Purpose: We assess the effect of sildenafil in a subgroup of patients after
prostatectomy with erectile dysfunction and determine whether nerve preser
vation improves sildenafil response in this subgroup.
Materials and Methods: Between April 1998 and January 1999, 53 patients who
had undergone radical retropubic prostatectomy and were prescribed oral si
ldenafil were surveyed using a confidential mail questionnaire. Of the pati
ents 21 underwent bilateral and 15 unilateral neurovascular bundle sparing
procedures, while in 17 a nonnerve sparing procedure was performed. All pat
ients received 25 to 100 mg. sildenafil in a flexible dose escalation manne
r. Response, satisfaction and side effects were assessed using a modified,
self-administered International Index of Erectile Function questionnaire. R
esponse was defined as erection sufficient for intercourse. Preoperative an
d postoperative/pretreatment erectile functions were assessed for baseline
comparison in each patient, and partner overall satisfaction with sildenafi
l was measured. Statistical data analysis was performed using analysis of v
ariance and Newman-Keuls multiple comparison tests.
Results: Of the 21 patients who underwent a bilateral nerve sparing procedu
re 15 had a positive response. Of the 15 patients who had undergone a unila
teral nerve sparing procedure 12 had a positive response, and only 1 of the
17 patients who had undergone a nonnerve sparing procedure responded to si
ldenafil. The most commonly reported adverse events of all causes were head
aches (21%), flushing (8.3%), visual disturbance (6.3%) and nasal congestio
n (6.3%).
Conclusions: Sildenafil is an equally effective treatment for erectile dysf
unction after bilateral and unilateral nerve sparing procedures, and patien
t response to sildenafil is confirmed by the partners. However, patients wh
o undergo nonnerve sparing procedures do not respond satisfactorily to sild
enafil.