Role of Viagra after radical prostatectomy

Objectives. To determine whether the response to sildenafil citrate (Viagra ) in patients with erectile dysfunction after radical prostatectomy was inf luenced by the presence or absence of neurovascular bundles, the interval f rom surgery to the initiation of drug therapy, and the dose of the drug, Methods. Baseline and follow-up data from 91 patients presenting with erect ile dysfunction after radical prostatectomy were obtained. The patients wer e stratified according to the type of nerve-sparing (NS) procedure: bilater al NS, unilateral NS, and non-NS. They were interviewed using the Cleveland Clinic Post Prostatectomy (CCPP) questionnaire and the International Index of Erectile Function (IIEF) questionnaire, Results. The presence or absence of the neurovascular bundles influenced th e ability to achieve vaginal intercourse. In the patients who had undergone bilateral NS, 71.7% (38 of 53) responded; in those with unilateral NS, 50% (6 of 12) responded; and in those with non-NS, 15.4% (4 of 26) responded. The IIEF questionnaire confirmed the quality of the positive responses, wit h significant improvements in response to question 3 (frequency of penetrat ion), question 4 (frequency of maintenance of erection), and question 7 (sa tisfaction with intercourse). The magnitude of improvement in responses was higher in the bilateral NS group than in the unilateral NS and non-NS grou ps (P <0.05). When the data of the 48 positive responders were analyzed, no difference in the response rate was found when the interval from surgery t o drug therapy was stratified by the following three intervals: 0 to 6 mont hs (44%), 6 to 12 months (55%), and greater than 12 months (53%). Of the po sitive responders, 14 (29.1%) required the 50-mg dose, and 34 (70.9%) requi red the 100-mg dose, The most common side effects were transient headaches (28,6%), flushing (21.9%), dizziness (8,8%), dyspepsia (6.5%), and nasal co ngestion (5.4%), with an increase in the incidence of headaches seen at the higher dose (P = 0.04). Conclusions. Successful treatment of erectile dysfunction with sildenafil c itrate after radical prostatectomy depends on the presence of the neurovasc ular bundles, Our data suggest that the response to sildenafil is not relat ed to the interval between the surgery and initiation of drug therapy but i s related to the dose. (C) 2000, Elsevier Science Inc.