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67th Annual Meeting Abstracts
Recovery of Erectile Function Following Nerve-Sparing Radical Prostatectomy After Penile Rehabilitation with Nightly Intraurethral Alprostadil vs Sildenafil Citrate
*Andrew R McCullough1, *Herbert Lepor1, *Run Wang2, *Kristofer R. Wagner3, *Wayne G. Hellstrom4, Jason D. Engel5
1New York University, New York, NY;2MD Anderson Cancer Center and University of Texas Medical School, Houston, TX;3Texas A & M Health Science Center College of Medicine, Temple, TX;4Tulane, New Orleans, LA;5George Washington University, Washinton DC, DC
Introduction: Radical prostatectomy can cause longstanding erectile dysfunction. The current clinical trial was conducted to assess if early, consistent use of intraurethral alprostadil (IUA) vs sildenafil citrate (SC) hastened return of erectile function after nerve sparing radical prostatectomy (NSRP).
Materials & Methods: Subjects with normal erectile function scheduled for bilateral NSRP were enrolled in this prospective, randomized, open label, multicenter study. They initiated nightly IUA, 125 mcg (started 250 mcg at 1 month), or SC, 50mg, within 1 month of surgery and continued for 9 months. Subjects were seen throughout the study and completed the International Index of Erectile Function (IIEF) erectile function domain, global assessment question (GAQ) sexual encounter profile and measured stretched penile length (SPL). After one month washout period (month 9) they self-administered SC, 100mg, 6 times prior to sexual activity. The Erectile Dysfunction Inventory of Treatment Satisfaction was completed at 11 months.
Results: 100 IUA and 61 SC subjects completed the trial. IUA increased the IIEF and GAQ by 12-14% and 11-27% at 3 and 6 months, respectively, vs SC (p<0.02 for GAQ at 6 months). Intercourse success rate was improved by IUA, and SPL decreased less for the IUA group (months 6 and 9). There were no differences between IUA and SC at study termination. Treatments were well tolerated.
Conclusions: Early, consistent use of low dose IUA after NSRP produced a quicker return of erectile function than SC. Early initiation of IUA after RP may hasten penile rehabilitation, providing for a better, earlier sexual response.
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