Effect of sildenafil citrate on post-radical prostatectomy erectile dysfunction

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.