Erectile dysfunction secondary to nerve-sparing radical retropubic prostatectomy: Comparative phosphodiesterase-5 inhibitor efficacy for therapy and novel prevention strategies |
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Authors: | Harin Padma-Nathan Andrew McCullough Christopher Forest |
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Institution: | (1) Male Clinic, 9100 Wilshire Blvd., Suite 360, East Tower, 90210 Beverly Hills, CA, USA |
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Abstract: | Postprostatectomy erectile dysfunction appears to be initiated by neuropraxia and perpetuated by cavernosal smooth muscle
apoptosis. Phosphodiesterase-5 (PDE-5) inhibitor therapy is the current cornerstone of erectile dysfunction (ED) therapy in
this population. Although no head-to-head trials have been performed with sildenafil, vardenafil, and tadalafil in this population,
there are numerous studies in the general ED population. The results of these studies demonstrate that neither of the new
PDE-5 inhibitors met statistical noninferiority to sildenafil. Sildenafil has been studied in a novel primary prevention modality
using nightly administration after a bilateral nerve-sparing prostatectomy. In this novel approach, it effected a sevenfold
improvement in return of spontaneous, normal erectile function 2 months after drug discontinuation. This effect appears to
be mediated by properties unique to sildenafil that include improved endothelial function and neuronal regeneration and neuroprotection.
In primary prevention, unlike ED therapy, one has only “one shot” by definition. Therefore, it is even more critical to apply
evidence-based medicine. |
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