Abstract 1325

Thirty-one sexually active men with measurable nocturnal erections after catheter removal received nightly sildenafil 25 mg (n=13) or no treatment (n=18) and were followed for 1 year. IIEF-5 questionnaires in both groups were recorded preoperatively and at weeks 6, 12, 24, 36, 51 (see Table). Statistical improvement (p<0.05) was noted at 36 and 52 weeks. These results demonstrate that early after nerve-sparing surgery men have measurable nocturnal erections and daily Sildenafil 25 mg improves recovery of erectile function although scores at 52 weeks were still substantially lower than at baseline.

IIEF-5 SCORES

Editor's Note: Several studies have addressed the efficacy of daily dosing with a PDE-5 inhibitor tablet in the post-op management of radical prostatectomy patients; at this very same meeting the Montorsi group from Italy concluded that there was not enhanced noted in daily dosing over prn dosing in these patients. Protocols for post-op erectile rehabilitation should be done in centers of excellence with appropriate informed consent that the therapy may not work. Without definitive consistent evidence of benefit can we recommend this in the clinic? This study highlights some interesting findings; the first is that despite nerve sparing surgery at 52 weeks mean IIEF-erectile function scores are only 9.3 in controls; the second is the failure of normalization of IIEF-erectile function scores in the treated group. Many questions remain: is daily dosing going to actually improve the outcomes for prostatectomy patients; is there any difference if men wait 12 months before starting daily dosing, does prn dosing at 12 months lead to equal erectile efficacy as daily dosing for the preceding year? Clearly a great deal of research with these drugs in prostatectomy patients needs to be done before physicians can stand behind the 'off label' recommendation to their patients that the out-of-pocket expense of daily PDE-5 inhibitor is worth the cost.

Andreas Bannowsky, Heiko Schulze, Stefan Hautmann, Christof van der Horst, Carsten Maik Naumann, Christoph Seif, Peter Martin Braun, Klaus-Peter J

Link: Abstract 1325

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