Recovery of Erectile Function After Nerve Sparing Radical Prostatectomy and Penile Rehabilitation With Nightly Intraurethral Alprostadil Versus Sildenafil Citrate

Abstract

This is the first study to directly compare the ability of alprostadil and a phosphodiesterase-5 inhibitor to enhance penile recovery subsequent to bilateral nerve sparing radical prostatectomy. The use of nightly subtherapeutic intraurethral alprostadil is well tolerated after radical prostatectomy. The benefit to return of erectile function of nightly sildenafil citrate and subtherapeutic intraurethral alprostadil appears to be comparable within the first year of surgery.

Mechanisms of Penile Erection and Basis for Pharmacological Treatment of Erectile Dysfunction

“…Prostaglandin E 1 . Although PDE5 inhibitor remains the most common initial therapy in men with erectile dysfunction, intraurethral alprostadil may be a reasonable treatment option for sildenafil nonresponders (Jaffe et al, 2004), particularly in men having undergone prior radical retropubic prostatectomy (McCullough, 2001;McCullough et al, 2010). Vasoactive agents can be administered topically to the urethral mucosa and can apparently be absorbed into the corpus spongiosum and transferred to the CC.…”

“…As mentioned, intraurethral alprostadil may also be an option in men having undergone prior radical retropubic prostatectomy (McCullough, 2001;McCullough et al, 2010). Penile pain remains a problem in many patients.…”

Penile rehabilitation after radical prostatectomy

“…While intraurethral alprostadil was very well tolerated, it did not show any benefit over sildenafil in terms of recovery of spontaneous erections one year postoperatively. 10 We believe that intraurethral therapy appears harmless and may have some modest benefit for patients who are unwilling or unable to perform ICI.…”

Optimizing postoperative sexual function after radical prostatectomy

“…However, neither IUA nor PDE5-I offers a total solution to successful penile rehabilitation after RP. Subtherapeutic IUA has results comparable with those of oral PDE5-I [McCullough et al 2010]. It is unclear if there is a benefit in the administration of IUAs in a penile rehabilitation capacity.…”