67th Annual Meeting Abstracts
The Longitudinal Effects On Penile Oxygen Saturation From A Prospective Randomized Study Of The Nightly Use Of Intraurethral Alprostadil Vs Sildenafil Following Nerve Sparing Radical Prostatectomy (NSRP)
*Andrew R McCullough, *Brianne Goodwin
New York University, New York, NY
Introduction: Early penile rehabilitation is recognized as an important part of the recovery of erectile function after RP. Postoperative intracorporal and intraurethral alprostadil as well as oral sildenafil have been reported to improve recovery of erectile function. Enhanced penile oxygenation is believed to be an important factor in the observed beneficial effect. The purpose of this study was to examine the longitudinal effect of nightly sildenafil or intraurethral prostaglandin on flaccid penile oxygen saturation.
Methods: A subgroup of 50 men enrolled in a larger (78 men) randomized comparative 11 month penile rehabilitation trial of nightly alprostadil (MUSE®) 250 mcgm vs sildenafil 50 mgs , underwent preoperative penile oximetry and at post op visit week one,and months 1.25,3 , 6, 9 and 11. Medications were started at catheter removal and continued through month 9. At each visit penile oximetry was done with a FDA approved tissue oximeter.
Results: All men were preoperatively potent (Avg IIEF 29) and underwent nerve sparing prostatectomy by two surgeons. Corporal oximetry in the IUA cohort increased over 9 months, achieving statistical significance over the second visit nadir throughout the treatment period. Corporal gradually decreased from baseline in the Sildenafil group but returned to baseline by the end of the study.
Conclusion:
Despite the short half life of intraurethral alprostadil , nightly alprostadil increased flaccid penile oximetry throughout the study. Flaccid penile oximetry in the sildenafil cohort decreased in the same period. This supports the early incorporation IUA for penile rehabilitation after RP to maintain corporal oxygenation.
