sildenafil-citrate and Urinary-Bladder-Neoplasms

Topics: Cystectomy; Erectile Dysfunction; Humans; Male; Piperazines; Purines; Quality of Life; Sildenafil Citrate; Sulfones; Urinary Bladder Neoplasms

Pharmacological rehabilitation of erectile function (EF) after nerve-sparing radical prostatectomy was repeatedly advocated.. To compare early vs. late penile rehabilitation in patients with nerve-sparing (NS) radical cystoprostatectomy based on a prospective randomized trial.. Eighteen patients without spontaneous erection 8 weeks after NS radical cystoprostatectomy were randomly divided into two groups; group I and II who started the erectogenic therapy at the 2nd and 6th month postoperatively, respectively. The pharmacological therapy constitutes of sildenafil citrate twice weekly to be shifted to intracavernosal injection (ICI) of prostaglandin E1 (PGE1) if not responding. The treatment continued for 6 months in both groups.. The EF status was evaluated before and at the end of the treatment by International Index of Erectile Function questionnaire and penile Doppler ultrasonography (PDU).. Six out of nine patients recovered unassisted erection after treatment in group I compared to three out of nine patients in group II. Two patients in group I and three patients in group II were maintained on sildenafil therapy on demand basis. The remaining four patients were dependent on ICI of PGE1. At final evaluation, a significant improvement was found in the EF, the intercourse satisfaction and overall satisfaction domains (P = 0.02, 0.03, and 0.02, respectively) in group I compared with group II. Regarding PDU findings, significant improvement in end-diastolic velocity was elicited in the early rehabilitation group compared with the pretreatment value (P = 0.03) with no significant difference between both groups.. Early compared with delayed erectile rehabilitation brings forward the natural healing time of potency and maintains nerve-assisted erection.

Topics: Adult; Alprostadil; Cystectomy; Erectile Dysfunction; Humans; Injections; Male; Middle Aged; Penis; Phosphodiesterase 5 Inhibitors; Piperazines; Prospective Studies; Prostatectomy; Purines; Sildenafil Citrate; Sulfones; Time Factors; Ultrasonography; Urinary Bladder Neoplasms; Vasodilator Agents

To assess the efficacy and safety of sildenafil citrate in the management of erectile dysfunction (ED) following radical cystectomy (RC) and to define the different prognostic factors predicting the response to sildenafil in such a challenging group of patients.. One hundred patients with ED following RC participated in an open-label, non-randomized, prospective, dose-escalation study. The median age of the patients was 53 years and the mean period after RC was 80.7 +/- 54.8 months. The study duration was 12 weeks, comprising a 4-week run-in period followed by two active treatment periods of 4 weeks each with 50 and 100 mg of sildenafil. Patients were assessed by means of the International Index of Erectile Function (IIEF) questionnaire at baseline and after each treatment period. At the end of the study, the Global Efficacy Assessment Question was used to evaluate treatment satisfaction. Factors affecting the patient's response to sildenafil were assessed by means of uni- and multivariate analysis.. The entire study group was suffering from severe ED at baseline, with a mean erectile function (EF) domain score of 6.5 +/- 0.93. EF scores improved to 12.2 +/- 7.76 and 18 +/- 10.3 with 50 and 100 mg of sildenafil, respectively. Sildenafil therapy significantly improved the ability of many patients to achieve and maintain an erection. The mean scores for question 3 of the IIEF were 1 +/- 0.14, 2.1 +/- 1.4 and 3 +/- 1.8 at baseline and with 50 and 100 mg of sildenafil, respectively, while the corresponding scores for question 4 were 1 +/- 0.10, 1.9 +/- 1.35 and 3 +/- 1.85. The satisfaction rate was 54%. The response was dose-dependent but the incidence of adverse effects increased from 6% with 50 mg of sildenafil to 34% with 100 mg. In univariate analysis, tumor histology and grade and postoperative partial tumescence were found to significantly impact the patient's response to sildenafil. In multivariate analysis, postoperative partial tumescence was the only independent predictive variable. CONCLUSIONS. Sildenafil was found to be a safe and satisfactory treatment for post-RC ED. The effect was dose-related. Patients with postoperative partial tumescence were the best responders.

Topics: Adult; Aged; Cystectomy; Dose-Response Relationship, Drug; Erectile Dysfunction; Follow-Up Studies; Humans; Male; Middle Aged; Multivariate Analysis; Patient Satisfaction; Phosphodiesterase Inhibitors; Piperazines; Prognosis; Prospective Studies; Prostatectomy; Purines; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Time Factors; Urinary Bladder Neoplasms

To assess sexual dysfunction in sexually active men after radical cystectomy (RC) and to determine whether sildenafil citrate can improve erectile dysfunction after surgery.. The baseline and follow-up data from 49 sexually active male patients (mean age 57.8 +/- 9.1 years) undergoing RC (1995 to 2002) were obtained. Of the 49 patients, 16 (33%) had undergone nerve-sparing RC; 38 (78%) had undergone orthotopic diversion; 8 (16%) had undergone ileal conduit diversion; and 3 (6%) had undergone cutaneous continent diversion. The data were assessed using the abridged 5-item International Index of Erectile Function questionnaire, referred to as the Sexual Health Inventory for Men (SHIM).. At a mean follow-up of 47.6 +/- 22.7 months, the total mean SHIM score decreased from 22.08 +/- 3.96 to 4.33 +/- 5.72 after RC (P <0.05). Of the 49 patients, 42 (86%) did not have erections sufficient for vaginal penetration. Of these 42 patients, 22 (52%) tried sildenafil citrate. Of these 22 patients, only 2 (9%) responded positively, with a total mean SHIM score of 23.50 +/- 2.12. Although the mean SHIM score after orthotopic substitution (5.24 +/- 6.21) was statistically significant compared with that after ileal conduit (1.13 +/- 0.33) and cutaneous continent (1.33 +/- 0.58) diversions, this was not clinically significant.. Male erectile dysfunction after RC is a prevalent problem. In our series, only 9 (14%) of 49 sexually active men were potent after surgery. Of these 9 potent patients, 8 (89%) had undergone nerve-sparing RC. Of concern, only 52% of the patients with erectile dysfunction sought treatment after RC.

Topics: Aged; Carcinoma; Comorbidity; Coronary Disease; Cystectomy; Diabetes Mellitus; Drug Evaluation; Drug Resistance; Erectile Dysfunction; Follow-Up Studies; Humans; Hypertension; Male; Middle Aged; Patient Acceptance of Health Care; Patient Satisfaction; Peripheral Nerve Injuries; Piperazines; Purines; Quality of Life; Sildenafil Citrate; Spouses; Sulfones; Surveys and Questionnaires; Urinary Bladder Neoplasms; Urinary Diversion