Phosphodiesterase type 5 inhibitors represent the standard treatment of erectile dysfunction after nerve-sparing prostatectomy. Avanafil is a second-generation phosphodiesterase type 5 inhibitor with a high selectivity for phosphodiesterase type 5 isoform. To date, there are no studies comparing the outcomes of avanafil versus sildenafil in this scenario. In this study, we evaluated the efficacy and safety of avanafil versus sildenafil as a drug for post-prostatectomy rehabilitation. Overall, 160 patients submitted to robot-assisted nerve-sparing prostatectomy for localized prostate cancer at three hospitals were enrolled for the present study. After 6 months of treatment, patients in the two groups showed no significantly different sexual function scores, except for the Erection Hardness Score and Sexual Encounter Profile-Q2 that were higher in the Sildenafil group. Adverse events in the Avanafil group occurred in four (5%) patients and in 16 (20%) patients in the Sildenafil group. According to our experience, in patients undergoing nerve-sparing prostatectomy, penile rehabilitation with avanafil compared to sildenafil showed a lower ability to produce a valid erection in the initial phase of sexual intercourse, a difference that disappears in the continuation of the same. Avanafil showed a greater tolerance profile with a lower rate of AEs and discontinuation of therapy due to AEs.
Urologia. 2019 Aug 23 [Epub ahead of print]
Pier Andrea Della Camera, Riccardo Tellini, Gianmartin Cito, Giulia Rastrelli, Mario Maggi, Tommaso Chini, Cosimo De Nunzio, Vincenzo Maria Altieri, Sergio Serni, Mauro Gacci, Alessandro Natali
1 Department of Urology, University of Florence, Careggi University Hospital, Florence, Italy., 2 Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy., 3 Department of Urology, University of Siena, Le Scotte Hospital, Siena, Italy., 4 Department of Urology, Sant'Andrea Hospital and Faculty of Health Sciences, Sapienza University of Rome, Rome, Italy., 5 Department of Urology, Humanitas Gavazzeni Hospital, Bergamo, Italy.