, New York, New
York, USA. andy.mccullough@nyumc.org
Publication date & source: 2010, J Urol. , 183(6):2451-6
PURPOSE: To our knowledge we report the first large, randomized, prospective
penile rehabilitation clinical trial to compare the effectiveness of nightly
intraurethral alprostadil vs sildenafil citrate after nerve sparing
prostatectomy.
MATERIALS AND METHODS: We performed a prospective, randomized, open label,
multicenter American study in men with normal erectile function who underwent
bilateral nerve sparing radical prostatectomy. The International Index of
Erectile Function erectile function domain was the primary end point. Subjects
initiated nightly treatment within 1 month of surgery with intraurethral
alprostadil or oral sildenafil citrate (50 mg) for 9 months. After 1-month
washout and before sexual activity subjects self-administered sildenafil citrate
(100 mg) for a total of 6 attempts in 1 month. Secondary end points were the
global assessment question, sexual encounter profile, Erectile Dysfunction
Inventory of Treatment Satisfaction and measured stretched penile length.
RESULTS: Of 139 men who started intraurethral alprostadil and 73 who started
sildenafil citrate, 97 and 59, respectively, completed the trial. There were no
statistically significant differences in International Index of Erectile Function
erectile function domain and intercourse success rates to intraurethral
alprostadil. The global assessment question was significantly better only at 6
months for intraurethral alprostadil (p <0.028). At completion there were no
differences between treatments for any of the end points.
CONCLUSIONS: This is the first study to directly compare the ability of
alprostadil and a phosphodiesterase-5 inhibitor to enhance penile recovery
subsequent to bilateral nerve sparing radical prostatectomy. The use of nightly
subtherapeutic intraurethral alprostadil is well tolerated after radical
prostatectomy. The benefit to return of erectile function of nightly sildenafil
citrate and subtherapeutic intraurethral alprostadil appears to be comparable
within the first year of surgery.
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