Effect of Nightly versus On-Demand Vardenafil on Recovery of Erectile Function in Men Following Bilateral Nerve-Sparing Radical Prostatectomy

Montorsi, Francesco; Brock, Gerald; Lee, James Chun-I; Shapiro, JoAnn; Poppel, Hendrik Van; Graefen, Markus; Stief, Christian G.

doi:10.1016/j.eururo.2008.06.083

Cited by 338 publications

(301 citation statements)

References 14 publications

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“…43 Penile rehabilitation after nerve-sparing radical prostatectomy: Clinical evidence Despite all the evidence in favor of chronic treatment with PDE5-I, only a few trials have assessed the role of penile rehabilitation in men who underwent RP. [46][47][48][49][50][51][52] Montorsi et al 46 demonstrated that, by using intracorporeal injections of alprostadil early after bilateral NSRP (BNSRP), the rate of recovery of spontaneous erections was significantly higher than the rate with observation alone. Those data also recently were confirmed by Mulhall et al,47 who demonstrated that the prophylactic use of intracorporeal injections of alprostadil in patients who did not respond to oral sildenafil resulted in higher rates of spontaneous functional erections and erectogenic drug response 18 months after NSRP.…”

Section: Pharmacologic Prophylaxis Of Postoperative Erectile Dysfunctmentioning

confidence: 99%

“…However, despite the enthusiasm associated with chronic administration of PDE5-I after surgery, results from a recent, well designed, prospective, randomized, double-blind study appear to support the on-demand use of PDE5-I after BNSRP over a daily dosing regimen. 52 The study included a total of 628 preoperatively potent patients who underwent BNSRP and were randomized to receive either vardenafil 10 mg nightly or flexible-dose, on-demand vardenafil or placebo for 9 months. This large and rigorous study demonstrated that on-demand use of vardenafil during the treatment period was associated with significantly greater IIEF-EF domain scores and significantly better Sexual Encounter Profile 3 (SEP3) success rates (defined as a positive answer to the question: ''Did your erections last enough to have successful intercourse?'')…”

Section: Pharmacologic Prophylaxis Of Postoperative Erectile Dysfunctmentioning

confidence: 99%

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Prediction of sexual function after radical prostatectomy

Briganti

Capitanio

Chun

et al. 2009

Cancer

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Radical prostatectomy (RP) is a commonly used procedure in the treatment of clinically localized prostate cancer. For this report, the authors critically analyzed the factors associated with recovery of erectile function after surgery. A systematic review of the literature using the Medline and CancerLit databases was conducted. Keywords for the literature search included prostate cancer, radical prostatectomy, erectile dysfunction, impotence, treatment, and prophylaxis. Accurate patient selection (based on patient age, preoperative erectile function, and comorbidity profile) and adequate surgical technique (ie, the preservation of neurovascular bundles) were the major determinants of postoperative erectile function. Moreover, better results were achieved when an appropriate pharmacologic treatment using either oral or local approaches was given. Therefore, the authors concluded that, if patients are stratified correctly according to preoperative, intraoperative, and postoperative factors, then a satisfactory functional recovery may be expected after surgery. For these reasons, an ideal multivariate model predicting the restoration of erectile function after surgery should include patient, surgeon, and postsurgical treatment variables. The authors also concluded that the stratification of patients with regard to their risk of developing erectile dysfunction after surgery was feasible based on several parameters, which should be taken into account for correct patient treatment and counseling. To address this objective, accurate tools for predicting the likelihood of complete functional recovery after surgery are needed. Radical prostatectomy (RP) is used increasingly as a therapeutic option for patients who have clinically localized prostate cancer and a life expectancy 10 years. The pioneering work by Walsh and Donker 1 contributed significantly to our understanding of the surgical anatomy of the prostate and represented the basis for the subsequent development of the anatomic RP technique. The objective of this surgical approach is complete excision of the prostate to provide optimal cancer control while maintaining the integrity of the anatomic structures devoted to the functions of urinary continence and sexual potency. [2][3][4] Since the initial reports on this technique, increasing numbers of studies have reported satisfactory *Predictive Modeling in Prostate Cancer, Supplement to Cancer

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Section: Pharmacologic Prophylaxis Of Postoperative Erectile Dysfunctmentioning

confidence: 99%

Section: Pharmacologic Prophylaxis Of Postoperative Erectile Dysfunctmentioning

confidence: 99%

Prediction of sexual function after radical prostatectomy

Briganti

Capitanio

Chun

et al. 2009

Cancer

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“…A number of RCTs have reported on the effects of daily PDE5i use on postoperative erectile function with discordant results. 5,6,14,15 In addition, there is strong evidence demonstrating that PDE5i affect and improve LUTS. 16 Moreover, an association between LUTS and erectile dysfunction has been clearly established, and recently reviewed by Mouli and McVary.…”

