Compared with no treatment, early oral therapy with phosphodiesterase type 5 inhibitors (PDE5-Is) is more successful at recovering erectile function in patients who had nerve-sparing radical retropubic prostatectomy (NSRRP), according to a new retrospective study. Among the oral therapies, a regimented rehabilitation program appears to be no better than on-demand therapy. For the study, investigators led by Alessandro Natali, MD, of the University of Florence in Italy, analyzed the medical records of 196 consecutive patients who had NSRRP at a single center between 2004 and 2006. After undergoing either bilateral or unilateral NSRRP, patients chose whether to receive oral therapy on demand (100 mg sildenafil, 20 mg tadalafil, and vardenafil); regimented rehab (100 mg sildenafil or 20 mg vardenafil 3 times a week, or 20 mg tadalafil twice a week at bedtime); or no therapy. All patients had mild to normal preoperative erectile function. The average preoperative potency was 22, as measured by the International Index of Erectile Function-5 (IIEF-5). Potency was significantly associated with surgical technique and oral therapy (compared with no treatment), the researchers reported in the International Journal of Impotence Research (2015;27:1-5). The potency rate at 24 months among bilateral prostatectomy patients was 68.7% (61% with no therapy and 71% with PDE5-Is) and 44% among unilateral prostatectomy patients (29% with no therapy and 51% with PDE5-Is). Oral therapy was started early in patients—2 weeks after surgery—as soon as the catheter was removed. Some patients who received PDE5-Is discontinued therapy because the effect of therapy was below their personal expectations. No patients discontinued due to side effects. “In our opinion, as atrophy and fibrosis in the penis occur in the first 3 months after RRP, it is likely that early postoperative intervention is crucial,” the researchers stated. They suggest clinicians discuss oral therapy with patients at the same time surgery is being considered. The investigators looked at potency by oncologic outcome (no progression versus PSA relapse) and Gleason score and found no significant differences in results. They confirmed that increasing age was related to lower potency. Large randomized and controlled trials are still needed to determine the optimal post-operative strategies for preserving erectile function, according to the researchers.
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The presence and severity of erectile dysfunction (ED) and a low estimated glomerular filtration rate (eGFR) may be used together to predict the likelihood of coronary artery disease (CAD) in male patients, according to researchers. Such early detection of CAD is potentially lifesaving when steps are taken to reduce the chances of a heart attack. This small study confirmed links between ED, eGFR, and the number of clogged coronary arteries in CAD patients. Lutfi Canat, MD, of Kastamonu State Hospital in Istanbul, Turkey, and colleagues studied 183 male patients having coronary angiography following a first acute myocardial infarction. For each patient, they calculated eGFR (using the Cockcroft-Gault equation) and evaluated ED (using the International Index of Erectile Function-5). The researchers then assessed the relationships between erectile function, eGFR, and occluded coronary arteries. According to findings published in the Korean Journal of Urology (2015;56:76-81), 55% of CAD patients had ED: 45% of those with single-vessel disease, 65% with 2-vessel disease, and 68% with 3-vessel disease. Average eGFRs were similar across CAD patient groups. The eGFR was significantly lower in the presence of ED only for single-vessel disease. “[T]he examination of patients with other risk factors for the presence or severity of ED may give some clues to the presence of prior CAD,” the investigators suggested. They also cited a study that indicated the penile vascular bed might be a “sensitive and early indicator of systemic vascular disease.” The association of ED and chronic kidney disease (CKD) with CAD is well-known. These conditions may increase the risk of CAD or predict its development. A variety of pathways may link these conditions. For example, endothelial dysfunction is common to all 3 conditions. ED, CKD, and cardiovascular disease also share common risk factors, such as cigarette smoking and obesity. The investigators were unable to assess the possible effects of testosterone and drugs, such as ACE inhibitors and oral diabetes medications. Preliminary research in animals highlighting the nitric oxide pathway hints that phosphodiesterase type 5 inhibitors might have clinical value in the treatment of CKD with CAD and ED. |
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