• 
• 
• 
• 
• 
• 
• 

• 
• 
• 
• 

• 
• 
• 

• 
• 
• 
• 
• 

Efficacy of sildenafil citrate in men with erectile dysfunction following radical prostatectomy: a systematic review of clinical data

Montorsi F, McCullough A; J Sex Med 2005;2:658-667.

KEY WORDS: Oral Vasoactive Agents; Pharmacologic Studies in Sexual Function; Male Erectile Disorder; Pelvic Cancer Treatments and Sexual Dysfunction

During the past 20 years, the disease specific or all cause survival rate for all stages combined has increased from 67% to 96%. There has been no randomized controlled trial that shows a clear survival advantage for any given treatment. and comparison of existing studies. Radical prostatectomy is a frequently used treatment option for prostate cancer; however, prostatectomy is often associated with significant morbidity, including erectile dysfunction (ED). This study aims to analyze the efficacy of sildenafil citrate in treating ED after radical prostatectomy.

• MEDLINE and CANCERLIT (1998 to January 2004) were searched for English language articles using the key words prostatectomy, sildenafil, and phosphodiesterase inhibitors. Eleven studies fulolled the inclusion criteria: primary, discrete data sets of postprostatectomy patients with ED treated with sildenafil monotherapy.
• Seven studies reported a response rate (range, 14%-53%) for an end point consistent with the primary analysis outcome (erection sufficient for vaginal intercourse); the combined estimate of probability of response was 35% (95% confidence interval [CI], 24%-48%). There was strong evidence for a lower response rate after non-nerve-sparing vs. nerve-sparing surgery, but not after unilateral vs. bilateral nerve-sparing surgery.
• The results of these studies demonstrate that with sildenafil, more than one third of patients with post prostatectomy ED achieved erection sufficient for intercourse. The odds of responding improved 12 fold with preservation of at least one neurovascular bundle. Early treatment failure does not necessarily imply lack of efficacy in the future, and patients should be encouraged to continue trying sildenafil, titrating up to 100 mg as needed.