Section: Discussionmentioning

confidence: 99%

“…3 Therefore in addition to affecting post-RP potency rates, the use of PDE5i may affect recovery of urinary continence and/or urinary quality of life after RP. 4 While several randomized controlled trials (RCT) suggest that nightly use of PDE5i is no more beneficial than on-demand use in terms of improving long-term erectile function after nerve-sparing RP, 5,6 many urologists nevertheless still prescribe chronic PDE5i immediately after RP. 7 The present study is a secondary outcomes analysis from a published randomized clinical trial that compared 2 different dosing regimens of postoperative sildenafil (50 mg nightly vs. 50 mg on-demand) for 1 year after nerve-sparing minimally invasive RP.…”

Section: Introductionmentioning

confidence: 99%

Nightly sildenafil use after radical prostatectomy has adverse effects on urinary convalescence: Results from a randomized trial of nightly vs on-demand dosing regimens

Hyndman

Bivalacqua

Mettee

et al. 2015

CUAJ

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Introduction: This is a report on potency results from a randomized trial of nightly versus on-demand sildenafil after nerve-sparing radical prostatectomy (RP). A secondary objective was to analyze the effects of these sildenafil administration schemes on urinary health-related quality of life after RP. Methods: In total, 100 potent men were equally randomized to nightly and on-demand sildenafil 50 mg after minimally-invasive RP for 1 year. Health-related quality of life questionnaires were administered at various postoperative intervals. Urinary function was assessed using appropriate expanded prostate cancer index composite (EPIC) subscales. Analyses of covariance and linear mixed-effects modeling were used to compare the effects of treatment over time on urinary recovery, controlling for age, nervesparing score, and time from surgery. Results: The nightly (n = 50) and on-demand (n = 50) sildenafil groups were well-matched at baseline. Nightly sildenafil patients had worse EPIC urinary bother and urinary irritative/obstructive subscale scores at 3 and 6 months after RP, even after controlling for multiple variables. On mixed-model analyses, the differences between groups for these EPIC subscales (4.9 and 2.5, respectively) were greater than documented thresholds for clinical significance. Increasing nerve-sparing score was associated with improvements in EPIC urinary summary, bother, incontinence, and function scores; time from surgery was associated with improvements in all EPIC urinary health-related quality of life subscales. Conclusions: In this specific population and drug dose, we found that on-demand short-acting phosphodiesterase-5 inhibitor (PDE5i) dosing may be more effective after RP to maximize early urinary and erectile health-related quality of life. In preoperatively potent men, nightly sildenafil 50 mg impaired urinary health-related quality of life more than on-demand use in the early months after nerve-sparing RP, independent of effects on urinary continence.

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“…Conversely, no statistical significance was seen in the groups during the washout or open-label phases, suggesting that regular nightly dosage may not hasten return of spontaneous erections, but ondemand use does seem definitely advantageous. 44 …”

Section: Penile Rehabilitationmentioning

confidence: 99%

The role of vacuum erection devices in penile rehabilitation after radical prostatectomy

Lehrfeld

Lee

2009

Int J Impot Res

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Even nerve-sparing radical prostatectomy damages the cavernous nerves and leads to temporary erectile dysfunction (ED) in men recovering from prostate cancer surgery. Historically, patients recovering from prostate cancer surgery have been advised that the return of erectile function (EF) can take from 6 to 18 months, or even longer. Unfortunately, the return of sexual function in these patients remains variable, but is generally thought to be dependent on the individual patient's pre-surgery EF, as well as the degree of cavernous nerve disruption during prostate removal. Recently, there has been a growing movement to proactively treat patients postoperatively for presumed nerve damage to stimulate nerve recovery and possibly reduce the degree of irreversible damage. This would reduce the on-demand therapy these patients would require, and hopefully remove the requirement for an implantable prosthesis. The underlying hypothesis is that the artificial induction of erections shortly after surgery facilitates tissue oxygenation, reducing cavernosal fibrosis in the absence of nocturnal erections, potentially increasing the likelihood of preserving EF. Vacuum erection devices (VED), because of their ability to draw blood into the penis regardless of nerve disturbance, have become the centerpiece of penile rehabilitation protocols. This review will discuss the pathophysiology of radical prostatectomy induced ED and the rationale for rehabilitation. It will then discuss current protocols, including those involving the VED.

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Effect of Nightly versus On-Demand Vardenafil on Recovery of Erectile Function in Men Following Bilateral Nerve-Sparing Radical Prostatectomy

Cited by 338 publications

References 14 publications

Prediction of sexual function after radical prostatectomy

Prediction of sexual function after radical prostatectomy

Nightly sildenafil use after radical prostatectomy has adverse effects on urinary convalescence: Results from a randomized trial of nightly vs on-demand dosing regimens

The role of vacuum erection devices in penile rehabilitation after radical prostatectomy

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