How important is the preservation of nocturnal penile tumescense with daily low-dose sildenafil 6 weeks after nerve-sparing radical prostatectomy for the erectile function after 2 years? - Penile rehabilitation in the long term follow-up
Bannowsky, A1; Ückert, S2; Aidarbekova, K3; Wedel, C3; Jünemann, KP4
1: Imland Hospital Rendsburg, Germany; 2: Hannover Medical School, Germany; 3: Imland Hospital Rendsburg, Germany ; 4: University Hospital Kiel, Germany
Objectives: Previous studies showed that daily low dose sildenafil leads to improvement of the preservation of nocturnal penile tumescense and rigidity (NPTR) 6 weeks after nerve-sparing radical prostatectomy (nsRP). Aim of this study was the evaluation of NPTR-preservation on further erectile function (EF) recovery in the long term follow-up.
Material and Methods: 24 sexual active patients were operated by nerve-sparing radical prostatectomy. An erectometer measurement of NPTR (Rigi-Scan®) was carried out on each patient after removal of the transurethral catheter and again 6 weeks after surgery. To maintain and support recovery of spontaneous erectile function 12 patients with preserved nocturnal erections detected during NPTR-recordings received sildenafil 25mg/d at night starting immediately one the day after catheter removal (group 1). A control of 12 patients underwent follow up without daily PDE-5-inhibitors (group 2). All patients completed an IIEF-5 questionnaire concerning erectile function preoperatively, 3, 6, 12, 18 and 24 months after surgery.
Results: Group 1 (daily 25mg sildenafil) showed 2-5 erections (mean 3.2 erections/night) during the first night after catheter removal. In the control (group 2) 1-5 erections (mean 3.1 erections/night) were recorded within this acute phase after nsRP. NPTR-recordings 6 weeks after nsRP showed a decline of nocturnal penile erections with only a slight decrease in group 1 (1-4 erections/night, mean 2.8 erections) vs. group 2 (0-2 erections/night, mean 1.1 erections/night) (p<0.05). In the group of daily sildenafil the IIEF-5 score decreased from preoperative 22.4 mean score to 3.8 at 3 months, 12.4 at 6 months, 17.5 at 12 months, 19.7 at 18 months and 21.3 at 24 months after nsRP. In the control group preoperative IIEF-5 mean score 23.2 decreased to 2.6 at 3 months, 7.4 at 6 months, 9.3 at 12 months, 10.8 at 18 months and 12.6 at 24 months. Statistical evaluation showed a correlation of NPTR-preservation with a significant increase of IIEF-5 score and time to recovery of erectile function (p<0.05).
Conclusions: EF rehabilitation with daily low dose sildenafil leads to significant preservation of nocturnal penile tumescense 6 weeks after nsRP which correlates with a significant increase of erectile function recovery in the long term follow-up over two years after nsRP.
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