Radical retropubic prostatectomy (RRP) is an important cause of iatrogenic erectile dysfunction (ED). While sildena®l has been widely used since its introduction as a new treatment option for ED, its ef®cacy in post-RRP patients has not been extensively studied. We retrospectively compared the ef®cacy of sildena®l in post-RRP and non-surgical patients with ED (NSED) using a subset of questions from the International Index of Erectile Function (IIEF) and correlated results with their speci®c etiology of ED based on penile blood¯ow study (PBFS).A brief questionnaire regarding satisfaction with sildena®l was administered to 72 consecutive post-RRP patients (nerve sparing status unknown) and 32 consecutive NSED patients who had previously undergone PBFS with pharmacotesting as part of their evaluation for ED. PBFS diagnoses were arterial insuf®ciency (AI) for peak systolic velocity (PSV)`25 cmasec; venogenic (CVOD) for PSV 35 cmasec, mixed vascular for PV b 25 but`35 cmasec and resistive index (RI)`0.9; a vascular normal diagnosis (neurogenic impotence) required excellent rigidity sustained for 20 min. Differences in the IIEF subscores for the different groups of patients were assessed. Success with sildena®l was de®ned as moderate or excellent improvement (3a4 or 4a4) with ability for penetration.No differences were found among the different subgroups of RRP patients with respect to IIEF scores or success rates with sildena®l. NSED patients had both signi®cantly higher post-treatment IIEF scores (3.6a3.4 vs 2.5a2.2; t 4.50, P`0.0001) and success rates (63% vs 31%; t 3.11, P`0.01) with sildena®l treatment than RRP patients.We found that sildena®l is signi®cantly less effective in impotent RRP patients than in agematched patients with ED (31% vs 63%). We had postulated that sildena®l would be least effective among RRP patients with excellent sustained rigidity to PGE1, as this subgroup is likely to have neurogenic impotence. We found that sildena®l response rates among subgroups of RRP patients were statistically similar regardless of PBFS diagnosis. IIEF scores for the RRP subgroups were similar but statistically lower than in men with ED and no history of RRP. While individuals with normal vascular responses to PGE1 have an increased likelihood of having neurogenic impotence, in RRP patients, we were unable to demonstrate any difference in ef®cacy of sildena®l, regardless of the PBFS diagnosis.

Few studies have evaluated erectile function after interstitial radiation therapy for localized prostate cancer. Using a validated quality of life questionnaire, we assessed post-treatment erectile function and its relationship to treatment satisfaction and quality of life. We retrospectively reviewed the records of 171 consecutive patients who underwent Pd-103 or I-125 brachytherapy for prostate cancer between December 1992 and June 1998. Seventy percent of patients received neoadjuvant androgen deprivation therapy. All patients were mailed a validated questionnaire assessing sexual function and overall quality of life (UCLA Prostate Cancer Index and SF-36). Sixty-seven percent of all questionnaires were available for evaluation (114a171). The mean age was 69.1 y with a mean follow-up of 23 months (range 4 ± 72, median 24). Seventy-one percent of patients (81a114) had pre-treatment erections suf®cient for sustained vaginal penetration. Of these patients, potency was maintained in 49% of men (40a81). An additional 26% had erections ®rm enough for foreplay but not penetration (21a81). Erectile dysfunction rates were signi®cantly lower in younger patients (48%) vs older patients (55%). There was no difference in post-treatment potency between men who received neoadjuvant hormonal therapy and those who did not (P b 0.05). In addition, there were no differences in physical function (86, scale 0 ± 100), general health perception (78), emotional well-being (83), energyafatigue (74), and overall satisfaction (84) between men with erectile dysfunction and those without.In summary, two years following brachytherapy 25% of patients complained of complete (20a81) or partial (26%, 21a81) erectile dysfunction, for an overall rate of 51% (41a81). Short-term neoadjuvant hormonal therapy (`3 ± 6 months) did not increase the likelihood of post-treatment erectile dysfunction. Interestingly, overall satisfaction rates among brachytherapy patients were high (84a100) and surprisingly did not correlate with post-treatment sexual function.