Phosphodiesterase type 5 inhibitors (PDE5i) are among the first line treatment options in men with erectile dysfunction (ED). On-demand sildenafil has proved to be an effective PDE5i but with lower spontaneity scores compared to daily tadalafil treatment. We aimed to investigate the impact of on-demand sildenafil compared to bedtime use on efficacy and spontaneity scores in men with ED. We retrospectively analysed data from a cohort of men with mild/moderate ED treated for three months with on-demand sildenafil 50 mg oral suspension formulation (OSF) (group 1, n = 40), bedtime sildenafil 50 mg OSF (group 2, n = 40) and bedtime sildenafil 37.5 mg OSF (group 3, n = 40). After three months patients were evaluated with the International Index of Erectile Function-5 items (IIEF-5) and the Psychological and Interpersonal Relationship Scales-Short Form (PAIRS-SF) questionnaires. Propensity score matching was used to adjust for baseline confounders. The IIEF-5 and PAIRS-SF scores were compared between groups at follow-up with the repeated measures ANOVA test. Linear regression analyses tested the associations between study variables and spontaneity scores. After matching, median patient's age and ED duration were 56 (50-61) years and 18 (10-20) months, respectively. Compared to baseline, IIEF-5 scores significantly improved after sildenafil OSF treatment, irrespective of the therapeutic approach (all p < 0.01 vs. baseline). The PAIRS-SF spontaneity score was significantly better in group 2 [15 (13-16), p < 0.01] and group 3 [14 (14-16), p < 0.01] compared to the on-demand use [13 (12-13)]. Fewer time concerns were reported for bedtime use than on-demand sildenafil. Sildenafil OSF bedtime use was found to be an independent predictor for better spontaneity and fewer time concerns scores (all p < 0.001). Bedtime sildenafil OSF showed similar efficacy but better spontaneity scores than on-demand use. Bedtime sildenafil is a valuable option for men with ED prioritizing efficacy and sexual spontaneity.
International journal of impotence research. 2025 Feb 24 [Epub ahead of print]
Luca Boeri, Fabrizio Palumbo, Tommaso Cai, Carlos Miacola, Carlo Ceruti, Marco Bitelli, Danilo Di Trapani, Andrea Piasentin, Giorgio Piubello, Chiara Polito, Davide Arcaniolo, Marco Magliocchetti, Alessandro Palmieri
Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. ., Urology Unit, Di Venere Hospital, 70100, Bari, Italy., Department of Urology, Santa Chiara Regional and Teaching Hospital, 38123, Trento, Italy., Department of Urology, University of Bari, 70100, Bari, Italy., Department of Urology, University of Turin, Le Molinette Hospital, 10024, Turin, Italy., Urology Unit, ASL Roma 2, Sandro Pertini Hospital, 00100, Rome, Italy., Department of Urology, University of Palermo, Palermo, Italy., Department of Urology, University of Trieste, Cattinara Hospital-ASUGI, Trieste, Italy., Andrology Unit, CEMS, 37100, Verona, Italy., Department of Urology, Asti Hospital, Asti, Italy., Urology Unit, Department of Woman Child and of General and Specialist Surgery, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy., Department of Urology, University of Naples, Federico II, 80013, Naples, Italy.