Sildenafil in the treatment of erectile dysfunction after radical prostatectomy

Objectives. To evaluate the efficacy of sildenafil for the treatment of ere ctile dysfunction after radical prostatectomy and to determine whether age, preservation of the neurovascular bundles (NVBs), or the interval between surgery and the initiation of sildenafil therapy influences the response to sildenafil. Methods. We began this study in April 1998, immediately after the Food and Drug Administration approved sildenafil. We surveyed 170 men who had underg one radical retropubic prostatectomy, had not recovered natural erections s ufficient for intercourse, and subsequently received sildenafil between 3 a nd 24 months postoperatively. The data were collected through a confidentia l mail survey conducted by a clinical nurse. The men used a dose of 50 mg s ildenafil and increased this to 100 mg if they did not obtain an adequate r esponse. Results. In the 120 men who began taking sildenafil at least 12 months afte r surgery, the overall response rate was 29%. Results varied markedly by pa tient age and number of NVBs preserved. in men younger than 55 years in who m both NVBs had been preserved, the response rate was 80%. in contrast, no patient older than 55 years in whom only one NVB had been preserved reporte d an adequate response. Regardless of age, no patient in whom both NVBs had been excised reported success with sildenafil. Of the 50 patients who bega n taking sildenafil less than 9 months after surgery and who had not recove red natural sexual function, none reported erections adequate for intercour se using sildenafil. Conclusions. Sildenafil is an effective treatment for men with erectile dys function after radical retropubic prostatectomy, particularly in younger me n in whom both NVBs have been preserved. It is ineffective in men in whom b oth NVBs have been excised, and it is also ineffective in older men in whom only one NVB has been preserved. Sildenafil appears ineffective in the fir st 9 months after prostatectomy. UROLOGY 56: 631-634, 2000. (C) 2000, Elsev ier Science Inc.